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
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2
Q

How to examine in acromegaly

A
  1. General inspection - diagnostic facies
  2. Hands - broad palms, spade like fingers, increased sweating, thick skin, finger prick for diabetes
  3. Phalen’s and Tinel’s test for carpal tunnel
  4. Elbow - ulnar nerve thickening
  5. Arms - Proximal myopathy, axillary skin tags, BP
  6. Face - frontal bossing, macroglossia, prognathism, splaying of the teeth, hirsutism
  7. Eyes - visual fields, fundoscopy (optic atrophy), eye movements, CN5
  8. Neck - goitre
  9. CV exam - failure
  10. Organomegaly
  11. Lower limbs - arthritis
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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
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4
Q

What is the treatment for acromegaly?

A

Surgery

Medications - somatostatin analogues (octreotide, lanreotide), dopamine agonists (cabergoline)

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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
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