Acromegaly resident survival guide: Difference between revisions
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{{familytree | E01 | | E02 | | | | |!|E01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Remission'''<br>❑ Monitor with annual IGF-1|E02=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Is there residual tumor that appears resectable and readily accessible (eg, not invading the cavernous sinus)?'''</div>}} | {{familytree | E01 | | E02 | | | | |!|E01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Remission'''<br>❑ Monitor with annual IGF-1|E02=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Is there residual tumor that appears resectable and readily accessible (eg, not invading the cavernous sinus)?'''</div>}} | ||
{{familytree | |!| | | |!|,|-|-|-|-|(| | | | }} | {{familytree | |!| | | |!|,|-|-|-|-|(| | | | }} | ||
{{familytree | F01 | | F02 | | | | | | |F01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Perform MRI for clinical or biochemical evidence of recurrence'''|F02=<div style="float: left; text-align: left; width: | {{familytree | F01 | | F02 | | | | | | |F01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Perform MRI for clinical or biochemical evidence of recurrence'''|F02=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Medical therapy'''</div> }} | ||
{{familytree | | | | | |!| | | | | | | | | | }} | {{familytree | | | | | |!| | | | | | | | | | }} | ||
{{familytree | | | | | G01 | | | | | | |G01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Failure of medical therapy'''</div>}} | {{familytree | | | | | G01 | | | | | | |G01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Failure of medical therapy'''</div>}} |
Revision as of 07:17, 20 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Diagnosis
The approach to diagnosis of Acromegaly is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of Acromegaly.
Characterize the symptoms: ❑ Headaches ❑ Enlargement of the hands (change in ring or glove size) and feet (change in shoe size) ❑ Lethargy ❑ Hyperhidrosis (excessive sweating) ❑ Paraesthesia ❑ Sexual dysfunction[1] ❑ Fatigue ❑ Jaw pain[2] | |||||||||||||||||||||||||||||||||||||||||
Examine the patient: ❑ HEENT
❑ Musculoskeletal exam:
❑ Fever and neurological signs are seen in TTP ❑ Hemoglobinuria in some cases | |||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[Acromegaly]] according the the [...] guidelines.
Transphenoidal surgery ❑ Complete resection ❑ Tumors that are unresectable, a surgical debulking procedure may be performed followed by medical therapy | Patient is not a surgical candidate ❑ Patient preference ❑ High risk due to medical comorbidities ❑ Unresectable tumors | ||||||||||||||||||||||||||||||
Are the following criteria met postoperatively? ❑ Morning serum GH the day after surgery <1ng/ml ❑ 12 weeks postoperative:
| |||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||
Remission ❑ Monitor with annual IGF-1 | Is there residual tumor that appears resectable and readily accessible (eg, not invading the cavernous sinus)? | ||||||||||||||||||||||||||||||
Perform MRI for clinical or biochemical evidence of recurrence | Medical therapy | ||||||||||||||||||||||||||||||
Failure of medical therapy | |||||||||||||||||||||||||||||||
Radiation therapy ❑ Stereotactic radiotherapy is most common method | |||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 Molitch ME (1992). "Clinical manifestations of acromegaly". Endocrinol Metab Clin North Am. 21 (3): 597–614. PMID 1521514.
- ↑ 2.0 2.1 2.2 "Acromegaly: MedlinePlus Medical Encyclopedia".