Acromegaly focussed exam

Question 1

Generic q

Answer 1

What did you notice first?
Have you noticed a change in your appearance?

Determining if there is active acromegaly - do you notice excessive sweating? do you have high blood pressure?

Headaches? Visual problems? Pins and needles? Backache? Muscle weakness? Change in shoe size?

Question 2

General inspection

Answer 2

Increased size of feet, hands, head
Mildly hirsute
Kyphosis

Question 3

Arms

Answer 3

Inspect and palpate with patient’s hands on pillow

Dorsum: large, spade-shaped with signs of OA
Palms: sweaty, doughy/boggy texture to palms, capillary glucose stick marks on finger pulps (secondary diabetes)
Signs of carpal tunnel syndrome e.g. scar / loss of sensation
BP

Question 4

Face

Answer 4

General: coarse facial features, acne, enlarged nose and ears, macrognathia (large mandible), hypophystectomy scar under upper lip
Eyes: visual fields, prominent supra-orbital ridges
Mouth: prognathism, splaying of teeth, macroglossia and ridges from teeth on sides of tongue

Question 5

Neck

Answer 5

Thyroid goitre (increased thyroid vascularity)
JVP (cardiomyopathy)

Question 6

Chest

Answer 6

Inspect: multiple skin tags
Acanthosis nigricans in axillae
Signs of cardiomyopathy (apex, auscultate HS and lung bases)

Question 7

Limbs

Answer 7

Peripheral oedema (cardiomyopathy)
Proximal myopathy
Gait: rolling gait with bowed legs

Question 8

To complete

Answer 8

BP, perform thyroid and CV exams and formally assess visual fields

Full hx
Insulin-like growth factor 1
Growth hormone response to oral glucose tolerance test
MRI pituitary