Acromegaly and Hypothyroidism Screening in OSA

Clinical Recognition and Diagnosis

The American Academy of Sleep Medicine guidelines recommend evaluating for hypothyroidism and acromegaly in patients with OSA, as these conditions can cause or exacerbate OSA symptoms 1, 2
Patients with acromegaly often present with progressive hand enlargement, ill-fitting dentures, macroglossia, and carpal tunnel syndrome, which can contribute to OSA 1, 2
Hypothyroidism is a critical differential diagnosis that must be excluded when evaluating OSA, particularly in women, as it can cause OSA through multiple mechanisms including macroglossia and pharyngeal muscle dysfunction 1, 2

The American Academy of Sleep Medicine guidelines suggest ordering thyroid function tests (TFTs) first, as hypothyroidism is more prevalent than acromegaly and treatment can directly improve OSA outcomes 1, 2
If TFTs are normal, evaluating for acromegaly with IGF-1 levels and MRI of the pituitary is indicated, as treatment of acromegaly can improve the apnea-hypopnea index and patient outcomes 3

Untreated hypothyroidism can increase cardiovascular mortality, cognitive impairment, and metabolic dysfunction beyond the OSA itself, emphasizing the importance of early diagnosis and treatment 1, 2
Untreated acromegaly can cause progressive cardiovascular disease, diabetes, arthropathy, and significantly increased mortality from cardiovascular complications, highlighting the need for prompt diagnosis and management 3