Question of the Day
Thursday, November 5, 2026
A 55-year-old man with a 6-year history of acromegaly caused by a growth hormone-secreting pituitary macroadenoma comes to the physician for counseling before surgery. He has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea treated with continuous positive airway pressure. His blood pressure is 150/94 mm Hg. Physical examination shows coarse facial features, enlarged hands, and macroglossia. His most recent colonoscopy 2 years ago showed one small tubular adenoma that was removed.
Which of the following is the most likely cause of increased mortality if his acromegaly remains poorly controlled?
Answer: B. Cardiovascular disease
In uncontrolled acromegaly, chronic GH/IGF-1 excess drives a specific cardiomyopathy (biventricular hypertrophy, diastolic then systolic dysfunction), hypertension, and accelerated atherosclerosis, and cardiovascular disease is the leading cause of the excess mortality; controlling GH/IGF-1 normalizes life expectancy. Colon cancer (C) risk is increased and warrants colonoscopy screening but is not the principal driver of mortality. Respiratory complications (E) contribute (sleep apnea, upper-airway obstruction) but rank below cardiovascular death. Adrenal insufficiency (A) and hypopituitarism (D) result from tumor mass or treatment rather than active GH excess and are not the main cause of death in uncontrolled disease. Teaching point: cardiovascular disease is the chief cause of premature death in acromegaly, motivating aggressive biochemical control.
Just show me the answer
Answer: B. Cardiovascular disease
In uncontrolled acromegaly, chronic GH/IGF-1 excess drives a specific cardiomyopathy (biventricular hypertrophy, diastolic then systolic dysfunction), hypertension, and accelerated atherosclerosis, and cardiovascular disease is the leading cause of the excess mortality; controlling GH/IGF-1 normalizes life expectancy. Colon cancer (C) risk is increased and warrants colonoscopy screening but is not the principal driver of mortality. Respiratory complications (E) contribute (sleep apnea, upper-airway obstruction) but rank below cardiovascular death. Adrenal insufficiency (A) and hypopituitarism (D) result from tumor mass or treatment rather than active GH excess and are not the main cause of death in uncontrolled disease. Teaching point: cardiovascular disease is the chief cause of premature death in acromegaly, motivating aggressive biochemical control.
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