Practice Easily Missed?

Acromegaly

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4189 (Published 16 August 2010) Cite this as: BMJ 2010;341:c4189
  1. Raghava Reddy, specialist registrar1,
  2. Sally Hope, general practitioner2,
  3. John Wass, professor of endocrinology1
  1. 1Department of Endocrinology, Oxford Centre of Diabetes, Endocrinology & Metabolism, Churchill Hospital, Oxford
  2. 2Woodstock General Practice, Woodstock, Oxfordshire
  1. Correspondence to: J A H Wass john.wass{at}noc.nhs.uk
  • Accepted 20 July 2010

Acromegaly is a clinical disorder of adults characterised by changes in the face and extremities caused by excess growth hormone secretion. Growth hormone excess that occurs before fusion of the epiphyseal growth plates in a child or adolescent is called pituitary gigantism. In adults the excess growth hormone secretion is usually caused by a benign growth hormone secreting pituitary adenoma,1 though it may occasionally (in about 15% of cases) be part of a genetic condition, such as familial isolated pituitary adenoma, multiple endocrine neoplasia type 1, or McCune-Albright syndrome.

Case scenario

A 44 year old woman, known to have type 2 diabetes mellitus, presented with backache and a six month history of sweating, increased sleepiness, more recent headache, and decreased vision. She attributed her tight rings and numbness in the hands to arthritis. In view of the latter symptoms and her suggestive facial features, her general practitioner thought that acromegaly was a possibility, and requested growth hormone and insulin-like growth factor-1 (IGF-1) to be measured. Both tests showed raised values, so she referred the patient to an endocrine centre for further investigation, and the diagnosis was confirmed.

How common is this condition?

  • Acromegaly has an estimated prevalence of around 60 per million and an annual incidence of 3-4 per million.2

  • More recently a higher prevalence of about 130 per million has been suggested by a study in Belgium with more active surveillance for pituitary adenomas.3 This figure is confirmed by our own study in Oxfordshire.4

  • The condition affects all races and both sexes, and the mean age at diagnosis is 40-45 years. However, larger, more aggressive tumours secreting growth hormone tend to present in younger patients. Patients with a family history of pituitary adenomas also present …

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