Acromegaly is caused by too much growth hormone in adults, almost always from a benign pituitary tumor. The changes appear slowly over years, so the diagnosis is often delayed until complications such as diabetes, heart disease or sleep apnea appear.
Key symptoms
- Larger hands and feet; rings and shoes no longer fit
- Coarse facial features, a larger jaw and gaps between the teeth
- Headaches and vision changes
- Joint pain, heavy sweating and snoring
- Numbness in the hands (carpal tunnel)
What you find on exam
- Prominent brow, large nose, jutting jaw and thick lips
- Large, doughy hands and thick skin
- Visual fields: loss of outer vision
- Blood pressure; high pressure is common
- Enlarged tongue, thyroid or other organs
Tests
- IGF-1 level: the best screening test
- Oral glucose tolerance test: growth hormone fails to drop
- Pituitary MRI
- Glucose, HbA1c and other pituitary hormones; sleep study, echocardiogram and colonoscopy for complications
Treatment basics
- Surgery through the nose (transsphenoidal) is first line
- Somatostatin analogs such as octreotide or lanreotide if disease persists
- Pegvisomant or cabergoline as other drug options
- Radiation if surgery and drugs are not enough
- Treat diabetes, high blood pressure and sleep apnea
Red flags
- Sudden severe headache with vision loss (pituitary apoplexy)
- Rapid loss of visual field
- Chest pain, breathlessness or signs of heart failure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.