Case 20-1

 A 48-year-old man seeks care for evaluation for

muscle weakness, headaches and excessive
sweating. He has poorly controlled hypertension
and, on questioning, admits to noticing a gradual
increase in both glove and shoe size, as well as a
reduction in libido. A review of older photographs of
the man documents coarsening of facial features,
progressive prognathism, and broadening of the
nose. Acromegaly is suspected.
Questions:
 What screening test are available?
 What is the definitive test for
autonomous growth hormone
production?
 Because the patient complains of
reduced libido, hypogonadism is
suspected. What evaluation is
appropriate?