title: Recognizing the clinical manifestations of acromegaly: case studies.
abstract: OBJECTIVE
  To present case studies of a 36-year-old woman and a 73-year-old man who presented with the syndrome of acromegaly, and to provide primary care nurse practitioners (NPs) with the understanding of the clinical and laboratory features needed for early recognition and treatment of this fascinating disease.
  
  
  METHODS
  A comprehensive review of published literature on acromegaly is presented. The findings discussed include the history, physical examination, and diagnostic studies of two patients presenting in different ways. They both saw multiple healthcare providers, and had symptoms and signs eventually leading to the diagnosis of acromegaly.
  
  
  CONCLUSIONS
  Acromegaly is the result of excessive amounts of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1), almost always caused by a benign adenoma of the pituitary gland. This leads to coarse facial features, soft tissue swelling (including the tongue), enlargement of the hands and feet, respiratory problems, hypertension, diabetes mellitus, carpal tunnel syndrome, and osteoarthritis. Early recognition and appropriate referral can reverse some of the signs and symptoms over time, and lead to decreased mortality and a markedly improved quality of life.
  
  
  CONCLUSIONS
  These cases exemplify the challenges faced by NPs and other healthcare providers in diagnosing patients with acromegaly.
authors.affiliation: Department of Neurosurgery, Pituitary/Neuroendocrine Center, Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Iuliano
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
mesh_terms: D000172:Acromegaly / Q000175:diagnosis* / Q000451:nursing / Q000473:pathology; D000236:Adenoma / Q000150:complications*; D000328:Adult; D000368:Aged; D005260:Female; D019382:Human Growth Hormone; D006801:Humans; D007334:Insulin-Like Growth Factor I; D008297:Male; D011788:Quality of Life
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I
keywords: Pituitary; clinical decision-making; diabetes; hormone; hypertension