Awake fiber-optic intubation – this is the choice method method for intubating these patients

Thorough airway exam – these patients are high risk for difficult intubation due to macroglossia, prognathism, hypertrophy and enlarged epiglottis, soft-tissue overgrowth in upper airway.

Allen Test – perform this test prior to A-line placement. 50% of acromegaly patients have compromised ulnar artery blood flow (entrapment neuropathy).

Glucocorticoids – a good consideration. These patients often have adrenal impairment. Refractory hypotension should cue this consideration.

Monitor blood glucose – These patients are prone to hyperglycemia.

Ensure euthyroid – Thyroid impairment is common.

Awake extubation – High risk for difficult intubation.

This is a disorder of too much growth hormone(GH). This is caused by pituitary adenomas and non-pituitary tumors. Pituitary adenomas account for > 95% of the cases and are typically micro-adenomas (>1cm). Non-pituitary tumors either directly secrete GH or indirectly cause a rise in GH by secreting growth hormone-releasing hormone (GHRH).

Signs of a patient with acromegaly: Enlarged lips, nose, tongue, deep/hoarse voice, enlarged hands and feet, prognathism, and enlarged brow.

Normal physiological effects of GH include decreases in glucose uptake (increased blood sugar) and increases in lean body mass/muscle, protein synthesis, lipolysis, and production of insuline-like growth factor.

In these patients, anticipate overgrowth of skeletal, soft, and connective tissues. Common problems include organomegaly, peripheral neuropathy, cardiovascular complications, glucose intolerance (increased blood sugars), osteoarthritis, osteoporosis, hyperhidrosis, skeletal muscle weakness, and pituitary deficiencies.

There is an equal incidence in all ethnic groups and genders. Incidence and prevalence rates increase with age. Diagnosis is usually in middle-age (40-50 years). Roughly 25,000 people in the United States have acromegaly, with approximately 3,000 new cases each year