Acromegaly—Hot or cold?: Some clinical and metabolic observations

Abstract

Subjects suffering from acromegaly may present with complaints related to (1) an expanding intracranial mass, (2) the anabolic and/or diabetogenic actions of HGH, and (3) irritation or compression of neighboring pituitary cells. In ‘fugitive’ acromegaly, peripheral nerve, joint, skeletal and cardiac muscle lesions may antedate florid evidence of acromegaly. Even when the anatomical diagnosis has been established, it may be difficult to distinguish active from burnt out acromegaly. Elevation of serum phosphorus and evidence of continuing acral enlargement are satisfactory but insensitive tests. These tests can be supplemented by (1) direct assay of growth hormone levels in plasma, and (2) measurement of basal forearm metabolism and the response of forearm to intra-arterial insulin.