Acromegaly

Courtesy of Dr Fadzli, Endocrine MO

1)Spend a few seconds in general inspection

2)Start off by examining the patient's hand, you notice that he has spade-like, sweaty hand, the skin is thickened and doughy.

3)Check for carpal tunnel syndrome(Phalen and Tinel Test)

4)Look at the face-check for prognathism(causing malocclusion of jaw), prominent supra-orbital ridges, wide inter-dental spaces and macroglossia

5)Offer to look for skin tag(molluscum fibrosum) at axilla

6)Look at lower limbs for pitting edema to suggest cardiac failure, look for evidences to suggest osteoarthritis of the knee, thicken heel pad

9)Check for proximal myopathy by asking patient to squat down

10)Assess the visual field to look for bitemporal hemianopia(acromegaly tends to be due to macroadenoma)

After eliciting all the positive signs, suggest to examiners you would like to complete your physical examination by

1)Check the blood pressure which is an indicator for active disease process

2)Check urine for glycosuria

3)Check fundus for DM/HPT changes

4)Examine the cardiovascular system for heart failure, neck for goitre and abdomen for hepatosplenomegaly

Questions

1)How do you confirm the diagnosis?

2)What are the modalities of treatment available?

3)How do you monitor treatment response?

4)Any endocrine syndrome which is associated with acromegaly?