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The HKU E-learning Platform in Clinical Medicine
The HKU E-learning Platform in Clinical Medicine
  • Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
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Endocrinology

Acromegaly

December 8th, 2014

Acromegaly

A middle-aged woman presented with bifrontal headache. On examination, she was noted to have acromegalic features:

  • Prominent supraorbital ridges
  • Large nose
  • Prognathism with protrusion of the lower jaw
  • Thick lips
  • Malocclusion and increased interdental separation
  • Large hands with broad palms, spatulate fingers and sweaty palms
  • Large feet, thick heel pads


Other classical signs of acromegaly

  • Macroglossia
  • Goitre
  • Bitemporal hemianopia, optic atrophy and papilloedema
  • Increased blood pressure
  • Glycosuria
  • Osteoarthritis

Diagnosis

  • Oral glucose tolerance test, with measurements of both plasma glucose and growth hormone levels. In normal subjects, growth hormone level falls to <1ug/L, but is not suppressed in acromegaly
  • Elevated basal insulin-like growth factor (IGF1) level
  • Magnetic resonance imaging of the pituitary gland to look for pituitary adenoma

Other important investigations

  • Perimetry to look for visual field defect due to optic chiasmal compression
  • Measurement of prolactin for any concomitant secretion by adenoma or due to stalk effect by macroadenoma
  • Measurement of other anterior pituitary hormones to look for evidence of hypopituitarism: fT4, TSH, morning cortisol, estradiol (women), testosterone (men), LH, FSH, alpha-subunit
  • Actively look for other possible complications of acromegaly:
    • Nerve entrapment including carpal tunnel syndrome
    • Obstructive sleep apnoea
    • Colonic polyps and cancer

Management

  • Trans-sphenoidal surgery
  • Medical therapy including dopamine agonists, somatostatin receptor agonists and growth hormone receptor antagonist
  • Primary or adjuvant radiotherapy

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