65Y/M with acromegaly , varicose veins and vision defect




A 65 year old male who is a daily wage labourer by occupation and a resident of suryapet presented to the opthalmology opd with  chief complaints of  

c/o blurring of vision in both eyes since 1 year

c/oburning sensation in both eyes since 1 year 

HISTORY OF PRESENTING ILLNESS 

The patient was apparently asymptomatic 1 year ago , then developed blurring of vision in both eyes , associated with burning sensation and watering of eyes 

n/h/o foreign body sensation 

h/o headache since 1 year which is dragging in type subsides in the night increases on straining vision 

 PAST HISTORY 

n/k/c/o DM2 , HTN , THYROID , EPILEPSY , TB , CVA, CAD


TREATMENT HISTORY 

no previous hospital admissions 

no previous blood transfusions 


PERSONAL HISTORY 

appetite: normal 

diet : mixed

bowel and bladder : regular and normal 

addictions : alcohol since 4 years weekly twice 

                      smoker since 40 years chutta-daily 7 chutta  

allergies:  not known 


FAMILY HISTORY 

no h/o DM,HTN,EPILEPSY , CAD , CANCERS 


EXAMINATION 

GENERAL EXAMINATION

VITALS 

patient was c/c/c oriented to space, time and person

pallor : absent 

icterus : absent 

clubbing : absent 

cyanosis : absent    

lymphadenopathy : absent 

pedal edema : absent 

pulse rate : 72

blood pressure : 130/90 

RR : 17cpm

head to toe examination










marcroglossia present

prognathism present 

thick eyelids present

prominent brow ridge present

large nose 

large hands 

large feet 

large lower lip

widely spaced dentition

prominent forehead

varicosity on both lower libs 

gynaecomastia  

Anthropometry

height : 183cm 

upper segment : 89cm 

lower segment : 94cm

arm span : 195cm 

upper limb : 80cm 

mid-arm circumference : 28cm

head circumference : 61cm  

SYSTEMIC EXAMINATION

CVS : S1 S2 heard 

CNS : NFND 

RS : BAE+

PA : Soft and non tender

in the view of the above findings a provisional diagnosis of acromegaly was made and MRI brain and IGF1 was done 

INVESTIGATIONS 


IGF : Rasied more than 4 times from upper limit 





IMPRESSION:
• Expansion of sella turcica with 15x10x17 mm (TxCCAP) T2 isointense and TI
hypointense lesion within the sella turcica.
/ E/o T2 hyperintense and T1 hypointense non enhancing component in the anterior
aspeIMPRESSION:
• Expansion of sella turcica with 15x10x17 mm (TxCCAP) T2 isointense and TI
hypointense lesion within the sella turcica.
/ E/o T2 hyperintense and T1 hypointense non enhancingct of the lesion consistent with cystic change /necrosis
--f/s//o? pituitary macroadenoma---IMPRESSION:
• Expansion of sella turcica with 15x10x17 mm (TxCCAP) T2 isointense and TI
hypointense lesion within the sella turcica.
/ E/o T2 hyperintense and T1 hypointense non enhancing component in the anterior
aspect of the lesion consistent with cystic change /necrosis
--f/s//o? pituitary macroadenoma---
• Extensions as above.
/ Complete sellar type of sphenoid sinus pneumatisation
• Extensions as above.
/ Complete sellar type of sphenoid sinus pneumatisation.

DIAGNOSIS
in the view of the examination and investigative findings a diagnosis of Acromegaly was established

TREATMENT 
-treated conservatively for cataract and referred to surgery for varicose veins 
-no features suggestive of raised intracranial tension
-no ccomplaints of headache and seizures 
-no complaints regarding cosmetic aappearance of face







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