Acromegaly

Name:	SSN:
Date of Exam:	C-number:
Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Date diagnosis established.
2. Joint pains.
3. Changes in vision.
4. Headaches (severity and frequency).
5. Cardiac symptoms.
6. Change in shoe, glove, or hat size.
7. Symptoms of glucose intolerance.
8. Treatments.

C. Physical Examination (Objective Findings):

Address each of the following and fully describe current findings:

1. Arthropathy.
2. Vascular fragility.
3. Evidence of increased intracranial pressure.
4. Size of acral parts, long bones.
5. Visual impairment, including visual fields.

D. Diagnostic and Clinical Tests:

Provide:

1. CT of brain or X-ray of sella turcica.
2. Glucose tolerance test.
3. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

Comment on:

1. Is the disease active or in remission?

Signature:

Date: