Snapshot A 52 year-old man complains of increased hat size and headaches when he wakes up in the morning. Physical exam reveals mild diastolic hypertension, prominant jaw with spaces between the teeth, large hands and feet, and generalized muscle weakness. Introduction Benign pituitary adenoma that releases excess growth hormone GH stimulates release of insulin growth-like factor 1 Gigantism if the condition occurs before the fusion of the epiphysis Acromegaly if it occurs after skeletal epiphyseal closure Presentation Symptoms generalized enlargement of bone and soft tissue large hands and feet frontal bossing leads to increased hat size space between teeth jaw grows but teeth remain the same size macroglossia carpal tunnel syndrome size of median nerve increases due to edema Physical exam HTN due to the antinatriuretic action of GH Evaluation Photographic changes for acromegalic features examine an old photograph to reveal changes in facial bones Serology ↑ IGF-1 more sensitive test because the level is more constant than the pulsatile release of GH hyperglycemia due to gluconeogenic action of GH Suppression tests GH release not suppressed by glucose challenge MRI/CT shows enlargement of sella turcica on imaging Cardiomegaly on CXR hypertrophy of left ventricle Treatment Surgical transphenoidal surgery Medical octreotide (somatostatin analogue) supresses GH release dopamine analog second line for refractory tumors GH receptor antagonists pegvisomant Prognosis, Prevention, and Complications Cardiomegaly progressing to CHF is the most common cause of death