Headaches not an indicator of acromegaly

The GP made a working diagnosis of migraine and prescribed pizotifen.

After some six months the headache frequency was much the same and the patient requested a specialist opinion from a consultant neurologist.

The consultant also diagnosed migraine and started the patient on a low dose tricyclic antidepressant used for migraine and a NSAID. The patient attended the practice a number of times over the coming months and saw another GP. She now complained of shooting pains in the left side of her neck and head. The GP reduced the dose of the anti-depressant, believing this to be the cause.

Some months later the patient asked for a second specialist opinion from another consultant neurologist. Neurological examination was normal and again the 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 patient was seen a number of times over the coming months by the first GP, and various adjustments were made to the migraine medication. The patient also 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.

The outcome

 

The MDU obtained expert reports from an endocrinologist, a neurologist and a GP. All the experts pointed out that acromegaly is extremely rare and that most GPs would not come across a case in their professional careers. The experts agreed that, given the presenting symptoms, the GP acted appropriately by maintaining a diagnosis of migraines with TMJ pain, and by making a referral to two different neurologists when the patient's headaches showed no improvement. The notes made no mention of the growth in head, hands and feet, and the experts felt that these unusual changes would be likely to be noted if they were present or reported.
 
The endocrinologist explained that acromegaly develops over a long period of time and that the tumour was likely to have been large for some years before the GP saw the patient. He felt that the treatment would have been the same, even if the condition had been diagnosed earlier as a result of the GP's actions.

The MDU wrote to the claimant's solicitors refuting the allegations on this basis, and following this the claim was discontinued.

This page was correct at publication on 22/12/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.