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Endocrine > 2: Acromegaly > Flashcards

2: Acromegaly Flashcards

1
Q

What is acromegaly

A

Excess GH

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2
Q

What usually causes acromegaly

A

Pituitary Tumour

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3
Q

What genetic syndrome may patients with acromegaly have

A

MEN I

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4
Q

What are symptoms of acromegaly

A
  • Parasthesia in extremities on waking
  • OSA
  • Sweating
  • Back-pain
  • Arthralgia
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5
Q

Why does parasthesia of extremities occur on waking

A

Compression of nerves on waking

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6
Q

What tumour mass effects of pituitary tumour in acromegaly

A

Headache
Bi-temporal hemianopia
CN palsy

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7
Q

What condition may acromegaly cause

A

DM

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8
Q

How may DM in acromegaly present clinically

A

Acanthosis Nigricans

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9
Q

What are organ symptoms in acromegaly

A

Enlarged Thyroid
Enlarged Kidney
Cardiomegaly: LVH, HTN

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10
Q

What are skeletal symptoms of acromegaly

A

Spade-like hands
Macrognathia
Enlarged feet
Wide spaced teeth

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11
Q

What are soft-tissue symptoms of acromegaly

A

Macroglossia

Coarse facial features

Puffy eyelids, lips

Curtis vertices gyrata = scalp folds - due to englarged skin

Proximal muscle weakness

Carpal tunnel

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12
Q

What is performed in those with clinical features of acromegaly

A

Serum IGF-1

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13
Q

What investigation is diagnostic of acromegaly

A

OGTT

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14
Q

When is OGTT performed

A

If IGF-1 is high

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15
Q

How will OGTT present in acromegaly

A

GH will not be surpassed (>2)

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16
Q

If OGTT indicates acromegaly, what is ordered

A

Pituitary MRI

17
Q

What is first-line management for acromegaly

A

Trans-sphenoidal surgery

18
Q

If unable to perform surgery, what medication is used in acromegaly

A

Somatostatin analogues (Octreotide)

19
Q

What is the role of octreotide

A

Inhibits GH release

20
Q

What is an alternative to somatostatin analogue

A

Dopamine agonist (Bromocriptine)

21
Q

What is third-line for GH

A

Pegvisomant

22
Q

What is pegvistomant

A

GH receptor antagonist

23
Q

Explain pegvisomant for acromegaly

A

Does not reduce tumour volume - meaning will need to be removed

24
Q

What are 5 complication of acromegaly

A 
DM 
Impaired glucose tolerance 
CCF
LVH
Stroke 
Increases risk colorectal cancer
25
Q

What cancer does acromegaly increase risk of

A

Colorectal cancer

Endocrine (20 decks)

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