1.

Sign of acromegaly
2. Complication : BP

General appearance :
HEENT
cutis verticis gyrata
Frontal brossing
Supraorbitaal ridge prominence
Prominence of nasolabial fold
Large nose
Large lips
Hoarseness:

: tongue indentation ,


Skin tag

soft tissue , CPS


Kyphosis
OA knee : , crepitus , joint line

Complication
Goiter : euthyroid diffuse enlarge
VF
CPS : thenar atrophy , autonomic
Heart exam : cardiomegaly , AR
Snoring -> OSA

Skin sign bone sign

Acromegaly Focussed Examination

NB. the instructions may be non-specific e.g. Examine this patients endocrine status (could
be Cushings, acromegaly or hypothyroidism). In this case, approach by asking a few
focussed questions and doing a general inspection to determine which condition is present
and then proceed with the relevant focussed examination to illicit all the signs of the
condition.

Introduction
Wash hands, Introduce self, ask Patients name & DOB & what they like to be
called, Explain examination and get consent

General Inspection

Focussed questions (NB. acromegaly is usually obvious

so ask questions to illicit symptoms you cannot examine
for)
What happened when you first presented with this
condition?
Have you noticed a change in your appearance?
DETERMINING IF THERE IS ACTIVE ACROMEGALY:
Do you notice excessive sweating?
Do you have high blood pressure?
OTHER SYMPTOMS- WORK DOWN BODY:
Headaches
Visual problems
Pins and needles
Back ache
Muscle weakness
Change in show size

Patient standing
Increased foot, hand and head size
Mildly hirsute
OA signs such as kyphosis

Hands
Inspection & palpation with hands on pillow
o Top: large, spade-shaped, feel joints for OA evidence
o Palms: sweaty, doughy/boggy texture to palms, capillary glucose stick marks in diabetes
o Signs of carpal tunnel syndrome (loss of thenar eminence and loss of sensation in median n. distribution)

Face
Inspection of face in general
o Coarse facial features
o Acne
o Enlarged nose and ears
o Macrognathia (large mandible)
o Look for hypophysectomy scar under upper lip
Eyes
o Visual fields (bitemporal hemianopia in pituitary adenoma)
o Prominent supra-orbital ridges
Inside mouth
o Prognathism
o Wide spaces between teeth
o Macroglossia, ridges from teeth on sides of tongue

Neck
Thyroid goitre
JVP (cardiomyopathy)

Chest
Inspect: thick, multiple skin tags
Acanthosis nigricans in axilla
Cardiac failure signs (listen to lung bases, assess JVP)

Limbs
Proximal myopathy (patient stand up with arms crossed; shrug shoulders against resistance)
Gait: tolling gait with bowed legs

2013 Dr Christopher Mansbridge at www.oscestop.com, a source of free OSCE exam notes for medicalstudents finals OSCE revision

To complete
Thank patient and cover them
Iwouldcompetemyexaminationbymeasuringbloodpressure,doingathyroidexam,acardiovascularexamandformally
testing visual fields
Summarise and suggest further investigations you would do after a full history
o GH response to oral glucose tolerance test
o MRI pituitary
o plasma IGF-1 (monitor response to Tx)

Normal hand

Acromegalic hand

Mandibular prognathism: protrusion of the lower jaw

Wide spaces between teeth

Facial features of acromegaly: coarse facial features,

prominent supra-orbital ridges, large nose and ears,
macrognathia

Images sourced from: Acromegaly. Orphanet Journal of Rare Diseases 2008, 3:17. doi:10.1186/1750-1172-3-17. Licensed under Creative Commons 2.0 licence
2013 Dr Christopher Mansbridge at www.oscestop.com, a source of free OSCE exam notes for medicalstudents finals OSCE revision



Lateral skull
: ballooning sign
: double floor
:
Film both knees
FBS
TFT
Cortisol
Calcium
IGF-1
GH
LH
Testos

Screening test :
1.IGF-1 ( day by day and minute variation) if <280 r/o acromegaly
Diagnostic test
1. 1 hr2 hrOGTT 3 = normal

Complication
BP
Lipid profile
Calcium Phosphate
CXR , EKG
Sleep disorder -> sleep lab

cardiovascular and ca colon
skin tag relate CA colon
Aim : GH<3 , IGF-1 mean+-2SD

Treatment
Surgery : treatment of choice
Alternative : Radiation ,
Medication : Sandostatin
Reduce risk cardiovascular : Control BP <140/80 , no smoking ,
LDL<100