Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acromegaly 13

■Sleep apnea and snoring

■Diabetes mellitus

■Coarsening change in facial appearance

■Frontal bossing

■Carpal tunnel syndrome

■Infertility

■Amenorrhea or oligoamenorrhea

■Family history of pituitary tumor

■Excessive linear growth (in children)

Signs & Symptoms

■Headache

■Arthralgias

■Impotence

■Skin tags

■Decreased libido

■Visual field cut

■Hypopituitarism

■Galactorrhea in some women

tests

Laboratory

■Basic blood studies:

➣Insulin-like growth factor-I (IGF-I) single best test

➣growth hormone (GH) 1 h after 75-g glucose load: <5 ng/dL in

normals

■Ancillary blood tests:

➣LH, FSH, prolactin, free T4, TSH

➣Testosterone

➣Estradiol

➣GH-releasing hormone

➣Fasting serum glucose, HgA1c

Imaging

■MRI of the pituitary to determine if there is pituitary mass

differential diagnosis

■GH-secreting pituitary tumor

■GH- and prolactin-secreting pituitary tumor

■GH- or GHRH-secreting neuroendocrine tumor (e.g., islet cell tumor

of the pancreas)

■Acromegaloidism: acromegalic facies in patient with severe insulin

resistance