Question

Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.

Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.

On physical examination we found:

Remarkable Signs

• Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism
• Neck: Thyroid is visible and palpable
• Thorax: Barrel appearance
• Abdomen: Hepatomegaly. Splenomegaly.
• SOMA: Enlargement of the hands and feet. Generalized arthralgia.

Remarkable Signs

• Integumentary system: Thick and oily skin. Numerous acrochordon disseminated throughout the body.
• Cardiovascular system: Blood pressure 150/100. Radial pulse 72.
• Digestive system: Megaloglossia. Diastema.

provided, respond to the following questions:

• Identify and differentiate the symptoms from the signs in this patient.
• Is there any remarkable personal, social, and/or family history?
• What results do you expect to find in the tests ordered?
• What is the etiology of acromegaly? What is the prognosis?
• How can you differentiate acromegaly from gigantism?

Answer 1

Etiology of acromegaly

In adults, a tumor is the most common cause of too much GH production:

Pituitary tumors. Most cases of acromegaly are caused by a noncancerous (benign) tumor (adenoma) of the pituitary gland.

The tumor secretes excessive amounts of growth hormone

prognosis

No studies have established, however, that the treatment of acromegaly leads to a reduction in morbidity and mortality rates, although successful treatment, with normalization of IGF-I levels, may be associated with a return to normal life expectancy.

differentiate acromegaly from gigantism

Gigantism refers to abnormally high linear growth (see the image below) due to excessive action of insulinlike growth factor I (IGF-I) while the epiphyseal growth plates are open during childhood.

Acromegaly is the same disorder of IGF-I excess but occurs after the growth plate cartilage fuses in adulthood.