Macroglossia
A 74-year-old woman with a history of diabetes, hypertension, multiple myeloma, and renal failure was hospitalized because of worsening renal insufficiency. She also complained of difficulty in chewing food. The oral examination revealed evidence of macroglossia.
On general physical examination, she had a heart rate of 92 beats per minute, a blood pressure of 142/98 mm Hg, and a respiration rate of 20 breaths per minute. Jugular venous distention was noted. Results of the chest examination were normal. Cardiovascular examination revealed a loud S2. She also had significant pedal edema. Hemodialysis was instituted to manage her renal failure.
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In patients with macroglossia, the tongue enlargement leads to functional and cosmetic problems. Swallowing requires normal tongue anatomy and function: the tongue mixes food with saliva to form a food bolus, which is then propelled into the pharynx by the tongue. As tongue enlargement occurs in macroglossia, this function may be impaired.
Generalized macroglossia can result from congenital, inflammatory, traumatic, and metabolic causes. A common inflammatory cause is chronic glossitis. Traumatic causes include postoperative edema. Among the metabolic causes are hypothyroidism, amyloidosis, chronic corticosteroid therapy, neurofibromatosis, and acromegaly. The congenital causes include primary idiopathic macroglossia, cretinism, hemangioma, lymphangioma, and Down syndrome. In this patient, systemic amyloidosis had developed and was responsible for the macroglossia; it also contributed to the renal dysfunction.
The presence of macroglossia should alert the clinician to any of the underlying conditions mentioned above, and efforts should be made to rule out these conditions as causative factors. Medical therapy for macroglossia is useful only when the cause of the disorder is a clearly defined medically treatable entity such as hypothyroidism, diabetes, or infection. In severe disabling cases, surgery should be considered.