Age / Sex : 49 / M

Acromegaly

Discussion

X-ray findings; Enlarged terminal
phalangeal tufts with ‘spade’ appearance

Laboratory findings; increased IGF-1 and
human Growth hormone level, oral glucose tolerance test induced growth hormone suppression
test positive

Sellar MRI; Pituitary macroadenoma (2.2cm)

Pathology; pituitary ademoma, Transsphenoidal
approach tumor removal

Acromegaly

Acromegaly is the result of excessive
growth hormone (GH) production in skeletally mature patients, most commonly
from an adenoma of the pituitary. It most commonly affects adults in middle age
and can result in severe disfigurement, serious complicating conditions, and
premature death. It has both an insidious onset and slow progression and may be
difficult to diagnose in the early stages, only being diagnosed when the
external features, especially of the face, become noticeable.

Pathology

Over 90% of cases are the result of a
pituitary macroadenoma. Expansion into the sella turcica may result in
compression of surrounding structures, most importantly, the optic chiasm. The
majority of pituitary tumours are incidental and do not have a genetic
component. The remaining 10% of cases are the result of other tumours of the
pancreas, lungs or adrenal glands that release GH. A very small number of cases
result from the excessive use of exogenous GH in athletes.

Radiographic features

Skull; Calvarial thickening, enlarged
sinuses and an enlarged sella turcica.

Hands; Terminal phalangeal tufts become
hypertrophied and have a "spade appearance", which is called spade
phalanx sign. Joint spaces may be minimally enlarged. Premature osteoarthritis
can set in the advanced stages of acromegaly.

Feet; Heel pad thickness may be increased
(>25 mm).

Complications

Severe headache, Arthritis and carpal
tunnel syndrome, Cardiomegaly, Hypertension, Diabetes mellitus, Heart failure, Renal
failure, Optic chiasm compression leading to visual field loss

Reference; http://radiopaedia.org/articles/acromegaly