Acromegaly

Question 1

What is Acromegaly?

Answer 1

Clinical manifestation of too much Growth Hormone (GH)

Question 2

What is the causes of Acromegaly? (2 things)

Answer 2

1. Pituitary tumour (99%)
2. Other tumour (e.g Pancreas / Lung) secreting Ectopic GH Relasing Hormone (GHRH)

Question 3

What are the CF of Acromegaly? (9 things)

Answer 3

1. Headache + bitemporal hemianopia (if tumour clarts optic chiasm)
2. Profuse sweating (bc high GH)
3. Frontal bossing (big forehead + brows)
4. Big nose
5. Big tongue (Macroglossia)
6. Big protruding jaw
7. Big hands + feet
8. Organ dysf (hypertophic heart / HTN / T2DM / CRC)
9. Arthritis from imbalanced joint growth

Question 4

What investigations should you do for sus Acromegaly? (5 things)

Answer 4

1. Basal GH levels
2. Bloods (High Glucose / High Calcium / High Phosphate)
3. MRI pituitary
4. Visual fields + acuity assessment
5. ECG / Echo (compare w old photos if available, to check for hypertrophy)

Question 5

What are the management options for Acromegaly? (3 things)

Answer 5

1. Trans-sphenoidal surgery (definitive treatment for Acromegaly caused by Pituitary tumours (99%))
2. Somatostatin analogues to block GH release (e.g ocreotide)
3. Dopamine agonists to block GH release (e.g Bromocriptine / Cabergoline)