A 45-year-old lady presents with complaints of a progressive increase in the size of hands and feet and shoe size for past 5 years. The family members have noticed a change in her facial appearance in the form of coarsening of features and her voice has become sonorous. She also has complaints of frequent headaches for past 1 year. She complains of amenorrhea for past 5 years. She also has complaints of joint pains for past 3 years which have become more severe for the past 3 months. She is hypertensive for past 1 year and complaints of grade 2 dyspnea on exertion and her hypertension is controlled on 10 mg of cilnidipine and 40 mg of telmisartan. She is not a known diabetic and has checked her random sugars 1 week back which was normal. She is not on any other medications presently (Fig. 1.1).
How is screening for colonic polyps advised in acromegaly?
Acromegaly is associated with increased colon polyps and may be associated with increased risk of colorectal cancer, but not cancer mortality (MQ). Colon length may increase during acromegaly resulting in increased mucosal folds known as dolichocolon. It is recommended that a screening colonoscopy be carried out at diagnosis in adults and if negative, then patients should be screened similarly to the general population, especially if insulin-like growth factor-I (IGF-I) levels are normalized. If IGF-I remains persistently elevated, more frequent screening is recommended (SR). If colonoscopy is abnormal, follow-up and screening should be in accordance with clinical guidelines.
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