Acromegaly

Question 1

What is acromegaly and what is the most common

cause?

Answer 1

Acromegaly is the excessive release of growth hormone. It is
most commonly due to an adenoma in the anterior pituitary
gland.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 404.

Question 2

What are the most common clinical features of

acromegaly?

Answer 2

The increased growth hormone levels stimulate the release of
insulin-like growth factor I. These two hormones result in an
increase in the proliferation of cartilage, bone, protein synthesis,
and lipolysis. It also decreases insulin sensitivity and promotes
the retention of sodium. As a result of these effects, common
manifestations include enlargement of the jaw, hands, and feet
as well as hypertension and diabetes mellitus.
Fleisher LA. Anesthesia and Uncommon Diseases. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2012: 22.

Question 3

How does acromegaly affect the integumentary

system?

Answer 3

Acromegaly results in thick, oily skin and hyperhidrosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 404.

Question 4

How does acromegaly affect the respiratory system?

Answer 4

Lung volumes are typically increased and V/Q mismatching
may occur.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 404.

Question 5

How is the musculoskeletal system affected by

acromegaly?

Answer 5

Osteoarthritis and osteoporosis are common. Skeletal muscle
weakness is a typical finding and may manifest as an increased
sensitivity to muscle relaxants.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 404.

Question 6

How does acromegaly affect the peripheral nervous

system?

Answer 6

Overgrowth of soft tissue results in trapping of peripheral
nerves. Carpal tunnel syndrome is a common finding, as is
decreased ulnar artery flow due to compression by soft tissue.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 404.

Question 7

What airway abnormalities are associated with

acromegaly?

Answer 7

Acromegaly results in numerous anatomical changes that can
complicate airway management including prolonged mandible,
overgrowth of pharyngeal tissue, recurrent laryngeal nerve
damage, macroglossia, and decreased subglottic diameter.
Hoarseness or stridor are indications that the upper airway is
probably involved. Tracheal compression and deviation can
occur due to thyroid enlargement. Sleep apnea is often
present. The risk of respiratory failure is three times higher in
patients with acromegaly.
Fleisher LA. Anesthesia and Uncommon Diseases. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2012: 22.

Question 8

What are the cardiac manifestations of acromegaly?

Answer 8

The chronic hypertension results in ventricular dysfunction,
enlarged heart, congestive heart failure, ischemic heart disease,
and dysrhythmias.
Fleisher LA. Anesthesia and Uncommon Diseases. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2012: 22.