A patient with enlarged hands and facial features, fatigue, and glucose intolerance has elevated IGF-1. What condition is most likely?

• A. Cushing syndrome.
• B. Dwarfism.
• C. Hyperthyroidism.
• D. Acromegaly.

Answer: (D)

When growth hormone is in excess in an adult, you get acromegaly: soft tissue enlarges and bones have increased thickness, leading to enlarged hands and coarse facial features. Growth hormone also raises IGF-1 production in the liver, so IGF-1 is elevated and serves as a key clue confirming GH excess. The fatigue and glucose intolerance fit the metabolic effects of GH, which promote insulin resistance. So this combination strongly points to acromegaly, often due to a GH-secreting pituitary adenoma.

Other conditions don’t fit this pattern: Cushing syndrome can cause facial rounding and glucose intolerance but typically doesn’t feature elevated IGF-1. Dwarfism involves short stature from GH or IGF-1 deficiency, not excess. Hyperthyroidism affects metabolism and can cause weight loss and tachycardia rather than these characteristic changes plus high IGF-1.