ACROMEGALY
--dt pituitary eosinophilic adenoma secreting growth hormone AFTER growth plates have fused
--excessive growth hormone production PRIOR to closure of long bone growth ctrs-->gigantism:
-->back to acromegaly
--facial changes: prominent forehead, thickened tongue
--hands: broad and large, widened shafts, bony protuberances, enlarged distal tufts (spade like), widened joint spaces (dt cartilage overgrowth)
--predisposition to degenerative arthritis, esp of spine and weight bearing jts
--predisposition to carpal tunnel syndrome dt extra bone @ tendon attachments
--feet: heel pds greater than 20mm thick dt soft tissue and spurs
--spine: increased size, hyperostoses, widened disc heights, posterior body scalloping
--skull: sella turcica enlargement (dt pituitary neoplasm), sinus overgrowth (esp frontal), malocclusion, widened mandibular angle (prognathism, jaw goes down not forward)
--prognathism:
--sella turcica and frontal sinus here:
Treatment flowchart: