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Acromegaly

Julie A. Creech, DO and Christine M. Broszko, MD Reviewed 06/2018
 


BASICS

  • Acromegaly: a rare endocrinologic disease characterized by excess secretion of growth hormone (GH), resulting in a syndrome of coarsened facial features and overgrowth of the jaw, hands, and fe...

DIAGNOSIS

HISTORY

  • Musculoskeletal

    • Enlarging shoe and ring size

    • Arthralgias/myalgias

  • Neurologic

    • Headache

    • Vision changes, particularly temporal hemianopsia

    • Hand numbness/carpal tunnel syndrome

    • Fatigue, weakness

    • ...

TREATMENT

  • Goals of treatment:

    • Decrease the serum IGF-1 level to within the reference range for the patient's age and sex.

    • Decrease the glucose-suppressed serum GH to <1 ng/mL.

    • Ameliorate symptoms with...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Monitoring for medical and surgical treatment: 
  • At baseline

    • Echocardiogram

    • Colonoscopy

  • Every 3 to 4 months

    • Cardiovascular exam and BP measurement

    • Meas...

REFERENCES

Borson-Chazot F, Garby L, Raverot G, et al; for GTE Group. Acromegaly induced by ectopic secretion of GHRH: a review 30 years after GHRH discovery. Ann Endocrinol (Paris).  2012;73(6)...

ADDITIONAL READING

  • Dekkers OM, Biermasz NR, Pereira AM, et al. Mortality in acromegaly: a metaanalysis. J Clin Endocrinol Metab.  2008;93(1):61–67.

  • Melmed S. Medical progress: acromegaly. N Engl J...

SEE ALSO

Algorithm: Tall Stature 

CODES

ICD10

E22.0 Acromegaly and pituitary gigantism 

ICD9

253.0 Acromegaly and gigantism 

SNOMED

  • 74107003 Acromegaly (disorder)

  • 240089002 Myopathy in acromegaly (disorder)

  • 230581008 Neuropathy in acromegaly...

CLINICAL PEARLS

  • The onset of acromegaly is insidious and may be initially subtle.

  • The serum IGF-1 level is the preferred screening test and is elevated in acromegaly.

  • An elevated IGF-1 should prompt an ...

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