Patient Demographics
Name:
Age:
Sex:
Date of Birth:
Attending Physician:
Date of Note:
Reason for Encounter
Briefly state the reason for this encounter. This could be:
Initial evaluation for suspected acromegaly.
Follow-up visit for a confirmed acromegaly diagnosis.
Evaluation of treatment response for acromegaly.
Management of acromegaly complications.
History of Present Illness (HPI)
Focus on symptoms suggestive of acromegaly, including:
Gradual enlargement of hands and feet over time
Facial coarsening (thickening of jawline, brow bones)
Deepening of voice
Increased sweating
Headaches
Visual disturbances (tunnel vision)
Fatigue
Sleep apnea
Carpal tunnel syndrome
Arthralgias (joint pain)
Menstrual irregularities (females)
Decreased libido
Mention the duration, progression, and any aggravating or alleviating factors for the symptoms.
Past Medical History (PMHx)
Briefly mention any relevant past medical history, such as:
Hypertension (high blood pressure)
Diabetes mellitus
Sleep apnea
Arthritis
Cardiovascular disease
Previous surgeries (pituitary)
Inquire about a family history of acromegaly or other pituitary tumors.
Social History (SHx)
Include relevant social history that may be pertinent, such as:
Use of hats, gloves, or shoe size changes due to enlargement
Medications
List all current medications the patient is taking.
Allergies
Document any known allergies, especially to medications.
Physical Examination
General: Assess overall health, appearance of acromegalic features (facial coarsening, enlarged hands/feet), and signs of underlying complications (arthralgias, sleep apnea).
Vital Signs: Document blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature.
Head and Neck:
Assess for facial bone enlargement, visual field deficits, and tongue enlargement.
Extremities:
Evaluate for enlargement of hands and feet.
Neurological:
Briefly assess for visual acuity and cranial nerve palsies.
Assessment
Summarize the key findings from the history and physical examination.
Formulate a differential diagnosis for the patient’s symptoms, including acromegaly and other conditions that can mimic it (e.g., obesity, certain bone disorders).
Plan
Outline the next steps in the patient’s management. This may include:
Diagnostic Tests:
Blood Tests:
Insulin-like growth factor 1 (IGF-1) level – the main diagnostic test for acromegality.
Growth hormone (GH) level – may be done in conjunction with IGF-1
Other tests to assess for complications (blood sugar, cholesterol, thyroid function)
Imaging Studies:
Pituitary MRI scan: to visualize the pituitary gland and identify potential tumors.
Skull X-ray (may be considered in some cases)
Treatment: (Depends on severity and patient factors)
Tumor Removal: Surgical resection of the pituitary tumor is the primary treatment for most patients.
Somatostatin Analogs: Medications that help suppress GH production.
Dopamine Agonists: Another class of medications that may help control GH levels.
Radiation Therapy: May be used for persistent tumors or inoperable cases.
Management of Complications:
Address any associated health problems like hypertension, diabetes, or sleep apnea.
Referral to an Endocrinologist: For specialized management of acromegaly and long-term follow-up.
Prognosis
Briefly discuss the prognosis. Early diagnosis and treatment can lead to good outcomes and symptom improvement.
However, acromegaly is a chronic condition requiring lifelong monitoring and treatment.
Patient Education
Educate the patient about acromegaly, the importance of treatment adherence, and the potential risks and benefits of treatment options.
Discuss the importance of regular follow-up to monitor treatment response and manage long-term health.
Additional Considerations