Question 1

Which neonatal complication is least likely in GDM?

Accepted Answer

Answer reason: Maternal diabetes is also associated with neonatal metabolic and hematologic issues such as hypocalcemia (often alongside hypomagnesemia) and polycythemia from relative intrauterine hypoxia. In contrast, congenital hypothyroidism is classically related to thyroid dysgenesis or iodine/thyroid hormone synthesis problems rather than maternal gestational diabetes. Therefore, among the listed choices, this is the least likely complication specifically linked to GDM.

Question 2

Insulin is secreted by –?

Accepted Answer

Answer reason: Beta cells synthesize and release insulin in response to elevated blood glucose to promote cellular glucose uptake and glycogen synthesis, thereby lowering serum glucose. Alpha cells are a common distractor because they also reside in the islets but they secrete glucagon, which raises blood glucose. The remaining options are not pancreatic islet cell types and do not represent insulin-secreting physiology.

Question 3

Male sex hormone is –?

Accepted Answer

Answer reason: The primary androgen produced by Leydig cells in the testes is responsible for male sexual differentiation, puberty changes (e.g., voice deepening, muscle mass), and spermatogenesis support. Progesterone and estrogen are predominantly associated with female reproductive physiology, although present in both sexes at lower levels. Insulin is a pancreatic hormone central to glucose metabolism and is not a sex hormone.

Question 4

Female sex hormone is –?

Accepted Answer

Answer reason: In females, estrogens produced mainly by the ovaries drive breast development, endometrial proliferation, and help regulate the menstrual cycle via feedback with the hypothalamic–pituitary axis. Testosterone is the primary male sex hormone (though present in smaller amounts in females) and is not the best answer when asked for the female sex hormone. Insulin and adrenaline are hormones, but they regulate glucose metabolism and stress responses rather than reproductive sexual development.

Question 5

Which gland secretes adrenaline hormone?

Accepted Answer

Answer reason: This hormone rapidly increases heart rate, bronchodilation, and blood glucose to support acute stress physiology. The thyroid primarily secretes T3/T4, the pancreas secretes insulin and glucagon, and the pituitary releases tropic hormones rather than catecholamines. Therefore the gland responsible for adrenaline secretion is the adrenal gland.

Question 6

Deficiency of insulin causes –?

Accepted Answer

Answer reason: When insulin is deficient, glucose cannot be effectively utilized by insulin-sensitive tissues, leading to persistent hyperglycemia and the clinical syndrome of diabetes mellitus (classically type 1). The resulting metabolic state also drives lipolysis and ketogenesis, explaining the risk for diabetic ketoacidosis in absolute insulin deficiency. Goitre is primarily related to thyroid enlargement (often iodine deficiency or autoimmune thyroid disease), while rickets relates to vitamin D/calcium-phosphate deficiency and anemia has diverse hematologic causes, not primary insulin lack.

Question 7

Which gland secretes insulin?

Accepted Answer

Answer reason: The pancreas contains these islet cells and is therefore the gland responsible for insulin secretion. The thyroid primarily regulates metabolic rate via T3/T4, not glucose homeostasis through insulin. The adrenal and pituitary glands secrete hormones that can raise glucose (e.g., cortisol, growth hormone) but they do not produce insulin.

Question 8

Which hormone is known as stress hormone?

Accepted Answer

Answer reason: During stress, catecholamines rapidly increase heart rate, blood pressure, bronchodilation, and blood glucose availability to prepare the body for immediate action. This immediate physiologic stress response aligns with catecholamine release rather than hormones mainly involved in metabolism regulation or reproductive function. A common distractor is insulin, which generally lowers blood glucose and is not the primary hormone associated with acute stress responses.

Question 9

Which gland secretes thyroxine hormone?

Accepted Answer

Answer reason: The thyroid gland uniquely produces and secretes T4 (and T3), using iodine and thyroglobulin as key substrates. The pituitary gland instead secretes TSH, which stimulates the thyroid but does not produce T4. Adrenal gland hormones are cortisol/aldosterone/catecholamines, and the pancreas primarily secretes insulin and glucagon, making them mismatched to thyroxine secretion.

Question 10

Hypoglycemia means —?

Accepted Answer

Answer reason: The term literally combines “hypo-” (low) with “glyc-” (glucose/sugar) and “-emia” (in blood), indicating low blood glucose. Clinically, low glucose limits brain fuel supply and triggers adrenergic and neuroglycopenic symptoms such as sweating, tremor, confusion, tachycardia, and vision changes. In contrast, elevated blood glucose describes hyperglycemia, which is the opposite disorder.

Question 11

Which gland regulates metabolism?

Accepted Answer

Answer reason: This makes the thyroid gland the key endocrine controller of overall energy expenditure and metabolism. The pituitary influences metabolism indirectly via TSH, but it is not the end-organ producing the metabolic hormones. Adrenal hormones mainly mediate stress responses and fluid/electrolyte balance, while the pancreas primarily regulates blood glucose rather than global metabolic rate.

Question 12

Insulin is produced by -?

Accepted Answer

Answer reason: When glucose rises, beta cells increase insulin release to promote cellular glucose uptake (especially in muscle and fat) and glycogen synthesis while suppressing hepatic glucose output. Alpha cells instead secrete glucagon, which raises blood glucose, making them a classic distractor. Delta cells secrete somatostatin, and gastric G cells secrete gastrin, neither of which is responsible for insulin production.

Question 13

Which hormone regulates sleep cycle?

Accepted Answer

Answer reason: Melatonin rises in darkness and promotes sleep onset and sleep–wake timing, making it the key hormone linked to sleep cycle regulation. Insulin mainly regulates glucose metabolism, not sleep timing. TSH and prolactin have diurnal variation but do not serve as the primary endocrine signal that entrains the sleep–wake cycle.

Question 14

Disease caused by iodine deficiency -?

Accepted Answer

Answer reason: Reduced T3/T4 triggers increased TSH release, which chronically stimulates thyroid follicular hyperplasia and hypertrophy. This compensatory enlargement presents clinically as goitre. A common distractor is rickets, which is primarily due to vitamin D deficiency affecting bone mineralization rather than thyroid function.

Question 15

High blood sugar is known as –?

Accepted Answer

Answer reason: This directly matches the stem asking for the term meaning “high blood sugar.” A common distractor is hypoglycemia, which is the opposite condition (low blood glucose). Hyponatremia relates to low serum sodium, and anemia relates to reduced hemoglobin/red cell mass, neither of which define blood glucose elevation.

Question 16

Hypoglycemia means low —?

Accepted Answer

Answer reason: The term breaks down to “hypo-” (low) and “-glycemia” (glucose in the blood), making glucose the specific substance that is low. This directly distinguishes it from electrolyte deficits like low sodium (hyponatremia) or low calcium (hypocalcemia), which have different terminology and clinical implications. Recognizing this definition is essential because low blood glucose can rapidly lead to neuroglycopenic symptoms and requires prompt correction.

Question 17

Calcitonin hormone is secreted by ...?

Accepted Answer

Answer reason: Parafollicular cells are located in the thyroid gland adjacent to, but distinct from, the follicular epithelium that makes T3 and T4. Follicular cells therefore are a classic distractor because they synthesize thyroid hormones (thyroglobulin/iodination), not calcitonin. Mast cells and macrophages can release inflammatory mediators and cytokines but are not physiologic sources of calcitonin.

Question 18

Thyroxine hormone contains —?

Accepted Answer

Answer reason: Thyroxine (T4) specifically contains four iodine atoms, and inadequate iodine intake directly impairs T3/T4 production. This is why iodine deficiency is classically associated with goiter and hypothyroidism due to reduced hormone synthesis and compensatory TSH rise. Minerals like sodium, iron, and calcium are important physiologically but are not incorporated into the thyroxine molecule itself.

Question 19

Low estrogen leads to –?

Accepted Answer

Answer reason: When estrogen is low (e.g., menopause, hypoestrogenism), the vaginal mucosa becomes thin and less lubricated, causing dryness and dyspareunia as part of genitourinary syndrome of menopause. Fever and cough are not direct endocrine consequences of low estrogen and instead suggest infection or respiratory illness. Acne is more associated with relative androgen excess or androgen sensitivity rather than isolated estrogen deficiency.

Question 20

A deficiency of vitamin D can lead to which condition?

Accepted Answer

Answer reason: When vitamin D is deficient, inadequate mineralization of growing bone leads to widened growth plates and bone deformities, classically presenting as rickets in children. This is distinct from other vitamin deficiencies: beriberi is due to thiamine (B1) deficiency, cheilosis is commonly linked to riboflavin (B2) deficiency, and scurvy results from vitamin C deficiency causing defective collagen synthesis. Therefore, the condition most directly caused by vitamin D deficiency is rickets.

Question 21

Hypothyroidism commonly shows —?

Accepted Answer

Answer reason: This commonly produces symptoms of slowed metabolism such as feeling cold, fatigue, weight gain, and constipation. In contrast, tachycardia, diarrhea, and weight loss are more characteristic of hyperthyroidism due to increased sympathetic activity and metabolic rate. Therefore the finding most consistent with hypothyroidism among the options is impaired tolerance to cold.

Question 22

The hallmark symptom of hyperthyroidism –?

Accepted Answer

Answer reason: A fine tremor is a hallmark manifestation alongside heat intolerance, weight loss, anxiety, and tachycardia. The alternatives listed are more consistent with hypothyroidism (weight gain and bradycardia/slow pulse) or are nonspecific and not a defining feature (hair whitening). Therefore, the option that best reflects the characteristic clinical presentation is the one indicating adrenergic overactivity.

Question 23

Insulin is produced by –?

Accepted Answer

Answer reason: The pancreas is the organ that contains these islet beta cells, so it is the direct source of endogenous insulin. The liver is a major target organ for insulin’s metabolic effects but does not produce insulin. The thyroid produces thyroid hormones (T3/T4), and the kidney primarily contributes to gluconeogenesis and insulin clearance rather than insulin production.

Question 24

Which drug is used in Hypothyroidism?

Accepted Answer

Answer reason: The correct choice is synthetic T4, which is converted peripherally to the active hormone T3 and provides stable, physiologic hormone replacement with once-daily dosing. In contrast, methimazole and carbimazole are antithyroid drugs that inhibit thyroid hormone synthesis and are used for hyperthyroidism, which would worsen hypothyroidism. Propranolol can control adrenergic symptoms in hyperthyroidism but does not correct thyroid hormone deficiency.

Question 25

Which hormone is secreted by the Pineal gland?

Accepted Answer

Answer reason: This secretion helps coordinate the sleep–wake cycle and seasonal biologic timing. Thyroxine is produced by the thyroid gland, cortisol by the adrenal cortex, and ADH is synthesized in the hypothalamus and released from the posterior pituitary. Therefore, the only option matching pineal gland secretion is the one that controls circadian sleep regulation.

Question 26

Thyroid-stimulating hormone (TSH) is secreted by –?

Accepted Answer

Answer reason: TRH from the hypothalamus stimulates pituitary release of TSH, which then acts on the thyroid to increase synthesis and release of T3 and T4. Circulating T3/T4 provide negative feedback to the pituitary and hypothalamus to regulate TSH secretion. The thyroid gland secretes T3/T4 (not TSH), while the adrenal gland and pancreas produce unrelated hormones (e.g., cortisol/catecholamines and insulin/glucagon).

Question 27

The hormone responsible for milk ejection is –?

Accepted Answer

Answer reason: Nipple stimulation triggers hypothalamic signaling that leads to release of this hormone, producing forceful movement of milk from alveoli into ducts. Prolactin instead primarily stimulates milk production in the alveolar epithelial cells, not ejection. Estrogen and growth hormone have permissive or developmental roles in breast tissue but do not mediate the acute let-down response.

Question 28

The largest endocrine gland is —?

Accepted Answer

Answer reason: The thyroid is a sizable cervical gland that produces T3/T4 and calcitonin and typically outweighs other endocrine glands such as the pituitary and adrenals. The pancreas has major endocrine function (islets) but is a mixed exocrine-endocrine organ, so it is not classically cited as the largest endocrine gland in standard anatomy/physiology questions. Therefore, the thyroid best fits the exam definition used in basic endocrine anatomy.

Question 29

The master gland is —?

Accepted Answer

Answer reason: The pituitary secretes TSH, ACTH, LH/FSH, GH, and prolactin, thereby controlling thyroid, adrenal cortex, and gonadal function as well as growth and lactation. While the thyroid and adrenal are vital hormone producers, they are primarily downstream targets rather than central controllers. The pituitary’s central coordinating role is why it is classically termed the “master gland” (under hypothalamic control).

Question 30

Thyroxine is produced by –?

Accepted Answer

Answer reason: It is stored in the thyroid as part of thyroglobulin and released into circulation to regulate basal metabolic rate, growth, and thermogenesis. The adrenal glands produce corticosteroids and catecholamines, not T4. The pituitary regulates thyroid function via TSH but does not produce thyroxine, and the kidney is not an endocrine source of T4.

Question 31

Which condition causes excessive facial hair in women ?

Accepted Answer

Answer reason: Excessive facial hair (hirsutism) in women is most commonly due to androgen excess. Polycystic ovary syndrome causes hyperandrogenism from ovarian theca cell androgen overproduction and is frequently associated with irregular menses, acne, and insulin resistance. This androgen excess leads to increased terminal hair growth in a male-pattern distribution. Asthma and tuberculosis do not cause androgen-driven hirsutism, and anemia is not an endocrine cause of increased facial hair.

Question 32

The LPN/LVN who is assigned to care for a patient with Cushing disease asks the RN why the patient has bruising and petechie across her abdomen. What is the RN’s best response?

Accepted Answer

Answer reason: ” Hypercortisolism in Cushing disease causes protein catabolism and connective-tissue breakdown, which weakens capillary support and makes small vessels prone to rupture with minimal trauma. This leads to easy bruising and petechiae, especially in areas exposed to pressure or minor shear. While skin thinning is also a classic finding, the immediate mechanism explaining petechiae is increased capillary fragility rather than a primary coagulation/platelet disorder. Asking about falls shifts away from the underlying pathophysiology and is not the best explanatory response.

Question 33

When caring for a patient with diabetic ketoacidosis, the nurse understands which is true regarding the insulin and blood glucose relationship?

Accepted Answer

Answer reason: In DKA, absolute or relative insulin deficiency prevents glucose from entering insulin-dependent tissues, contributing to marked hyperglycemia despite intracellular “starvation.” Administered insulin reverses this by driving glucose into cells and suppressing hepatic glucose output, helping close the anion gap as ketogenesis falls. A common distractor is focusing on renal excretion; glucosuria occurs when blood glucose exceeds the renal threshold, but insulin’s key therapeutic effect is restoring cellular uptake. Additionally, insulin shifts potassium into cells, so it clearly affects electrolytes, making the “no impact” option incorrect.

Question 34

A patient is likely to have hyperthyroidism with which of the following lab results?

Accepted Answer

Answer reason: Elevated thyroid hormone exerts negative feedback on the pituitary, suppressing TSH release, so TSH is typically low. This pattern differentiates primary hyperthyroidism from secondary (pituitary-driven) hyperthyroidism, where TSH would be inappropriately high. Options showing low T3/T4 align more with hypothyroidism or central hypothyroidism rather than hyperthyroidism.

Question 35

Which electrolyte abnormalities would the nurse expect to see in a client experiencing an Addisonian crisis?

Accepted Answer

Answer reason: Low aldosterone leads to renal sodium wasting and volume depletion, producing hyponatremia (and typically hyperkalemia). Low cortisol reduces gluconeogenesis and impairs the stress response, making hypoglycemia common in crisis. Options featuring hypokalemia or hypernatremia contradict the expected mineralocorticoid-deficient state, and hyperglycemia is more consistent with cortisol excess rather than deficiency.

Question 36

A 68-year-old makes an appointment with her primary care provider. She states she has been gaining weight, experiencing fatigue, and “feeling cold a lot.” What medication would the patient most likely be prescribed?

Accepted Answer

Answer reason: Treatment is thyroid hormone replacement to restore physiologic T4 levels and normalize TSH, improving energy and thermoregulation over time. Metformin targets hyperglycemia/insulin resistance and would not address cold intolerance or brady-metabolic symptoms. Chemotherapy and vitamin A injection are not indicated for this endocrine presentation and would expose the patient to unnecessary risk.

Question 37

The nurse is taking vital signs on a patient with hypothyroidism. Which vital sign would be most related to the hypothyroidism?

Accepted Answer

Answer reason: Temperature 36.1 degrees Celsius Hypothyroidism reduces basal metabolic rate and heat production, so patients commonly exhibit cold intolerance and lower-than-usual body temperature. A temperature of 36.1°C is low-normal and is the vital sign change most directly tied to decreased thyroid hormone effect. By contrast, a heart rate of 96 suggests mild tachycardia, whereas hypothyroidism more typically causes bradycardia. Oxygen saturation is generally unaffected unless there is concurrent respiratory compromise, and mild BP elevation is less specific than temperature for this endocrine state.

Question 38

A nurse is reviewing laboratory results for a client admitted with suspected adrenal insufficiency. Which of the following findings would the nurse expect to see if the client has primary adrenal insufficiency (Addison's disease)?

Accepted Answer

Answer reason: Low aldosterone reduces sodium and water reabsorption, leading to volume depletion with hypotension and hyponatremia. Low cortisol is the hallmark lab finding and also contributes to impaired vascular tone and stress response. Options describing hypertension/hyperglycemia or increased cortisol/low ACTH fit cortisol excess or secondary causes rather than Addison’s disease.

Question 39

Nurse Lee is assessing a newly admitted patient who is taking propylthiouracil (PTU) daily. Based on the medication history, which condition does the nurse suspect the patient might have?

Accepted Answer

Answer reason: Propylthiouracil is a thioamide antithyroid drug that inhibits thyroid hormone synthesis (and also reduces peripheral conversion of T4 to T3), so it is used to treat hyperthyroidism. Graves’ disease is the most common cause of hyperthyroidism and is a classic indication for PTU (notably in thyroid storm and in some pregnancy situations). Myxedema represents severe hypothyroidism, which would not be treated with an antithyroid medication. Addison’s and Cushing’s involve adrenal hormone disorders rather than primary thyroid hormone excess.

Question 40

After a hypophysectomy, vasopressin is given IM for which of the following reasons?

Accepted Answer

Answer reason: Hypophysectomy can disrupt posterior pituitary function and eliminate or reduce endogenous ADH release, predisposing the patient to central diabetes insipidus with polyuria, dehydration, and hypernatremia. Vasopressin is exogenous ADH, so administering it corrects the hormone deficiency and restores renal water reabsorption in the collecting ducts. SIADH represents excess ADH and would not be prevented by giving an ADH analog; it would worsen water retention and hyponatremia. Growth failure is treated with growth hormone (somatropin), and reducing cerebral edema/ICP is managed with osmotic/loop diuretics and other neurocritical measures rather than vasopressin.

Question 41

A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following glands?

Accepted Answer

Answer reason: Excess aldosterone increases renal sodium and water reabsorption, expanding intravascular volume and causing hypertension, often with associated hypokalemia and metabolic alkalosis. The adrenal medulla instead secretes catecholamines (epinephrine/norepinephrine) and is linked to episodic hypertension in pheochromocytoma, not aldosterone excess. The pancreas and parathyroid regulate glucose and calcium balance, respectively, and do not produce aldosterone.

Question 42

Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find?

Accepted Answer

Answer reason: Cushing’s syndrome reflects chronic excess cortisol, which causes characteristic fat redistribution and protein catabolism. This produces central (truncal) obesity and dorsocervical fat pad (“buffalo hump”), often with a rounded face. Hypotension is more consistent with adrenal insufficiency, while cortisol excess more typically contributes to hypertension via increased vascular responsiveness and mineralocorticoid effects. Extremities tend to be relatively thin from muscle wasting rather than gaining weight in the arms and legs.

Question 43

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it?

Accepted Answer

Answer reason: It rapidly stimulates hepatic glycogenolysis and also promotes gluconeogenesis, increasing circulating glucose even when the patient cannot take oral carbohydrates. This is why it is used for severe hypoglycemia, particularly when IV access is not immediately available. Options suggesting insulin release or increased glucose storage describe actions that would worsen hypoglycemia rather than correct it.

Question 44

Which of the following is not a potential explanation for diabetes?

Accepted Answer

Answer reason: Insulin is a peptide hormone primarily cleared by hepatic and renal degradation, but normal physiology does not involve the kidneys “excreting all insulin” as a primary mechanism that would produce diabetes. By contrast, failure of pancreatic beta-cell insulin production, peripheral insulin resistance, and impaired suppression of hepatic gluconeogenesis are core, well-established mechanisms in type 1 and type 2 diabetes. The phrasing about the body “retaining glucose” is also inconsistent with diabetes physiology, where excess glucose spills into urine when the renal threshold is exceeded.

Question 45

A patient with diabetes had a blood glucose level of 94 at bedtime and 128 when he awoke. The nurse recognizes this as?

Accepted Answer

Answer reason: The rise from a normal bedtime glucose (94 mg/dL) to a higher fasting level (128 mg/dL) fits this pattern without evidence of nocturnal hypoglycemia. The Somogyi effect would be rebound hyperglycemia after an unrecognized overnight low, typically suggested by low 2–3 AM glucose, which is not provided here. The value of 128 mg/dL reflects mild fasting hyperglycemia rather than an imminent hypoglycemic event.

Question 46

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

Accepted Answer

Answer reason: Levothyroxine is synthetic T4 with predictable oral absorption and a long half-life, making it the standard first-line therapy for chronic replacement, including post-thyroidectomy hypothyroidism. It is titrated to normalize TSH and restore normal metabolic function over weeks, aligning with the goal of replacing deficient hormone rather than suppressing overproduction. In contrast, Graves’ disease and thyrotoxicosis represent hyperthyroid states where antithyroid drugs, beta-blockers, radioiodine, or surgery are used rather than thyroid hormone administration.

Question 47

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect?

Accepted Answer

Answer reason: Excess catecholamine release (epinephrine/norepinephrine) from an adrenal medulla tumor causes marked sympathetic stimulation with alpha-1–mediated vasoconstriction. This produces episodic or sustained hypertension as the most characteristic assessment finding. A normal blood pressure would be unlikely during symptomatic periods, and catecholamines typically increase heart rate rather than causing bradycardia (though reflex changes can occur). Mild hyperglycemia can occur from catecholamine-driven glycogenolysis, but hypertension is the most direct and expected finding.

Question 48

Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

Accepted Answer

Answer reason: Diabetes insipidus results from inadequate ADH production (central DI) or impaired renal response to ADH (nephrogenic DI), leading to inability to concentrate urine. Without effective ADH action at the kidney collecting ducts, water reabsorption falls and patients develop polyuria, polydipsia, and risk of dehydration with hypernatremia. Teaching should therefore focus on the role of ADH (and, clinically, desmopressin for central DI) in water balance and urine concentration. TSH, FSH, and LH are pituitary hormones but are not responsible for regulating renal free-water retention, making them incorrect for DI.

Question 49

A nurse caring for two patients with endocrine issues – Patient A has diabetic ketoacidosis and Patient B has hyperosmolar hyperglycemic nonketotic syndrome. Which plan of care is correct?

Accepted Answer

Answer reason: Therefore, metabolic acidosis is an expected core finding in Patient A. In HHS, profound osmotic diuresis causes severe dehydration, so aggressive isotonic fluid replacement is the initial priority and typically larger than in DKA. A common trap is assuming HHS can be managed with oral agents; both conditions are acute emergencies requiring IV therapy and close monitoring.

Question 50

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?

Accepted Answer

Answer reason: The clinical clues of enlarged hands, deep/hoarse voice, and obstructive sleep apnea symptoms (loud snoring) are classic consequences of soft-tissue and bony overgrowth from elevated GH/IGF-1. In contrast, hypothyroidism is more associated with weight gain and fatigue rather than the specific acral enlargement and typically does not directly cause marked hyperglycemia via insulin resistance. Growth hormone deficiency would tend to reduce counter-regulatory hormones and would not explain the acromegalic physical features.

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