Acromegaly

Vignette says a 50 year old male presents to the primary care physician with gradual onset of SOB, headache and visual disturbances over the past few months; He also reports of fatigue, snoring at nights and daytime sleepiness; He has a history of hypertension and diabetes for which he takes amlodipine and metformin; On examination, he has coarse facial features with prominent frontal bones and jaw, enlarged feet and hands; Vital signs show blood pressure of 150/90 mm of Hg; Lab shows increased IGF-1; OGT test shows failure of GH suppression; Echocardiography shows left ventricular hypertrophy with EF of 55%; MRI of the brain shows pituitary mass; Diagnosis?

Diagnosis is Acromegaly.

Presents with coarse facial features, macroglossia, enlarged feet and hands, diaphoresis, headache, bitemporal hemianopia, OSA, carpal tunnel syndrome, Type 2 DM, HTN, left ventricular hypertrophy and HFpEF (most common cause of death). 

Diagnosis:- 

1. Increased IGF-1. 

2. OGT test shows failure of suppression of growth hormone with oral glucose suppression test. 

3. MRI shows pituitary mass. 

Management:- 

1. Medical therapy includes:- 

a. Somatostatin analogues (e.g. octreotide). 

b. Dopamine receptor agonist (e.g. Cabergoline, Bromocriptine). 

c. Growth hormone receptor antagonist (e.g. pegvisomant). 

2. Surgical resection of the mass (i.e. transsphenoidal surgery).