1/9. acromegaly: report of two patients with an unusual presentation.The presenting features of functionally active pituitary tumours depend on the specific hormone which is overproduced. growth hormone (GH) producing tumours usually present with the clinical manifestations of acromegaly due to excessive GH secretion or symptoms resulting from mass effects of the enlarging tumour. The changes in physical features and the increase in tumour size are usually insidiously slow and therefore, recognition of the disease is delayed. In this report two patients with acromegaly are described with an atypical presentation due to acute onset of symptoms. The first patient presented with central diabetes insipidus. The diagnosis acromegaly was made on physical examination. The second patient presented with a generalized seizure during sleep. On CT-scanning a large tumour protruding into the left temporal lobe connected to the pituitary gland was seen. immunohistochemistry of the tumour after partial transcranial resection confirmed the clinical diagnosis of acromegaly. At a later stage transsphenoidal resection of the pituitary tumour was performed with full recovery and without loss of pituitary function.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/9. acromegaly diagnosed in a young woman presenting with headache and arthritis.BACKGROUND: A 38-year-old woman presented with severe headaches to her primary-care physician. The patient had been diagnosed with rheumatoid arthritis and had begun having headache 4 years previously. An MRI scan revealed an 11-12 mm pituitary tumor. Her physical examination was unremarkable for the classic acral or facial changes characteristic of acromegaly, and she was referred for neuroendocrine consultation for a presumed nonfunctioning adenoma. INVESTIGATIONS: MRI of the pituitary, and laboratory investigations that included measurement of serum insulin-like growth factor 1 (IGF1) and prolactin levels. diagnosis: In view of the elevated level of IGF1 and presence of a pituitary adenoma, the patient was diagnosed with acromegaly caused by a pituitary adenoma that secretes growth hormone. MANAGEMENT: The patient underwent trans-sphenoidal surgery, which resulted in resolution of joint pain and headache, eradication of the tumor mass, normal IGF1 levels, and appropriate suppression of growth hormone (confirmed by oral glucose tolerance test postoperatively).- - - - - - - - - - ranking = 0.90061547776105keywords = physical examination, physical (Clic here for more details about this article) |
3/9. Preoperative diagnosis of acromegaly by growth hormone-releasing factor radioimmunoassay.acromegaly was diagnosed in a 37-year-old woman with classical physical and biochemical findings; an enlarged sella on computed tomography suggested the presence of a pituitary macroadenoma. Radiologic evidence of a lung mass prompted radioimmunoassay of plasma growth hormone-releasing factor (7,500 pg/ml; normal less than 100 pg/ml). After resection of a bronchial carcinoid, which stained positive for growth hormone-releasing factor, circulating growth hormone-releasing factor levels normalized. Subsequently, her clinical, biochemical, and radiologic evidence for acromegaly resolved. This case represents the first reported use of the human pancreatic growth hormone-releasing factor 1-40 radioimmunoassay to preoperatively diagnose this rare etiology of acromegaly.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |
4/9. A case of cerebral gigantism and hepatocarcinoma.A 14-year-old boy, who had the physical and neurological characteristics of cerebral gigantism (sotos syndrome), developed hepatocarcinoma. This tumor is rare in children and has never, to our knowledge, been recorded in a patient with cerebral gigantism. An autopsy was performed, the first we are aware of in a patient with cerebral gigantism without increased size in ventricles.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |
5/9. anorexia nervosa associated with acromegaloid features, onset of acrocyanosis and Raynaud's phenomenon and worsening of chilblains.patients with anorexia nervosa may develop many physical and endocrinological complications. We wish to report two patients who developed soft tissue swelling of their hands and worsening of their peripheral vascular disease, evidenced by the appearance of acrocyanosis and Raynaud's phenomenon and more severe perniosis, following the onset of their anorexia nervosa.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |
6/9. Normal insulin-like growth factor-I in an elderly woman with acromegaly and medical illness.insulin-like growth factor-I (IGF-I) has been advocated as a simple and reliable test for confirming the diagnosis of acromegaly and following a patient's response to treatment. We describe an elderly woman admitted to the hospital with altered mental status, congestive heart failure, and arthritis who was noted to have clear features of acromegaly. An IGF-I level was in the normal range, while results of an oral glucose tolerance were diagnostic of acromegaly. As her medical condition, mobility, and nutrition improved, her IGF-I level increased above the normal range and continued to rise when she was seen as an outpatient. Therefore, illness, physical activity, nutritional status, and advanced age must be considered when interpreting IGF-I levels in patients with known or suspected acromegaly.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |
7/9. The external rhinoplasty approach for the treatment of acromegaly.acromegaly produces a syndrome of physiological and physical derangements. patients afflicted with this disease are often as concerned with the changes in their appearance as with the pituitary tumor. The external rhinoplasty approach to transphenoid hypophysectomy has recently been shown to improve visualization and to have fewer complications compared with the sublabial approach devised initially by Cushing. Three patients are presented in whom this approach was used to simultaneously treat the physiological derangement of acromegaly and to correct the nasal deformity.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |
8/9. acromegaly and transsphenoidal hypophysectomy: a case report.Anterior pituitary tumors account for nearly 18% of all intracranial tumors. Pituitary adenomas that cause hypersecretion of growth hormone lead to acromegaly in adults. patients with acromegaly may present unique problems for the anesthetist because of the overgrowth of airway soft tissues; a difficult mask ventilation and challenging intubation can be expected. A careful preoperative assessment of the patient's airway is essential, and an awake oral or fiberoptic bronchoscopy may be necessary. Postoperatively, these patients are at risk for developing airway problems and diabetes insipidus; therefore, they warrant careful observation. A 42-year-old, 75-kg, ASA physical status III, white male presented 8 months after suffering a head injury in which he was knocked unconscious for approximately 3 minutes. He began experiencing severe headaches, visual changes, and a marked increase in the size of his hands and feet. Four months before admission, he underwent bilateral carpal tunnel repairs. The patient was diagnosed with acromegaly after an extensive endocrine and neurosurgical evaluation. This is a case report of a patient with acromegaly who underwent an elective transsphenoidal hypophysectomy.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |
9/9. Psychological features of acromegaly.acromegaly is a serious but often undiagnosed condition that is often unrecognized for many years. The delay from onset of symptoms until the time of diagnosis results in a unique constellation of physical and mental problems for patients and health care professionals. The purpose of this chapter is to identify the psychological consequences experienced by individuals affected with pituitary tumors which alter growth hormone release. As little research has been completed on the subject, very little is known, or has been applied, in the treatment of these patients. To identify the presence of psychological features, the research which exists and an in-depth qualitative analysis of the personal experience of one of the author (K.F.), having suffered a pituitary macroadenoma with accompanying acromegaly, is described. Our findings are compared with those from an earlier series and the few published reports.- - - - - - - - - - ranking = 0.099384522238946keywords = physical (Clic here for more details about this article) |