2: Acromegaly Flashcards
What is acromegaly
Excess GH
What usually causes acromegaly
Pituitary Tumour
What genetic syndrome may patients with acromegaly have
MEN I
What are symptoms of acromegaly
- Parasthesia in extremities on waking
- OSA
- Sweating
- Back-pain
- Arthralgia
Why does parasthesia of extremities occur on waking
Compression of nerves on waking
What tumour mass effects of pituitary tumour in acromegaly
Headache
Bi-temporal hemianopia
CN palsy
What condition may acromegaly cause
DM
How may DM in acromegaly present clinically
Acanthosis Nigricans
What are organ symptoms in acromegaly
Enlarged Thyroid
Enlarged Kidney
Cardiomegaly: LVH, HTN
What are skeletal symptoms of acromegaly
Spade-like hands
Macrognathia
Enlarged feet
Wide spaced teeth
What are soft-tissue symptoms of acromegaly
Macroglossia
Coarse facial features
Puffy eyelids, lips
Curtis vertices gyrata = scalp folds - due to englarged skin
Proximal muscle weakness
Carpal tunnel
What is performed in those with clinical features of acromegaly
Serum IGF-1
What investigation is diagnostic of acromegaly
OGTT
When is OGTT performed
If IGF-1 is high
How will OGTT present in acromegaly
GH will not be surpassed (>2)
If OGTT indicates acromegaly, what is ordered
Pituitary MRI
What is first-line management for acromegaly
Trans-sphenoidal surgery
If unable to perform surgery, what medication is used in acromegaly
Somatostatin analogues (Octreotide)
What is the role of octreotide
Inhibits GH release
What is an alternative to somatostatin analogue
Dopamine agonist (Bromocriptine)
What is third-line for GH
Pegvisomant
What is pegvistomant
GH receptor antagonist
Explain pegvisomant for acromegaly
Does not reduce tumour volume - meaning will need to be removed
What are 5 complication of acromegaly
DM Impaired glucose tolerance CCF LVH Stroke Increases risk colorectal cancer
What cancer does acromegaly increase risk of
Colorectal cancer
