Red flag to remember
Clear nasal drainage positive for glucose or a 'halo' ring after pituitary surgery indicates a CSF leak — report immediately.
What is acromegaly?
Onset is gradual, so changes are often noticed in old photos. In children with open growth plates the same excess causes gigantism.
Key points to remember
- Hallmark features: enlarged hands and feet, coarse facial features, protruding jaw and brow, enlarged tongue, and increasing ring/shoe/hat size.
- GH raises blood glucose, so diabetes mellitus and glucose intolerance are common; soft-tissue overgrowth causes carpal tunnel syndrome and deep voice.
- Diagnosis is confirmed by elevated IGF-1 and failure of GH to suppress during an oral glucose tolerance test; MRI locates the pituitary tumor.
- Transsphenoidal hypophysectomy (tumor removal through the nose/sphenoid sinus) is the primary treatment; octreotide, lanreotide, pegvisomant, and bromocriptine are medical options.
- Untreated acromegaly increases cardiovascular disease, hypertension, cardiomyopathy, and colon polyps/cancer risk, shortening life expectancy.
- Bony enlargement is permanent and does not reverse with treatment, though soft-tissue swelling may improve.
Signs & symptoms
- Large hands, feet, jaw
- Coarse features, ↑ring/shoe size
- Deep voice, sweating, HTN
Nursing priorities
- Monitor blood glucose and assess for signs of hyperglycemia given GH's diabetogenic effect.
- After transsphenoidal surgery, keep the head of bed elevated, avoid coughing/sneezing/straining/bending, and instruct against blowing the nose.
- Assess for CSF leak by testing nasal drainage for glucose/halo sign and watch for persistent postnasal drip or severe headache.
- Provide emotional support for altered body image and assess cardiovascular and joint/mobility status.
- Monitor for postoperative diabetes insipidus by tracking intake, output, and urine specific gravity.
Labs & values
Elevated IGF-1 (somatomedin C)
GH not suppressed below ~1 ng/mL after oral glucose tolerance test
Fasting glucose often elevated >100 mg/dL
Patient teaching
- Lifelong follow-up is needed; if the entire pituitary is removed, lifelong hormone replacement (thyroid, cortisol, sex hormones) is required.
- Avoid activities that increase intracranial pressure (straining, bending, vigorous coughing) for several weeks after surgery.
- Expect decreased sense of smell temporarily after transsphenoidal surgery; do not brush teeth vigorously near the incision.
Red flags: report now
- Clear nasal drainage positive for glucose or a 'halo' ring after pituitary surgery indicates a CSF leak — report immediately.
- Severe headache, vision changes, or signs of increased intracranial pressure after surgery.
- Signs of meningitis (fever, nuchal rigidity, photophobia) following a CSF leak.
References
Clinical references for this topic
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