142 Acromegaly
Salient features
History
• Ask the patient about old photographs of the patient for comparison
• Whether the patient has outgrown their wedding rings and shoes
• Headaches, visual field defects (depends on the size of the tumour)
• Paraesthesia and symptoms of carpal tunnel syndrome (p. 296)
• Oligomenorrhoea/amenorrhoea, galactorrhoea in females (prolactin is coproduced with growth hormone in approximately 40% of patients with acromegaly)
• Shortness of breath (cardiac failure)
Examination
• On shaking hands there is excessive sweating: moist doughy, enveloping handshake.
• Large hands with broad palms, spatulate fingers; there is an increase in the ‘volume’ of the hands (Fig. 142.1).
• Look for evidence of carpal tunnel syndrome (tap over the flexor retinaculum for Tinel’s sign; see Fig. 76.1A).
• Prominent supraorbital ridges
• Protrusion of the lower jaw (prognathism); ask the patient to clench his teeth and note the malocclusion and splaying of the teeth (i.e. interdental separation)
• Ask the patient to show his tongue and look for macroglossia and for impressions of the teeth on the edges of the tongue (p. 829)
• For bitemporal hemianopia (p. 188) and optic atrophy
• Axillae for skin tags (molluscum fibrosum), acanthosis nigricans (black velvety papillomas)
• Chest for cardiomegaly, gynaecomastia and galactorrhoea
• Abdomen for hepatosplenomegaly
• Joints for arthropathy, i.e. osteoarthrosis, chondrocalcinosis
• Blood pressure for hypertension (present in 15% of cases)
• Tell the examiner that you would like to examine the urine for sugar (impaired glucose tolerance).
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