Endocrine

Question 1

Signs of acromegaly

Answer 1

Acral enlargement 
Hyperhidrosis
Thickened skin over dorsum 
Carpal tunnel syndrome 
Prominent supraorbital ridges 
Prognathism 
Spreading of teeth 
Macroglossia 
Skin tags - look in axilla 
Gynaecomastia  
BSL check signs 
Impaired visual fiedls 
Other CN deficits 
Displaced apex beat if cardiomyopathy 
Evidence of arthritis/joint replacements
Proximal myopathy 
Hirsutism

Question 2

How to examine in acromegaly

Answer 2

1. General inspection - diagnostic facies
2. Hands - broad palms, spade like fingers, increased sweating, thick skin, finger prick for diabetes
3. Phalen’s and Tinel’s test for carpal tunnel
4. Elbow - ulnar nerve thickening
5. Arms - Proximal myopathy, axillary skin tags, BP
6. Face - frontal bossing, macroglossia, prognathism, splaying of the teeth, hirsutism
7. Eyes - visual fields, fundoscopy (optic atrophy), eye movements, CN5
8. Neck - goitre
9. CV exam - failure
10. Organomegaly
11. Lower limbs - arthritis

Question 3

What investigations would you like to order in acromegaly?

Answer 3

IGF-1 levels 
Glucose tolerance test 
MRI head/pituitary 
HbA1c 
Rest of the pituitary panel

Question 4

What is the treatment for acromegaly?

Answer 4

Surgery

Medications - somatostatin analogues (octreotide, lanreotide), dopamine agonists (cabergoline)

Question 5

What are the complications of acromegaly?

Answer 5

Carpal tunnel syndrome and other peripheral neuropathies 
Hypertension 
CN deficits 
Cardiomyopathy 
Multinodular goitre 
Arthritis and arthropathies 
Diabetes 
Tumours 
Sleep apnoea