Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s hyperglycemia?
A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone
Correct Answer: A. Acromegaly
Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea.
Option B: Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. At presentation, children usually have a history of polyuria, polydipsia, and weight loss for days to months. If the diagnosis is delayed, there may be vomiting, lethargy, altered mental status, dehydration, and acidosis.
Option C: Hypothyroidism isn’t associated with hyperglycemia. Patients with severe hyperglycemia should be assessed for clinical stability including mentation and hydration. Diabetic ketoacidosis and hyperglycemic hyperosmolar state are acute, severe disorders related to hyperglycemia.
Option D: Hypothyroidism isn’t associated with growth hormone deficiency. Countless studies have shown that untreated hyperglycemia shortens lifespan and worsens the quality of life. Thus, an aggressive lowering of hyperglycemia must be initiated, and patients must be closely followed.
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