A 43-year-old man presents to the physician as a new patient to establish care. He had previously not seen a physician in years due to feeling very healthy and not having health insurance. Review of systems is notable for frequent headaches, heavy sweating, poor sleep, and reduced libido for the past several years. Vital signs are temperature 37.6°C (99.7°F), pulse 83 beats/minute, blood pressure 143/94 mmHg, respirations 15/minute, and BMI of 28. On physical examination, he is a well-appearing though overweight male with a deep voice. His face displays coarse features, and there are spaces between his teeth. His tongue is enlarged. His hands and feet are enlarged though not edematous, with thickening of the thumb and heel pads. Skin tags are found over his back and neck.
Which of the following findings would most likely be found on a chest X-ray?
- A) Bilateral pulmonary infiltrates
- B) Bronchiectasis
- C) Cardiomegaly
- D) Dextrocardia
- E) Granulomatous infiltrates
C) Cardiomegaly
This patient has acromegaly, caused by excess growth hormone, usually secondary to a pituitary adenoma. Physical exam findings stem from tissue effects of growth hormone excess. These include coarse facies, deep voice, large tongue, spaces between the teeth, wide, doughy hands and feet with thickening of the thumb and heel pads, and skin tags. Acromegaly is also associated with headaches, diaphoresis, poor sleep, reduced libido, and hypertension. These patients are at risk of heart failure secondary to left ventricular hypertrophy and cardiomyopathy, so cardiomegaly may be seen on chest X-ray.
Key Learning Point
Acromegaly is also associated with headaches, diaphoresis, poor sleep, reduced libido, and hypertension. Signs include coarse facies, deep voice, large tongue, spaces between the teeth, wide hands and feet with thickening of the thumb and heel pads, and skin tags. Patients with acromegaly are at increased risk of left ventricular hypertrophy and cardiomyopathy.