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Chapter 46. Pituitary Gland Disorders

Student Questions

All of the following complications are associated with prolonged exposure of elevated growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations in patients with acromegaly, except:

A. Colon cancer

B. Osteoarthritis

C. Diabetes mellitus

D. Urinary incontinence

Answer: D

Option A: Incorrect. Patients with acromegaly have an increased risk for the development of esophageal, stomach, and colon cancer.

Option B: Incorrect. Acromegaly can develop joint damage and osteoarthritis in up to 90% of patients.

Option C: Incorrect. Type 2 diabetes mellitus can develop in 25% of patients with acromegaly.

Option D: Correct. Urinary incontinence has not been associated with elevated GH and IGF-I in patients with acromegaly.

A 43-year-old man with acromegaly presented with elevated IGF-I and GH concentrations. After experiencing intolerance to somatostatin analogs, octreotide LAR is discontinued and the patient is started on pegvisomant 10 mg daily. Which of the following is the most important parameter to monitor in this patient?

A. Serum creatinine

B. Growth hormone concentration

C. Liver function tests

D. Presence of gallstones

Answer: C

Option A: Incorrect. Use of pegvisonmant is not associated with renal impairments and dose of pegvisonmant does not need to be adjusted in patients with renal failure.

Option B: Incorrect. Pegvisomnant is a genetically modified GH-receptor antagonist that is detected in commercial GH assays, resulting in falsely elevated GH concentrations. Therefore, monitoring GH level is not recommended when patient is treated with pegvisonmant.

Option C: Correct. Hepatotoxicity and elevated liver enzymes have been reported in clinical trials with long-term use of pegvisomant; therefore, routine monitoring of liver function tests is recommended.

Option D: Incorrect. Gallstones are often associated with use of somatostatin analogs, not with use of pegvisonmant; therefore, routine monitoring is not necessary.

A 36-year-old kidney transplant patient recently started octreotide LAR for acromegaly. Her current medications include lisinopril 5 mg PO daily, insulin glargine 25 units daily, cyclosporine 25 mg PO daily, prednisone 60 mg PO daily, and sulfamethoxazole/trimethoprim 800/160 mg PO twice daily. Which of the following medication(s) will likely require dosage adjustment in this patient?

A. Cyclosporine

B. Insulin glargine, sulfamethoxazole/trimethoprim

C. Cyclosporine, insulin ...

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