Snap Shot A 52 year-old man complains of increased hat size and headaches when he wakes up in the morning. He is a famous wrestler. Physical exam reveals mild diastolic HTN, prominant jaw with spaces between the teeth, large hands and feet, and generalized muscle weakness. Introduction Usually caused by benign pituitary adenoma that release excess growth hormone If the condition occurs before the fusion of the epiphysis, gigantism occurs If occurs after skeletal epiphyseal closure, then acromegaly Presentation Symptoms generalized acute enlargement of bone and soft tissue large hands and feet frontal bossing space between teeth increased hat size muscle weakness and peripheral neuropathies due to nerve compression visual defects from pressure in the optic chiasm voice deepening Physical exam diastolic hypertension diabetes mellitus from gluconeogenic properties of GH Evaluation Increased insulin growth-like factor 1 MRI / CT shows enlargement of sella turcica on imaging Labs hyperglycemia (40%) secondary to reduced liver uptake of glucose and increased gluconeogenesis in the liver Hypertrophy of left ventricle leads to cardiomegaly on CXR Treatment Transphenoidal surgery and radiation. Octreotide (somatostatin analog) second line for refractory tumors medical therapy produces clinical improvement in 70% Prognosis, Prevention, and Comlications Cardiomegaly progressing to CHF is the most common cause of death