Alice Smyth is a 42 year-old woman who is referred to you by a neurosurgeon who saw her for carpal tunnel syndrome, but became concerned that she may have acromegaly.
List 10 clinical manifestations of acromegaly.
- Facial changes:
- proganthism
- enlarged nose/tongue
- frontal bossing
- Enlarged hands and feet
- Cardiomegaly/CHF
- Metabolic syndrome:
- hypertension
- hypertriglyceridemia
- diabetes mellitus
- Osteoporosis
- Hypercalcemia
- BPH
- Multinodular goiter
- Carpal tunnel syndrome
- Obstructive sleep apnea
- Colonic polyps
- Skin tags, hyperhydrosis
How do you screen for and confirm the diagnosis of acromegaly?
Screen for elevated IGF-1 level.
Diagnose with 2 hour 75 g glucose suppression test.
If normal: GH suppresses to <1
