Endocrine Flashcards
1
Q
Signs of acromegaly
A
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
2
Q
How to examine in acromegaly
A
- General inspection - diagnostic facies
- Hands - broad palms, spade like fingers, increased sweating, thick skin, finger prick for diabetes
- Phalen’s and Tinel’s test for carpal tunnel
- Elbow - ulnar nerve thickening
- Arms - Proximal myopathy, axillary skin tags, BP
- Face - frontal bossing, macroglossia, prognathism, splaying of the teeth, hirsutism
- Eyes - visual fields, fundoscopy (optic atrophy), eye movements, CN5
- Neck - goitre
- CV exam - failure
- Organomegaly
- Lower limbs - arthritis
3
Q
What investigations would you like to order in acromegaly?
A
IGF-1 levels Glucose tolerance test MRI head/pituitary HbA1c Rest of the pituitary panel
4
Q
What is the treatment for acromegaly?
A
Surgery
Medications - somatostatin analogues (octreotide, lanreotide), dopamine agonists (cabergoline)
5
Q
What are the complications of acromegaly?
A
Carpal tunnel syndrome and other peripheral neuropathies Hypertension CN deficits Cardiomyopathy Multinodular goitre Arthritis and arthropathies Diabetes Tumours Sleep apnoea
