Article
Diagnosing acromegaly from an oral presentation: a case review
A woman in her 50s presented to her general dental practitioner complaining of movement of her lower teeth that had changed the way in which her upper and lower teeth met. She had also noticed an enlarged tongue and lower lip (Figure 1). Apart from the oral changes, she also presented with an increased shoe and finger size. The GDP had referred the patient to the oral and maxillofacial team at Hillingdon Hospital. The patient was seen by the oral and maxillofacial consultant who, following a detailed history, advised specific blood tests and an MRI scan to assist with the diagnosis. The patient's past medical history included sleep apnoea for which she used a CPAP machine, and hypertension for which she took amlodipine. Her investigation results confirmed a diagnosis of acromegaly with elevated growth hormone (19.8 µg/L) and IGF-1 (56.9 nmol/L) levels. Her Hb1Ac level was 36 mmol/mol. The remainder of her blood tests, including calcium, thyroid and liver function tests, were normal.
The patient was referred to the endocrine and neurosurgical teams who carried out transphenoidal surgery, which involves surgical resection to remove the pituitary adenoma. The patient has done well post-operatively and has noticed a reduction in finger and shoe size, with her main concerns being to straighten her teeth to bring the occlusion back to normal. She continues to see the maxillofacial surgeon.
An early diagnosis of acromegaly can help to reduce mortality risk, so it is important to identify the signs and symptoms as soon as possible. Studies have shown that all patients had visited their GP prior to the acromegaly diagnosis, with the second most visited health professionals being dentists. Consider bloods to measure growth hormone and IGF-1 levels and an MRI scan as first-line investigations for diagnoses of acromegaly.