Difficult access in the anaesthetic room leads to a difficult diagnosis

摘要: A 50 year old man was admitted for laser ablation of the left long saphenous vein to treat his symptomatic varicose veins. In anaesthetic room he noted have unusually tough skin and rather large hands during cannulation. This confirmed when operating surgeon attempted cannulate perform endovenous ablation—the thickness made this difficult. He also had bigeminy on heart monitoring a prominent jaw. In clinic said that always put down being “muscly,” having worked in garage all life. surgery carpal tunnel decompression 2005, longstanding muscle aches. His visual fields were normal, shoe size 9, snored excessively at night. ### 1. What is likely diagnosis what are initial investigations needed diagnose it? #### Answer The most acromegaly. Initial tests include measurement insulin like growth factor 1 (IGF-1) hormone, as well hormone response glucose tolerance test. If indicated, these should be followed by magnetic resonance imaging pituitary field tests. #### Discussion Acromegaly can cause thickening skin, mainly secondary dermal thickening.1 acromegaly suspected then both IGF-1 measured. measured because its secretion regulated hormone. The results interpreted according normal ranges patients’ age sex. Raised supports acromegaly, although result affected poorly controlled diabetes other systemic illnesses lead false negative results.2 Growth …