acromegaly is abnormal development of face ,hands,and feet usually present later in life . it could be associated with hyperprolactinemia , headache , sweating , and bone growth.
in this presentation systemic examination with major complaints are mentioned.
2. investigations
• IGF 1 if markedly raised then MRI brain or piturity fossa.
• If not raised then glucose tolerance test (75mg) and do test for GH ( if
not 1ug/l or less suppressed then acromegaly).
• Hypertension and diabetes is also present in acromegaly
• Visual perimetry
• We cant do GH level as there production is pulsatile.
• Hypertension then echo for heart and RFT.
• And blood sugar level or HBA1C
• Serum calcium level and albumin level
3. presentation
• Bitemporal hemianopia
• Headache
• Big finger
• Shoe size increased
• And hat size also increased
• If associated with prolactin then galactorrhea
• Amenorrhea and acromegaly
• Size of hand increased and sausage shape fingers
• Excessive sweating
• In hand s there is carpel tunnel syndrome due to mps deposition
4. face
• Prominent supraorbital ridge
• Macroglossia
• Enlarge nose
• Lip are enlarge and thick
• Space b/w teeth increase
• Prognathism , protrusion of jaw forward
9. heart
1. Sign of recent heart failure
Basal crackles
Gallop rhythm ( S3 and S4 with tachycardia)
Play it
10. Rx
• Surgical removal of tumor with radiation for 6 week
• If IGF-1 still increased then given long acting somatostatin
analogue(octreotide)
With cabergoline (dopamine receptor antagonist)
• Pegvisoment(synthetic growth hormone receptor antagonist)
• Keep GH below 5ug/l less and symptomatic control
