Acute exacerbation of upper airway obstruction in acromegaly.

Obstruction of the upper airway is recognized as a feature of acromegaly. Evans, Hipkin and Murray (1977) found abnormal flow volume curves suggesting upper airway obstruction in 6 out of 20 patients with acromegaly and no other cardiorespiratory disease. Such obstruction has been proposed as a cause of shortness of breath (Siegler, 1952), problems with endotracheal intubation (Kitahata, 1971), and obstructive sleep apnoea (Perks et al., 1980). On occasions it has necessitated tracheostomy (Jackson, 1918; Grotting & Pemberton, 1950). Jackson recommended routine examination of the larynx in acromegaly but upper airway obstruction still goes unrecognized. We report a case where sudden exacerbation of the obstruction by an upper respiratory tract infection precipitated stridor requiring urgent tracheostomy.