Endocrinology: acromegaly: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: acromegaly

Sample item

A 40-year-old man has enlarging hands and shoe size, coarse facial features, carpal tunnel syndrome and headache. Which is the best initial screening test for acromegaly?

AInsulin tolerance testBSerum insulin-like growth factor 1COvernight dexamethasone suppression testDA random serum growth hormone level

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Serum insulin-like growth factor 1

Growth hormone is secreted in pulses, so a random level is unreliable, while IGF-1 is stable and reflects integrated GH secretion. A raised IGF-1 is confirmed by failure of GH to suppress during an oral glucose tolerance test, and then MRI of the pituitary is done. Treatment is transsphenoidal surgery, with somatostatin analogues or pegvisomant as needed.

Option by option

A. Insulin tolerance test
The insulin tolerance test assesses GH and cortisol deficiency, not excess.
B. Serum insulin-like growth factor 1 (correct)
IGF-1 does not fluctuate through the day and is the screening test of choice.
C. Overnight dexamethasone suppression test
Dexamethasone suppression screens for Cushing syndrome.
D. A random serum growth hormone level
Random GH is pulsatile and may be normal or high in healthy people.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Serum insulin-like growth factor 1. Growth hormone is secreted in pulses, so a random level is unreliable, while IGF-1 is stable and reflects integrated GH secretion.

Why is "Insulin tolerance test" not the answer?

The insulin tolerance test assesses GH and cortisol deficiency, not excess.

Why is "Overnight dexamethasone suppression test" not the answer?

Dexamethasone suppression screens for Cushing syndrome.

Why is "A random serum growth hormone level" not the answer?

Random GH is pulsatile and may be normal or high in healthy people.

What concept does this question test?

It tests Endocrinology: acromegaly in General Medicine. A raised IGF-1 is confirmed by failure of GH to suppress during an oral glucose tolerance test, and then MRI of the pituitary is done. Treatment is transsphenoidal surgery, with somatostatin analogues or pegvisomant as needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: acromegaly?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.