Section 1Diagnosis delays
Headaches not an indicator The outcome
of acromegaly
An otherwise healthy woman in her early 30’s saw The MDU obtained expert reports from an endocrinologist,
her GP shortly after registering at the practice. a neurologist and a GP. All the experts pointed out that
She complained of headaches occurring once or acromegaly is extremely rare and that most GPs would
twice a week for about a year. The headaches were not come across a case in their professional careers.
on the left side, and the patient told the GP that The experts agreed that, given the presenting symptoms,
she felt these were work-stress related. The GP the GP acted appropriately by maintaining a diagnosis of
made a working diagnosis of migraine and migraines with TMJ pain, and by making a referral to
prescribed pizotifen. two different neurologists when the patient’s headaches
After some six months the headache frequency was
showed no improvement. The notes made no mention of
much the same and the patient requested a specialist
the growth in head, hands and feet, and the experts felt
opinion from a consultant neurologist.
that these unusual changes would be likely to be noted if
they were present or reported.
The consultant also diagnosed migraine and started the
patient on a low dose tricyclic antidepressant used for
The endocrinologist explained that acromegaly develops
migraine and a NSAID. The patient attended the practice
over a long period of time and that the tumour was
a number of times over the coming months and saw
likely to have been large for some years before the GP
another GP. She now complained of shooting pains in the
saw the patient. He felt that the treatment would have
left side of her neck and head. The GP reduced the dose
been the same, even if the condition had been
of the anti-depressant, believing this to be the cause.
diagnosed earlier as a result of the GP’s actions.
Some months later the patient asked for a second
The MDU wrote to the claimant’s solicitors refuting the
specialist opinion from another consultant neurologist.
allegations on this basis, and following this the claim was
Neurological examination was normal and again the
discontinued.
diagnosis was a mixture of muscle contraction pain and
migraine. The consultant recommended an increased
dose of the anti-depressant, which the first GP prescribed.
“…the tumour was likely to have
The patient was seen a number of times over the coming
been large for some years before
months by the first GP, and various adjustments were
made to the migraine medication. The patient also
the GP saw the patient.”
complained of jaw pain, and another GP at the practice
made a referral to a consultant maxillofacial surgeon
who made a diagnosis of temperomandibular joint (TMJ)
dysfunction. The patient saw another maxillofacial
surgeon some months later who diagnosed acromegaly
caused by a pituitary tumour.
The patient had surgery and radiotherapy to treat the
tumour but was left with slurred speech and loss of
sensation around the mandible.
Some six months later the patient brought a claim
against the first GP for the pain and injury suffered due
to the delayed diagnosis of acromegaly. She alleged that
the changes in the size and shape of her hands and feet
and appearance over time should have raised suspicions,
and that when the treatment of migraine proved
unsuccessful the GP should have referred her for another
specialist opinion and arranged for a brain scan.
14
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74