👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: gigantism in children · growth hormone excess · GH-secreting pituitary tumor
💡
Use this quick-reference guide to spot, treat, and prevent Acromegaly on the NCLEX. Keep it handy during review and on exam day!
🩺
📒 The 1-minute cheat sheet
📌 Mechanism
Pituitary tumor → ↑GH
After growth plates close
🩺 Signs
Large hands, feet, jaw
Coarse features, ↑ring/shoe size
Deep voice, sweating, HTN
🧪 Labs
↑IGF-1, ↑GH, MRI pituitary
✅ Do
Transsphenoidal surgery = primary
Octreotide ↓GH; no nose blow post-op
📚 Acromegaly — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Acromegaly is excess growth hormone (GH) in adults, almost always from a benign pituitary adenoma, causing overgrowth of bones and soft tissue after the growth plates have closed. Onset is gradual, so changes are often noticed in old photos. In children with open growth plates the same excess causes gigantism.
🔑
Key points
Understand these first
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.
✅
Nursing priorities
What to do, in order
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.
🚩
Red flags — report now
Escalate immediately
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.
🧪
Labs & values
Numbers to know
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
What patients must know
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.
❓ Acromegaly: NCLEX FAQs
What are the priority nursing interventions for Acromegaly?
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.
What are the warning signs of Acromegaly a nurse must report?
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.
What do I need to know about Acromegaly for the NCLEX?
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.
What patient teaching is important for Acromegaly?
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.
✨
Quick Tip
Hallmark features: enlarged hands and feet, coarse facial features, protruding jaw and brow, enlarged tongue, and increasing ring/shoe/hat size.