Acromegaly physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with acromegaly usually appear tired. Physical examination of patients with acromegaly is usually remarkable for [[skin tags]], [[acanthosis nigricans]], and [[hyperhidrosis]]. Common findings in physical examination include [[frontal]] bossing, [[headache]], [[macroglossia]], and [[prognathism]]. Cardiovascular findings include [[ventricular hypertrophy]], [[heart failure]], and [[arrhythmias]]. Skeletal findings include joint effusion, [[osteopenia]], [[kyphoscoliosis]], [[muscle weakness]], [[paraesthesia]], and [[malocclusion]] of the mouth leading [[temporomandibular joint]] tenderness. | |||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
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===Vital Signs=== | ===Vital Signs=== | ||
*Hypertension | *[[Hypertension]] | ||
===Skin=== | ===Skin=== | ||
*Thickening of the skin | *Thickening of the [[skin]] | ||
*Skin tags | *[[Skin tags]] | ||
*Acne | *[[Acne]] | ||
*Acanthosis nigricans | *[[Acanthosis nigricans]] | ||
*Hyperhidrosis | *[[Hyperhidrosis]] | ||
<gallery widths="200px"> | <gallery widths="200px"> | ||
| Line 34: | Line 32: | ||
* Hearing acuity may be reduced | * Hearing acuity may be reduced | ||
* Facial tenderness | * Facial tenderness | ||
* Headache | * [[Headache]] | ||
* Macroglossia | * [[Macroglossia]] | ||
* Prognathism | * [[Prognathism]] | ||
===Lungs=== | ===Lungs=== | ||
*Obstruction of the upper airways | *Obstruction of the upper airways | ||
*Obstructive sleep apnea | *[[Obstructive sleep apnea]] | ||
===Heart=== | ===Heart=== | ||
Cardiac manifestations in acromegaly patients include the following:<ref name="pmid9100571">{{cite journal| author=López-Velasco R, Escobar-Morreale HF, Vega B, Villa E, Sancho JM, Moya-Mur JL et al.| title=Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension? | journal=J Clin Endocrinol Metab | year= 1997 | volume= 82 | issue= 4 | pages= 1047-53 | pmid=9100571 | doi=10.1210/jcem.82.4.3876 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9100571 }} </ref><ref name="pmid144034">{{cite journal |vauthors=Martins JB, Kerber RE, Sherman BM, Marcus ML, Ehrhardt JC |title=Cardiac size and function in acromegaly |journal=Circulation |volume=56 |issue=5 |pages=863–9 |year=1977 |pmid=144034 |doi= |url=}} </ref> | Cardiac manifestations in acromegaly patients include the following:<ref name="pmid9100571">{{cite journal| author=López-Velasco R, Escobar-Morreale HF, Vega B, Villa E, Sancho JM, Moya-Mur JL et al.| title=Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension? | journal=J Clin Endocrinol Metab | year= 1997 | volume= 82 | issue= 4 | pages= 1047-53 | pmid=9100571 | doi=10.1210/jcem.82.4.3876 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9100571 }} </ref><ref name="pmid144034">{{cite journal |vauthors=Martins JB, Kerber RE, Sherman BM, Marcus ML, Ehrhardt JC |title=Cardiac size and function in acromegaly |journal=Circulation |volume=56 |issue=5 |pages=863–9 |year=1977 |pmid=144034 |doi= |url=}} </ref> | ||
*Ventricular hypertrophy | *[[Ventricular hypertrophy]] | ||
*Diastolic heart failure (the most common cause of death) | *Diastolic heart failure (the most common cause of death) | ||
*Diastolic and systolic dysfunction | *Diastolic and systolic dysfunction | ||
*Arrhythmias | *[[Arrhythmias]] | ||
*Cardiomyopathy | *[[Cardiomyopathy]] | ||
=== Abdomen === | === Abdomen === | ||
| Line 54: | Line 52: | ||
===Back=== | ===Back=== | ||
*Vertebral fractures | *[[Vertebral fractures]] | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Patient is usually oriented to persons, place, and time | *Patient is usually oriented to persons, place, and time | ||
*Osteopenia | *[[Osteopenia]] | ||
*Osteoarthritis | *[[Osteoarthritis]] | ||
*Joints effusion, swelling, and crepitus | *Joints effusion, [[swelling]], and [[crepitus]] | ||
*Acromegaly rosary: hypertrophy of the ribs and costochondral junction enlargement in the chest wall.<ref name="pmid1670798">{{cite journal| author=Ibbertson HK, Manning PJ, Holdaway IM, Gamble G, Synek BJ| title=The acromegalic rosary. | journal=Lancet | year= 1991 | volume= 337 | issue= 8734 | pages= 154-6 | pmid=1670798 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1670798 }} </ref> | *Acromegaly rosary: [[hypertrophy]] of the [[ribs]] and [[Costochondral joint|costochondral junction]] enlargement in the chest wall.<ref name="pmid1670798">{{cite journal| author=Ibbertson HK, Manning PJ, Holdaway IM, Gamble G, Synek BJ| title=The acromegalic rosary. | journal=Lancet | year= 1991 | volume= 337 | issue= 8734 | pages= 154-6 | pmid=1670798 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1670798 }} </ref> | ||
*Muscle weakness | *[[Muscle weakness]] | ||
*Joint stiffness in late cases | *[[Joint stiffness]] in late cases | ||
*Malocclusion of patient jaw associated with temporomandibular joint tenderness | *[[Malocclusion]] of patient jaw associated with [[temporomandibular joint]] tenderness | ||
*Kyphoscoliosis<ref name="pmid1521514">{{cite journal| author=Molitch ME| title=Clinical manifestations of acromegaly. | journal=Endocrinol Metab Clin North Am | year= 1992 | volume= 21 | issue= 3 | pages= 597-614 | pmid=1521514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1521514 }} </ref> | *[[Kyphoscoliosis]]<ref name="pmid1521514">{{cite journal| author=Molitch ME| title=Clinical manifestations of acromegaly. | journal=Endocrinol Metab Clin North Am | year= 1992 | volume= 21 | issue= 3 | pages= 597-614 | pmid=1521514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1521514 }} </ref> | ||
* | *[[Paraesthesia]] | ||
*Cranial nerves palsy | *[[Cranial nerve palsy|Cranial nerves palsy]] | ||
*Carpal tunnel syndrome | *[[Carpal tunnel syndrome]] | ||
===Genitourinary=== | ===Genitourinary=== | ||
*In females:<ref name="IulianoLaws2014">{{cite journal|last1=Iuliano|first1=Sherry L.|last2=Laws|first2=Edward R.|title=Recognizing the clinical manifestations of acromegaly: Case studies|journal=Journal of the American Association of Nurse Practitioners|volume=26|issue=3|year=2014|pages=136–142|issn=23276886|doi=10.1002/2327-6924.12076}}</ref> | *In females:<ref name="IulianoLaws2014">{{cite journal|last1=Iuliano|first1=Sherry L.|last2=Laws|first2=Edward R.|title=Recognizing the clinical manifestations of acromegaly: Case studies|journal=Journal of the American Association of Nurse Practitioners|volume=26|issue=3|year=2014|pages=136–142|issn=23276886|doi=10.1002/2327-6924.12076}}</ref> | ||
**Amenorrhea | **[[Amenorrhea]] | ||
**Galactorrhea | **[[Galactorrhea]] | ||
*In males:<ref name="IulianoLaws2014">{{cite journal|last1=Iuliano|first1=Sherry L.|last2=Laws|first2=Edward R.|title=Recognizing the clinical manifestations of acromegaly: Case studies|journal=Journal of the American Association of Nurse Practitioners|volume=26|issue=3|year=2014|pages=136–142|issn=23276886|doi=10.1002/2327-6924.12076}}</ref> | *In males:<ref name="IulianoLaws2014">{{cite journal|last1=Iuliano|first1=Sherry L.|last2=Laws|first2=Edward R.|title=Recognizing the clinical manifestations of acromegaly: Case studies|journal=Journal of the American Association of Nurse Practitioners|volume=26|issue=3|year=2014|pages=136–142|issn=23276886|doi=10.1002/2327-6924.12076}}</ref> | ||
**Sexual dysfunction | **[[Sexual dysfunction]] | ||
**Loss of libido | **[[Loss of libido]] | ||
**Gynecomastia | **[[Gynecomastia]] | ||
==References== | ==References== | ||
Revision as of 19:15, 14 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients with acromegaly usually appear tired. Physical examination of patients with acromegaly is usually remarkable for skin tags, acanthosis nigricans, and hyperhidrosis. Common findings in physical examination include frontal bossing, headache, macroglossia, and prognathism. Cardiovascular findings include ventricular hypertrophy, heart failure, and arrhythmias. Skeletal findings include joint effusion, osteopenia, kyphoscoliosis, muscle weakness, paraesthesia, and malocclusion of the mouth leading temporomandibular joint tenderness.
Physical Examination
Appearance of the Patient
- Patients with acromegaly usually appear tired.
Vital Signs
Skin
- Thickening of the skin
- Skin tags
- Acne
- Acanthosis nigricans
- Hyperhidrosis
-
Description Template:Acanthosis nigricans in the axilla
HEENT
- Abnormalities of the head include frontal bossing
- Acral enlargement
- Visual deficits
- Hearing acuity may be reduced
- Facial tenderness
- Headache
- Macroglossia
- Prognathism
Lungs
- Obstruction of the upper airways
- Obstructive sleep apnea
Heart
Cardiac manifestations in acromegaly patients include the following:[1][2]
- Ventricular hypertrophy
- Diastolic heart failure (the most common cause of death)
- Diastolic and systolic dysfunction
- Arrhythmias
- Cardiomyopathy
Abdomen
- Colon diverticula
Back
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Osteopenia
- Osteoarthritis
- Joints effusion, swelling, and crepitus
- Acromegaly rosary: hypertrophy of the ribs and costochondral junction enlargement in the chest wall.[3]
- Muscle weakness
- Joint stiffness in late cases
- Malocclusion of patient jaw associated with temporomandibular joint tenderness
- Kyphoscoliosis[4]
- Paraesthesia
- Cranial nerves palsy
- Carpal tunnel syndrome
Genitourinary
References
- ↑ López-Velasco R, Escobar-Morreale HF, Vega B, Villa E, Sancho JM, Moya-Mur JL; et al. (1997). "Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension?". J Clin Endocrinol Metab. 82 (4): 1047–53. doi:10.1210/jcem.82.4.3876. PMID 9100571.
- ↑ Martins JB, Kerber RE, Sherman BM, Marcus ML, Ehrhardt JC (1977). "Cardiac size and function in acromegaly". Circulation. 56 (5): 863–9. PMID 144034.
- ↑ Ibbertson HK, Manning PJ, Holdaway IM, Gamble G, Synek BJ (1991). "The acromegalic rosary". Lancet. 337 (8734): 154–6. PMID 1670798.
- ↑ Molitch ME (1992). "Clinical manifestations of acromegaly". Endocrinol Metab Clin North Am. 21 (3): 597–614. PMID 1521514.
- ↑ 5.0 5.1 Iuliano, Sherry L.; Laws, Edward R. (2014). "Recognizing the clinical manifestations of acromegaly: Case studies". Journal of the American Association of Nurse Practitioners. 26 (3): 136–142. doi:10.1002/2327-6924.12076. ISSN 2327-6886.