Bulldog scalp and gorilla face are the features of:

DSSSB 12 August 2024

Medical & Surgical Nursing

Easy

Appeared in: DSSSB 12 August 2024

Explanation

Acromegaly is a hormonal disorder caused by excessive secretion of Growth Hormone (GH) from the pituitary gland during adulthood.
Since the long bone growth plates (epiphyses) are closed in adults, excess GH causes bones to thicken and soft tissues to enlarge, rather than increasing height.
The term 'gorilla face' describes the resulting coarse facial features, including a prominent brow, broad nose, thick lips, and a protruding lower jaw (prognathism).
'Bulldog scalp' (cutis verticis gyrata) refers to the deep, thick folds and wrinkles that form on the scalp due to skin thickening.

Option A: Dwarfism is characterized by stunted growth and short stature due to a deficiency of growth hormone in childhood, which is the opposite of the overgrowth features described.
Option B: Gigantism is caused by GH excess in childhood, leading to extreme, proportional height. It does not typically cause the coarse, disproportionate facial features and soft tissue thickening seen in acromegaly.
Option C: Acromicria is a rare condition involving GH deficiency in adults, leading to atrophy (shrinking) of the extremities (hands and feet). This is the opposite of the enlargement seen in acromegaly.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of Growth Hormone (GH) disorders as background academic context rather than a clinical decision trigger.
Early recognition of acromegaly is crucial for preventing long-term complications. Nurses should be alert for patient complaints of increasing shoe, glove, or ring size, which are early signs of soft tissue and bone growth.
Untreated acromegaly significantly increases the risk of serious health problems, including type 2 diabetes, hypertension, cardiovascular disease, sleep apnea, and an increased risk of colon polyps and cancer.
What if? If the same symptoms of GH excess appeared in a 10-year-old, the diagnosis would be Gigantism. Because the child's bone growth plates are still open, the primary manifestation would be a dramatic increase in height, rather than the acral and soft tissue enlargement seen in adults.

How to Approach the Question

First, identify the key descriptive phrases in the question: 'Bulldog scalp' and 'gorilla face'. These are classic, highly specific clinical signs.
Recall the major disorders of the pituitary gland, specifically those related to Growth Hormone (GH).
Differentiate between conditions of GH excess (Gigantism, Acromegaly) and GH deficiency (Dwarfism, Acromicria). The features described are of overgrowth, which rules out deficiency disorders.
Distinguish between the two GH excess disorders based on the age of onset. Gigantism occurs in childhood (before growth plates close), causing increased height. Acromegaly occurs in adulthood (after growth plates close), causing thickening of bones and soft tissues.
Match the specific signs ('gorilla face', 'bulldog scalp') to the pathophysiology of Acromegaly, where bone and soft tissue thickening leads to these characteristic coarse features.

Concept Tested & Keywords

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E6 Physiology Essentials Sembulingam 10e Part 2 p. 32-34

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1070-1072