A 45-year-old lady presents with complaints of a progressive increase in the size of hands and feet and shoe size for past 5 years. The family members have noticed a change in her facial appearance in the form of coarsening of features and her voice has become sonorous. She also has complaints of frequent headaches for past 1 year. She complains of amenorrhea for past 5 years. She also has complaints of joint pains for past 3 years which have become more severe for the past 3 months. She is hypertensive for past 1 year and complaints of grade 2 dyspnea on exertion and her hypertension is controlled on 10 mg of cilnidipine and 40 mg of telmisartan. She is not a known diabetic and has checked her random sugars 1 week back which was normal. She is not on any other medications presently (Fig. 1.1).What imaging investigation should be ordered in this patient?
Once the diagnosis of acromegaly is confirmed, a pituitary MRI should be performed. A dynamic MRI with contrast will give the best delineation. If the MRI is contraindicated patient may be subjected to CT scan, e.g. if the patient has a pacemaker. It is recommended that the MRI be performed with 2 mm slices to diagnose small microadenomas.
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