Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Elevated somatomedin C blood levels Inability to suppress growth hormone to < 2 ng/mL during glucose tolerance test Pituitary adenoma found on MRI Biventricular hypertrophy with systolic and diastolic dysfunction Hypertension, diabetes, and premature coronary artery disease +++ GENERAL CONSIDERATIONS ++ Acromegaly is caused by excessive growth hormone secretion from a pituitary adenoma It is characterized by excess bone growth, organ enlargement, and premature death due to cardiorespiratory complications Rarely other endocrine tumors can secrete growth hormone +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Headache, bitemporal hemianopsia from tumor growth Impotence, galactorrhea or amenorrhea Diaphoresis, hoarseness, polyuria, polydipsia Carpal tunnel syndrome Symptoms of: – Heart failure, such as dyspnea – Coronary artery disease, such as chest pain +++ PHYSICAL EXAM FINDINGS ++ Systemic hypertension Thick lips, macroglossia, bulbous nose, protrusive lower jaw, frontal bossing, prominent cheek bones, and hollow temporal fossae Joint swelling, kyphosis, barrel chest, spade-like hands with sausage-like digits Left ventricular lift Signs of congestive heart failure, such as pulmonary rales +++ DIFFERENTIAL DIAGNOSIS ++ Other causes of cardiomyopathy and heart failure Other causes of hypertension Other causes of premature coronary artery disease +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Growth hormone, somatomedin C, and insulin-like growth factor-1 levels Growth hormone during a glucose tolerance test Hyperglycemia, hypertriglyceridemia Hyperphosphatemia +++ ELECTROCARDIOGRAPHY ++ Left ventricular hypertrophy Atrial and ventricular tachyarrhythmias Nonspecific ST-T changes and intraventricular conduction defects +++ IMAGING STUDIES ++ Chest x-ray: cardiomegaly Echocardiography: eccentric left ventricular hypertrophy or asymmetric hypertrophy and left ventricular systolic dysfunction Doppler echocardiography: diastolic dysfunction +++ DIAGNOSTIC PROCEDURES ++ Stress cardiac imaging or cardiac catheterization may be indicated to diagnose coronary artery disease +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Suspected cardiac disease Difficult to control hypertension +++ HOSPITALIZATION CRITERIA ++ Heart failure Acute coronary syndromes Planned surgery +++ MEDICATIONS ++ Pharmacologic therapy with somatostatin analogs, eg, octreotide 200–500 μg/day SC, or Sandostatin LAR (octreotide) Depot 10–40 mg IM every 4 weeks, or lanreotide 60–120 mg SC every 4 weeks, or dopamine agonists, eg, bromocriptine 5–30 mg/day PO (start at 2.5 mg/day) Heart disease treated conventionally +++ THERAPEUTIC PROCEDURES ++ Cardiac catheterization and angioplasty may be required +++ SURGERY ++ Surgical removal of the pituitary tumor with postoperative radiation therapy +++ MONITORING ++ ECG monitoring in hospital as appropriate +++ DIET AND ACTIVITY ++... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth