Acromegaly resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Diagnosis

The approach to diagnosis of Acromegaly is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of Acromegaly.

Characterize the symptoms: ❑ Headaches ❑ Enlargement of the hands (change in ring or glove size) and feet (change in shoe size) ❑ Lethargy ❑ Hyperhidrosis (excessive sweating) ❑ Paraesthesia ❑ Sexual dysfunction ❑ Fatigue ❑ Jaw pain

Examine the patient: ❑ HEENT Changes in facial appearance (large bones of the face, large jaw and tongue, widely spaced teeth) Visual disturbance Hoarseness of voice ❑ Musculoskeletal exam: Joint pain Limited joint movement Swelling of the bony areas around a joint ❑ Fever and neurological signs are seen in TTP ❑ Hemoglobinuria in some cases

Treatment

Shown below is an algorithm summarizing the treatment of [[Acromegaly]] according the the [...] guidelines.

Acromegaly

Transphenoidal surgery ❑ Complete resection ❑ Tumors that are unresectable, a surgical debulking procedure may be performed followed by medical therapy

Patient is not a surgical candidate ❑ Patient preference ❑ High risk due to medical comorbidities ❑ Unresectable tumors

Are the following criteria met postoperatively? ❑ Morning serum GH the day after surgery <1ng/ml ❑ 12 weeks postoperative: Normal serum IGF-1 (for age and gender) No evidence of residual tumor on pituitary MRI

Yes

No

Remission ❑ Monitor with annual IGF-1

Is there residual tumor that appears resectable and readily accessible (eg, not invading the cavernous sinus)?

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Perform MRI for clinical or biochemical evidence of recurrence

Medical therapy

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Do's

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Don'ts

• The content in this section is in bullet points.

References

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