Acromegaly physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

  • Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
  • Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Appearance of the Patient

  • Patients with acromegaly usually appear tired.

Vital Signs

  • High-grade / low-grade fever
  • Hypertension
  • Hypothermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea
  • Kussmal respirations may be present in _____ (advanced disease state)
  • Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse

Skin

  • Thickening of the skin
  • Skin tags
  • Acanthosis nigricans
  • Hyperhidrosis

HEENT

  • Abnormalities of the head include frontal bossing
  • Acral enlargement
  • Visual deficits
  • Hearing acuity may be reduced
  • Facial tenderness
  • Headache
  • Prognathism

Lungs

  • Obstruction of the upper airways
  • Obstructive sleep apnea

Heart

  • Ventricular hypertrophy
  • Diastolic heart failure (the most common cause of death)
  • Diastolic and systolic dysfunction
  • Arrhythmias

Back

  • Vertebral fractures

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Carpal tunnel syndrome
  • Osteopenia
  • Osteoarthritis
  • Joints effusion, swelling, and crepitus
  • Acromegaly rosary: hypertrophy of the ribs and costochondral junction enlargement in the chest wall.[1]
  • Muscle rigidity in late cases
  • Malocclusion of patient jaw associated with temporomandibular joint tenderness

Extremities

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

  1. Ibbertson HK, Manning PJ, Holdaway IM, Gamble G, Synek BJ (1991). "The acromegalic rosary". Lancet. 337 (8734): 154–6. PMID 1670798.

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