Acromegaly resident survival guide: Difference between revisions
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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]]. | 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]]. | ||
{{familytree/start |summary=Acromegaly.}} | {{familytree/start |summary=Acromegaly.}} | ||
{{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the symptoms:''' <br> ❑ [[Headaches]]<br> ❑ Enlargement of the hands (change in ring or glove size) and feet (change in shoe size)<BR> ❑ [[Lethargy]] <br> ❑ [[Hyperhidrosis]] (excessive sweating)<br> ❑ [[Paraesthesia]]<br> ❑ [[Sexual dysfunction]]<ref name="pmid1521514">{{cite journal| author=Molitch ME| title=Clinical manifestations of acromegaly. | journal=Endocrinol Metab Clin North Am | year= 1992 | volume= 21 | issue= 3 | pages= 597-614 | pmid=1521514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1521514 }} </ref><br> ❑ [[Fatigue]] <br>❑ [[Jaw pain]]<ref name="urlAcromegaly: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/000321.htm |title=Acromegaly: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref></div> }} | {{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the symptoms:''' <br> ❑ [[Headaches]]<br> ❑ Enlargement of the hands (change in ring or glove size) and feet (change in shoe size)<BR> ❑ [[Lethargy]] <br> ❑ [[Hyperhidrosis]] (excessive sweating)<br> ❑ [[Paraesthesia]]<br> ❑ [[Sexual dysfunction]]<ref name="pmid1521514">{{cite journal| author=Molitch ME| title=Clinical manifestations of acromegaly. | journal=Endocrinol Metab Clin North Am | year= 1992 | volume= 21 | issue= 3 | pages= 597-614 | pmid=1521514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1521514 }} </ref><br> ❑ [[Fatigue]] <br>❑ [[Jaw pain]]<br>❑ Body odor<ref name="urlAcromegaly: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/000321.htm |title=Acromegaly: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref></div> }} | ||
{{familytree | | | | | | | | | | | | | |!| | | | | | }} | {{familytree | | | | | | | | | | | | | |!| | | | | | }} | ||
{{familytree | | | | | | | | | | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Examine the patient:'''<BR>❑ HEENT <br> | {{familytree | | | | | | | | | | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Examine the patient:'''<BR>❑ HEENT <br> | ||
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* Joint pain | * Joint pain | ||
* Limited joint movement | * Limited joint movement | ||
* Swelling of the bony areas around a joint <ref name="urlAcromegaly: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/000321.htm |title=Acromegaly: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref> | * Swelling of the bony areas around a joint <ref name="urlAcromegaly: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/000321.htm |title=Acromegaly: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref></div>}} | ||
{{familytree | | | | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 08:14, 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 ❑ Body odor[2] | |||||||||||||||||||||||||||||||||||||||||
Examine the patient: ❑ HEENT
❑ Musculoskeletal exam:
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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 | Yes | 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".