Acromegaly physical examination

Acromegaly Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

• Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
• Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
• The presence of [finding(s)] on physical examination is diagnostic of [disease name].
• The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Appearance of the Patient

• Patients with acromegaly usually appear tired.

Vital Signs

• High-grade / low-grade fever
• Hypertension
• Hypothermia / hyperthermia may be present
• Tachycardia with regular pulse or (ir)regularly irregular pulse
• Bradycardia with regular pulse or (ir)regularly irregular pulse
• Tachypnea / bradypnea
• Kussmal respirations may be present in _____ (advanced disease state)
• Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse

Skin

• Thickening of the skin
• Skin tags
• Acanthosis nigricans
• Hyperhidrosis

• 

  Description Template:Acanthosis nigricans in the axilla

HEENT

• Abnormalities of the head include frontal bossing
• Acral enlargement
• Visual deficits
• Hearing acuity may be reduced
• Facial tenderness
• Headache
• Prognathism

Lungs

• Obstruction of the upper airways
• Obstructive sleep apnea

Heart

• Ventricular hypertrophy
• Diastolic heart failure (the most common cause of death)
• Diastolic and systolic dysfunction
• Arrhythmias

Back

• Vertebral fractures

Neuromuscular

• Patient is usually oriented to persons, place, and time
• Carpal tunnel syndrome
• Osteopenia
• Osteoarthritis
• Joints effusion, swelling, and crepitus
• Acromegaly rosary: hypertrophy of the ribs and costochondral junction enlargement in the chest wall.
• Muscle rigidity in late cases
• Malocclusion of patient jaw associated with temporomandibular joint tenderness

Extremities

• Clubbing
• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities
• Muscle atrophy
• Fasciculations in the upper/lower extremity