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Detecting Acromegaly:
Know the Signs & Symptoms

The gradual onset and varied symptoms of acromegaly can make diagnosis challenging –– especially as many of the initial signs of the disease can be attributed to other conditions. This is why acromegaly often has a delay in diagnosis that can be as long as 10 years.1


Patients often first seek medical advice for orthopedic or rheumatologic issues, cardiac events, or even dental disorders.1 Being aware of the chief clinical complaints of the disease can help you make a differential diagnosis.


Presenting Complaints of Acromegaly

The following complaints can result from either the physical effects of a pituitary tumor or as a consequence of the hypersecretion of growth hormone (GH) and insulin-like growth factor-1 (IGF-1).1


  • Headaches
  • Visual impairment
  • Gigantism
  • Change in appearance, acral and soft tissue overgrowth: 2,3
    • Large fleshy lips and nose
    • Spade-like hands, frontal skull bossing, cranial ridges
    • Mandibular overgrowth, maxillary widening, teeth separation, jaw malocclusion, and overbite
    • Enlarged tongue, bones, salivary glands, thyroid, heart, liver, and spleen
    • Increase in shoe, ring or hat size
  • Thyroid disorder
  • Diabetes mellitus impaired glucose intolerance
  • Heart disease
  • Hypertension
  • Arthralgia and joint symptoms
  • Hyperhidrosis and oily skin
  • Skin tags
  • Thickened heel pads and coarsening of body hair
  • Carpal tunnel syndrome
  • Menstrual disorder in women
  • Impotence in men
  • Fatigue
  • Somnolence
  • Sleep apnea

Causes of Mortality in Acromegaly

Concomitant conditions account for an enhanced risk of mortality in patients with acromegaly.1 Among the diseases associated with acromegaly and increased risk of mortality are:1

  • Cardiac disease
  • Respiratory disease
  • Diabetes
  • Cancer

Diagnosing Opportunities by Specialty

As a result of the expansive number of symptoms associated with acromegaly, heightened awareness to the symptoms specific to your field of expertise is vital. By knowing what to look for and by working collaboratively with other health care professionals, you can help determine an accurate diagnosis.



  Symptom Specialty  
  Teeth separation, jaw malocclusion, enlarged lips and tongue Dentistry  
  Headaches/sleep apnea Neurology  
  Visual impairment Opthalmology  
  Increase in shoe size GP/Podiatry  
  Diabetes GP/Internal Medicine/Endocrinology  
  Heart disease/hypertension Cardiology/Endocrinology  
  Joint symptoms/carpal tunnel
syndrome
Rheumatology  
  Hyperhidrosis GP  
  Menstrual disorder OBGYN  
  Impotence Internal Medicine/Urology  
       
References:
1.
Melmed S, Kleinberg D. Anterior pituitary. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia Pa.: WB Saunders Company; 2003:177-260.
2.
AACE Guidelines Taskforce. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly. Endocrine Practice. 2004;10:213-225.
3.
NIDDK. Acromegaly. Available at: www.endocrine.niddk.nih.gov/pubs/acro/Acromegaly.pdf. Accessed August 18, 2010.
RESOURCES FOR
PROFESSIONALS

The more information you have
about acromegaly, the better
prepared you'll be to support
your patients. Click here for a
listing of important resources
.

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