Acromegaly

Question 0

Face:

Answer 0

• Prominent supraorbital ridges
• Big ears, lips and nose
• Ask patient to extrude tongue – may be big
• Look from side for prognathism (protrusion of jaw due to overgrowth of mandible also leads to wide separation of teeth)
• Ask patient “Show me your gums” to demonstrate lower teeth in front of upper teeth and wide gaps between teeth

Question 1

Hands:

Answer 1

• Size: increased compared with examiner
• Thenar eminence: wasting if carpal tunnel syndrome
• Check sensation in median distribution
• Sweating increased
• Bogginess of palms
• Skin fold thickness increased in active disease

Question 2

Acromegaly: other

Boggy and Sweaty = active

Answer 2

A​ arthopathy
B ​BP
C​ carpal tunnel syndrome
D​ diabetes
E​ enlarged tongue, heart, thyroid
F​ fields; bitemporal hemianopia

Question 3

Confirmation of diagnosis

Answer 3

• Failure of suppression of GH levels during oral glucose tolerance test
• GH is an insulin antagonist and is normally suppressed by glucose
• Average of hourly growth hormone levels (single level unreliable as pituitary hormones normally pulsatile)
• Insulin-like growth factor levels

Question 4

Treatment options

Answer 4

• Surgery
• Radiotherapy
• Medical treatment (somatostatin analogues - octreotide, dopamine agonists - bromocryptine)
• NB Colonoscopy screening from age 40