Acromegaly

Chronic progressive multisystem disease caused by excess growth hormone.

Epidemiology and Risk Factors

Excessive growth hormone secretion occurring after puberty.

Usually presents in an advanced stage at middle age. Symptoms may be due to:

A
- Usually straightforward mask ventilation
  Small hands may struggle.
- Potential difficult laryngoscopy
  - Macrognathia
  - Macroglossia
  - Soft tissue bulk
  - ↑ Size epiglottis
- AFOI may be preferable
- Soft tissue enlargement
  Ask about vocal changes.
B
- OSA
  Present in up to 70%.
- Restrictive lung disease due to kyphoscoliosis
C
- Treatment-resistant hypertension
  Occurs in 40%. Leads to secondary:
  - Eccentric LV hypertrophy
    Preoperative TTE beneficial.
- Ischaemic heart disease
- Arrhythmias
E
- Proximal myopathy
  May limit respiratory function.
- Entrapment neuropathy
  Peripheral nerve compression.
- Difficult cannulation
E
- Associated endocrine disease
  - Diabetes
  - Thyroid dysfunction
  - Adrenal dysfunction