MBBS OSCE · General Medicine
OSCE — Acromegaly
Eight-minute OSCE station on Acromegaly: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Acromegaly.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Acromegaly is chronic growth hormone (GH) excess, nearly always from a pituitary somatotroph adenoma, driving hepatic IGF-1 overproduction and progressive somatic overgrowth. Features include enlarging hands and feet, coarse facial features (prognathism, frontal bossing), dental malocclusion, macroglossia, headache, hyperhidrosis, carpal tunnel and bitemporal visual field loss (optic chiasm compression), with hypertension, diabetes, obstructive sleep apnoea and acromegalic cardiomyopathy. Screening is by elevated age/sex-matched IGF-1, confirmed by a 75 g oral glucose tolerance test in which GH fails to suppress under 1 ng/mL, and a pituitary MRI localises the adenoma. Transsphenoidal surger
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Coarsening facial features and enlarging hands or feet over years - check IGF-1 |
| Safety | Bitemporal visual field defect with headache - pituitary macroadenoma; urgent MR |
| Safety | New-onset diabetes, hypertension and sleep apnoea with acral enlargement - scree |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.