Growth Hormone Hypersecretion Museuloskeletal Increas

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ng hat, glove, or shoe sizes; prognathism; prominent supraorbital ridges; coarsening of facial features (e.g, large bulbous nose, thick lips, separated teeth) Endocrine: Hyperhidrosis, fatigue, exercise intolerance, hoarseness, sleep apnea (peripheral and central)

Cardiopulmonary: Hypertension, hyperlipidemia, cholelithiasis, carbohydrate intolerance, overt diabetes, heart disease (e.g., arrhythmias, congestive heart failure, coronary artery disease)

Other: Arthralgias, slight kyphosis, visceromegaly, reproductive problems (women: amenorrhea, galactorrhea, anovulatory problems; men: decreased libido, hypogonadism), hyperprolactinemia, adenomatous polyps and colon cancer, esophageal and gastric cancer, parathyroid and pancreatic islet cell adenomas (MEN-I syndrome)

Pituitary Gland Enlargement Headaches, visual changes (e.g., bitemporal hemianopsia due to optic chiasm involvement), hypopituitarism, diabetes insipidus, diplopia

MEN-I, Multiple endocrine neoplasia, type I Data from Kissel IT Endocrine myopathies, In Update on Neuromuscular Disease course 423 of the AAN annual meeting, Washington, D.C., May, 1994, pp 34-35 Maugans TA, Coates ML Diagnosis and treatment of acromegaly Am Fam Phys 1995 52:207-213; Molitch ME Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am 1992;21:597-614; and Grunstein RR, Ho KY, Sullivan CE Sleep apnea in acromegaly Ann Intern Med 1991;115:527-532.

The most sensitive and specific screening test for acromegaly is the IGF-1 level. The pulsatile nature of GH secretion may result in a randomly high GH level being obtained in a normal person, as may physical stressors, making this a less useful test. All patients with elevated IGF-1 levels should have an oral glucose tolerance test, the gold standard for acromegaly. MRI can confirm the suspicion of a pituitary adenoma. When MRI is negative in an acromegalic patient, consideration should be given to the rarer etiologies of acromegaly.

The prevention of many of the sequelae of disorders associated with acromegaly (e.g., hypertension, cardiovascular disease, stroke, sleep apnea, diabetes, arthropathy) requires early identification and treatment. The management of acromegaly includes the identification of the source of the excess GH secretion and its excision, irradiation, or medical suppression. The somatostatin analog octreotide is a highly effective pharmacological means of controlling GH secretion, ^ but has the disadvantage of high cost and the need for multiple daily injections.

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