Scribd Logo
Upload

Welcome to Scribd!

  • 174 views

    Can Present As:: Clinical Communication Skills

    Uploaded by

    Mazin obeid
    This document outlines signs and symptoms of acromegaly, a condition caused by excessive growth hormone production from a benign pituitary tumor. Key symptoms include enlarged hands and feet, headaches, vision changes, joint pain, and sleep apnea. A focused history and physical exam assessing these features is important. Urgent testing including MRI and blood work is needed to establish the diagnosis and assess pituitary function and complications. Treatment may involve surgery, radiation, or medication to control symptoms and stop tumor growth.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Can Present As:: Clinical Communication Skills

    Uploaded by

    Mazin obeid
    174 views3 pages
    This document outlines signs and symptoms of acromegaly, a condition caused by excessive growth hormone production from a benign pituitary tumor. Key symptoms include enlarged hands and feet, headaches, vision changes, joint pain, and sleep apnea. A focused history and physical exam assessing these features is important. Urgent testing including MRI and blood work is needed to establish the diagnosis and assess pituitary function and complications. Treatment may involve surgery, radiation, or medication to control symptoms and stop tumor growth.

    Original Title

    Acromegaly.pdf

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document outlines signs and symptoms of acromegaly, a condition caused by excessive growth hormone production from a benign pituitary tumor. Key symptoms include enlarged hands and feet, headaches, vision changes, joint pain, and sleep apnea. A focused history and physical exam assessing these features is important. Urgent testing including MRI and blood work is needed to establish the diagnosis and assess pituitary function and complications. Treatment may involve surgery, radiation, or medication to control symptoms and stop tumor growth.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    174 views3 pages

    Can Present As:: Clinical Communication Skills

    Uploaded by

    Mazin obeid
    This document outlines signs and symptoms of acromegaly, a condition caused by excessive growth hormone production from a benign pituitary tumor. Key symptoms include enlarged hands and feet, headaches, vision changes, joint pain, and sleep apnea. A focused history and physical exam assessing these features is important. Urgent testing including MRI and blood work is needed to establish the diagnosis and assess pituitary function and complications. Treatment may involve surgery, radiation, or medication to control symptoms and stop tumor growth.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Can present as:

    ▪ Carpal tunnel syndrome


    ▪ Headaches
    ▪ OSA
    ▪ Bitemporal hemianopia/vision problem

    Clinical communication skills:


    Focused presenting history:
    • Carpal tunnel syndrome
    ▪ Tingling of lateral 3 and half fingers
    ▪ Pain more at night
    ▪ Look for scars at wrist for carpal tunnel release surgery
    ▪ Wasting of thenar muscle
    • Change in appearance over time?
    • Change in shoe and ring size?
    • Old photographs?
    • Headaches, sweating
    • Bumping into objects, decreased vision
    • DM-increased thirst
    • Joint pains
    • -daytime somnolence, early morning headaches, snoring
    • CCF features
    • Proximal myopathy
    • Alarm symptoms
    1. change in bowel habit
    2. rectal bleeding
    3. severe headache with double vision with ptosis (pituitary
    apoplexy)

    Past medical and surgical history:


    • DM, HTN, OSA, arthropathy, CCF
    • Transphenoidal surgery
    • carpal tunnel release
    Drug history:
    Social history
    Family history
    Personal history-? smoker
    Occupational history? taxi driver
    Physical examination:
    • Hands- large and doughy (spade like) hand
    ▪ look for CTS
    ▪ sweaty?
    ▪ BM testing marks
    • Face
    ▪ prominent supraorbital ridges
    ▪ enlarged nose and lips
    ▪ prognathism
    ▪ bitemporal hemianopia
    ▪ visual acuity and othalmoscopy for optic atrophy
    ▪ macroglossia
    ▪ interdental separation
    ▪ look for surgical scars
    o transphenoidal surgery inside the nose
    o underside of upper lips
    o transcranial (forehead or side of head)
    • Neck-? goiter
    • Chest and axilla
    ▪ Gynaecomastia
    ▪ Hyperpigmentation
    ▪ skin tags
    ▪ acanthosis nigricans
    ▪ hirsuitism
    • Heart-? CCF
    • Check for proximal myopathy
    • Features of hypopituitarism
    • Ask to measure BP, dip urine for glycosuria, any old photographs?

    Concerns and questions? And addressing it


    ▪ Your symptoms are due to a benign growth in the pituitary gland
    that produces too much of growth hormone.
    ▪ For your headaches, I am going to give pain killers as a
    temporary measure however, it is very important to
    establish the cause with urgent investigations.
    ▪ As your vision is impaired, I am afraid you will have to inform
    DVLA and stop driving immediately.
    ▪ I am going to do some urgent blood tests and urgent scan (MRI) of
    brain and ask the eye specialists to see you to assess what extent the
    growth has affected vision.
    ▪ Most physical features do not regress after treatment (if asked)

    ▪ Failure of GH to suppress to <2nmol/l following OGTT.


    ▪ IGF1
    ▪ MRI of pituitary
    ▪ Test anterior pituitary function (TFT, LH, FSH, Testosterone, short
    Synacthen test, cortisol levels)
    ▪ Test for complications
    ▪ fasting blood glucose
    ▪ measure BP
    ▪ ECG, ECHO
    ▪ Nerve conduction studies for CTS
    ▪ Sleep studies for OSA
    ▪ Visual perimetry
    ▪ colonoscopy

    :
    ▪ Surgery
    ▪ Transphenoidal hypophysectomy
    ▪ Radiotherapy
    ▪ Medical
    • Somatostatin analogues (octreotide and lancreotide)
    • Dopamine agonists
    • GH receptor antagonists(pegvisomant)

    ▪ Sweating
    ▪ HTN
    ▪ Skin tags
    ▪ Peripheral oedema

    ENDURANCE
    19-08-2018

    You might also like