Date Published: March 6, 2007
Publisher: Public Library of Science
Author(s): Salman Razvi, Petros Perros
Partial Text: A 52-year-old female presented to an otolaryngologist with a hoarse voice. An endocrine opinion was sought to exclude an underlying endocrinopathy. She had been investigated three years previously by a neurologist for right-sided facial pain. A magnetic resonance imaging (MRI) scan had shown a small “cyst” in the pituitary gland. She had been reassured that this was a coincidental finding. The patient did not volunteer any specific symptoms and had no complaints other than a hoarse voice. Her appearance is shown in Figure 1.
Acromegaly is a rare condition with prevalence rates of 60 per million population. The condition can cause significant morbidity and mortality but may present with vague features; therefore a high index of clinical suspicion is warranted. The average delay in diagnosis after onset of the disease is about eight years. It can cause hypertension and disorders of glucose metabolism, which are increasing in prevalence, as well as soft tissue enlargement, which may take years to be noticed. The increasing use of imaging techniques has invented a new disorder—the incidentaloma. When incidentalomas are found in the pituitary, a thorough history and examination is required with relevant biochemical tests. The biochemical diagnostic criteria for acromegaly have changed over the past decade, bringing the GH diagnostic threshold to lower levels. The advent of better and more sensitive GH assays and better imaging have helped to diagnose more subtle forms of the disease, which would not have been picked up earlier, and may therefore hopefully reduce morbidity and mortality. Furthermore, newer treatment options, whilst expanding the therapeutic armour, also pose a challenge to the treating endocrinologist in deciding what best suits the patient.