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 …