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Acromegaly

Introduction

Acromegaly is a disorder that occurs due to an excess secretion of growth hormone (GH), after the fusion of the growth plates. The most obvious, and often the earliest sign is enlargement of the hands and feet. Sufferers also often have very tall stature, and distinctive facial features including enlarged jaw, brow and nose.

95% of causes are caused by a pituitary adenoma – a type of pituitary tumour which is otherwise benign.

Diagnosis is performed by means of an oral glucose tolerance test  (OGTT) similar to that used in the diagnosis of type 2 diabetes.

Acromegaly should be differentiated by gigantism – which instead results from excess growth hormone before fusion of the growth plates.

Epidemiology

Pathophysiology

Clinical features

Symptoms

Signs

Acromegaly in a male patient. Note the enlarged hands and nose, and prominent jaw.

Investigations

Management

Surgical

Medical

Radiotherapy

Follow up

Complications

Prognosis

 

Examining for Acromegaly

Very common station in OSCEs although the condition itself is rare. Usually in OSCE the patient will have been treated, and thus the disease is not active, but many of the physical features may remain.
 

Hands

  • Size of the handscompare to your own. Often grossly enlarged
  • Skin fold thickness – again, compare to your own. Often increased in acromegaly
  • Palm – feel for bogginess of the palm
  • Sweating – feel the palms for sweating
  • Thenar eminence / median sensory distribution – check for thenar eminence wasting and sensation on the lateral 3 ½ fingers (carpal tunnel syndrome)
  • Proximal myopathy – check the power in the upper arm

Face

  • Prominent supra-orbital ridges
  • Large tongue
  • Large ears
  • Prognathism – an ‘underbite’ – the lower teeth protrude out below the upper ones

Visual Fields

  • Check the visual fields
 

Cardiovascular system

  • Check the BP (may be raised)
  • Check for cardiomegaly
    • Displaced apex beat
    • Raised JVP

References

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