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 ❑ Body odor ❑ Blood in the stool ❑ Sleep apnea ❑ Weight gain

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 Enlargement of thyroid gland ❑ Musculoskeletal exam: Joint pain Limited joint movement Swelling of the bony areas around a joint Carpal tunnel syndrome ❑ Neurological exam: Decreased muscle strength and power (weakness) ❑ Cardiovascular exam: High blood pressure

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

Yes

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)?

Perform MRI for clinical or biochemical evidence of recurrence

Medical therapy

Failure of medical therapy

Radiation therapy ❑ Stereotactic radiotherapy is most common method

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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