Acromegaly

Question 1

Where is GH produced?

Answer 1

Anterior pituitary

Question 2

Most common cause of acromegaly?

Answer 2

Unregulated GH secretion by a pituitary adenoma

Question 3

Rarer cause of acromegaly?

Answer 3

Secondary to lung or pancreatic cancer, that secretes ectopic GHRH or GH

Question 4

What type of vision loss occurs as a result of a pituitary adenoma?

Answer 4

Bitemporal hemianopia

Question 5

How does Acromegaly present?

Answer 5

1. Headaches
2. Visual field defect
3. Large nose, tongue, hands, feet
4. Large protruding jaw (”prognathism”)
5. Profuse sweating
6. Development of new skin tags

Question 6

List 2 complications of Acromegaly

Answer 6

1. Hypertrophic heart
2. Hypertension
3. Type 2 diabetes
4. Colorectal cancer

Question 7

Investigations for suspected acromegaly

Highlight first line

Answer 7

1. IGF-1 (first line)
2. OGTT while measuring GH
3. MRI brain
4. Refer to ophthalmology for visual field testing

Question 8

Explain the OGTT + GH for acromegaly

Answer 8

High glucose normally suppresses GH

(+) test, GH remains elevated

Question 9

Definitive treatment for acromegaly?

Answer 9

Trans-sphenoidal surgery if pituitary adenoma

If caused by ectopic hormones, surgery for specific cancer

Question 10

List an example of a medication which can be used to block GH

Answer 10

Somatostatin analogues eg. ocreotide