Acromegaly: clinical features at diagnosis

Abstract

Acromegaly affects both males and females equally and the average age at diagnosis ranges from 40 to 50 years (up to 5% of cases < the age 20). Due to insidious onset and slow progression, acromegaly is often diagnosed five to more than ten years after its onset. The typical coarsening of facial features include furrowing of fronthead, pronounced brow protrusion, enlargement of the nose and the ears, thickening of the lips, skin wrinkles and nasolabial folds, as well as mandibular prognathism that leads to dental malocclusion and increased interdental spacing. Excessive growth of hands and feet (predominantly due to soft tissue swelling) is present in the vast majority of acromegalic patients. Gigantism accounts for up to 5% of cases and occurs when the excess of GH becomes manifest in the young, before the epiphyseal fusion. The disease also has rheumatologic, cardiovascular, respiratory, neoplastic, neurological, and metabolic manifestations which negatively impact its prognosis and patients quality of life. Less than 15% of acromegalic patients actively seek medical attention for change in appearance or enlargement of the extremities. The presentation of acromegaly is more often related to its systemic comorbidities or to local tumor effects.

High levels of IGF-1 predict difficult intubation of patients with acromegaly

“…These radiological findings were expected to be helpful in evaluating anatomic changes and predicting the difficulty of intubation. Previous studies revealed typical radiological characteristics of the respiratory changes in patients with acromegaly, including macroglossia, an extended mandible, soft palate and uvula hypertrophy, and a thickened pharyngeal wall [6, 20, 27–29]. However, no significant differences in these characteristics were observed in the radiological imaging in this study.…”

“…More than 95% of the patients with acromegaly harbor a GH-secreting pituitary adenoma in the sella region, and complete pituitary tumor resection via transsphenoidal surgery is the first-line therapy [5, 6]. Anesthesia and surgical safety play important roles in ensuring a high cure rate and low mortality.…”

Left ventricular twist is impaired in acromegaly: Insights from the three‐dimensional speckle tracking echocardiographic MAGYAR‐Path Study

“…Acromegaly was diagnosed based on typical clinical features and elevated serum human growth hormone (hGH) and IGF‐1 levels not suppressible with oral glucose tolerance test (OGTT, 75 g) . Acromegaly was considered active if serum hGH levels and/or serum IGF‐1 levels were above the diagnostic threshold . IGF‐1 indices were also calculated in acromegalic patients, where serum IGF‐1 concentration was divided by the upper limit of normal serum IGF‐1 level of the same age and sex control group.…”

GH-secreting pituitary macroadenoma (acromegaly) associated with progressive dental malocclusion and refractory CPAP treatment

“…The facial changes typically associated with acromegaly include an increasingly prominent forehead, growth of the nose and ears, thickening of the lips and the development of marked nasolabial folds. Patients also present mandibular prognathism, which may cause malocclusion and diastema [3, 4]. Macroglossia is common in these patients and contributes to the occurrence of OSAS.…”