Acromeagly Flashcards

1
Q

What is the presentation of acromegaly

A
  • Headache
  • Arthritis
  • Carapl tunnel
  • Dabetes
  • Hypertension
  • Visual field defec
  • Obstructive sleep apnoea
  • Coronary artery disease
  • Menstrual upset
  • Headache
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2
Q

describe the growth hormone axis

A
  • Hypothalamus releases GnRH
  • this causes GH production from the anterior pituitary
  • GH has direct effects on bone and skeletal muscle
  • skeletal muscle produces IGF-1 which acts as a feedback loop
  • it also has indirect effects = GH acts on the liver and produces IGF-1 in the liver
  • IGF-1 acts on the bone and the muscle
  • when IGF-1 rises too much it causes negative feedback to the hypothalamus
  • GnRH is also inhibited by somatostatin
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3
Q

what can cause acromegaly

A

Pituitary adenoma

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4
Q

how do you remove a pituitary adenoma

A

transsphenoidal surgery in order to remove the adenoma

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5
Q

what can you use to stop growth hormone release

A

somatostatin agonist

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6
Q

what is a side effect of dopamine agonist use

A
  • inability to understand risk
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7
Q

How do you diagnose acromegaly

A
  • This is because they are released in a pulsatile moment
  • Screen for growth hormone excess by a growth hormone and IGF-1 level
  • Confimriatory test for acromegaly is a dynamic test – if you think they are producing too much cortisol they give them something to reduce cortisol, if it doesn’t fall then it is pathological,
  • Have to give something that will reduce growth hormone level – give glucose tolerance test – get 75g of glucose and supress growth hormone to 0 and if it doesn’t then diagnosis is made
  • Then move onto scans
  • Pituitary MRI scan
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8
Q

How do you treat acromegaly

A
  • Radiotherapy – exepct them to become hypopituitarism as the radiotherapy damages the exisiting tissue
  • Gamma knife – know used
  • Surgery more likely now
  • somatostatin agonists
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