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Acromegaly (Examination (Extras (Armpits: acanthosis nigricans (Acanthosis…
Acromegaly
Examination
Hands
- Spade-like: compare directly c¯ your own
- Tight rings
- ↑ skin fold thickness
- Boggy, sweaty palms: if active
- Thenar wasting + loss of sensation: carpal tunnel syn.
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Face
- Coarse facial features: large nose, big ears
- Prominent supra-orbital ridges
- Macroglossia
- Widely spaced teeth: “show me your gums”
- Prognathism: inspect from side
- Look up nose for scars
Macroglossia DDX
- Acromegaly
- Amyloidosis
- Hypothyroidism
- Down’s syn.
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Mx
General
- MDT: GP, endocrinologist, neurosurgeon
- CV risk
Follow up Yearly
- Bloods: GH, PRL
- Visual fields
- ECG
- ± MRI head
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Viva
Hx
Symptoms
- Headaches
- Problems c¯ vision
- Change in appearance
- Hat and ring size ↑
- Pain or paraesthesia in hands
- Snoring, stop breathing when sleeping (OSA)
Associations
- Polyuria and polydipsia
- Chest pain, SOB, palpitations
- Change in bowel habit
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Ix
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Bloods
- ↑ IGF-1
- Glucose tolerance test: non-suppression of GH
- Other pituitary hormones: TFT, PRL, testosterone
- Glucose
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Imaging
- CXR: cardiomegaly
- MRI of pituitary fossa: pituitary adenoma