acromegaly Flashcards

1
Q

define acromegaly

A

Excess GH production, usually due to GH-secreting pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is a growth hormone- ( GH/somatotropin)?

A

is a peptide hormone secreted by the anterior pituitary gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the causes of acromegaly?

A

-Primary GH-secreting pituitary adenoma
-Ectopic GH-secreting tumours
e.g. Pancreatic-Islet Cell Tumours and Lymphoma.
-Iatrogenic GH
-Excessive GHRH (Rare)
e.g. Hypothalamic Hamartomas, Bronchial Carcinoid Tumours, Small cell lung cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does the secretion of GH lead to and what does it stimulate?

A

-GH leads to increased Insulin Growth Factor –1 (IFG1) secreted by the liver, which stimulates protein synthesis, cell division, lipolysis etc… for growth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what can excessive GH cause?

A

Excess GH however causes excessive enlargement and growth of bone and soft tissue; Acromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the signs of acromegaly?

A

-Acral Enlargement (Clubbing/Enlargement of hands and feet)
-Big tongue and widely spaced teeth
-Deep voice
-Prominent Superior Orbital fissure
-Puffy Lips, Thick Eyelid, Big Nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the symptoms of acromegaly?

A

-Joint Pain
-Wrist Pain and Numbness (Carpal Tunnel Syndrome)
-Sleep/Snoring disorders (Sleep Apnoea)
-Headache and visual disturbance
-Erectile Dysfunction/Low libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the epidemiology of acromegaly

A

Occurs in adults after the epiphyseal plates have fused; characterised by enlarged features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe the epidemiology of giantism

A

Occurs in children before fusion of EP; have tall height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the risk factors for acromegaly?

A

Familial condition – Multiple Endocrine Neoplasia Type 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the two types of treatment/ management of acromegaly?

A
  1. surgical
  2. medical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the surgical treatment/ management of acromegaly

A

-Endoscopic Transsphenoidal Surgery – Removes GH-secreting pituitary adenoma
-Surgical Removal of Ectopic cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the medical treatment/ management of acromegaly

A

-Somatostatin Analogues (Octreotide, Lanreotide)
-Dopamine Agonists (Cabergoline, Bromocriptine)
-GH Antagonists (Pegvisomant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the first line test of suspected acromegaly?

A

Measure serum IGF-1 levels NOT GH (as GH varies throughout the day).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the gold standard test for acromegaly?

A

ORAL GLUCOSE TOLERANCE TEST: 75g of oral glucose (Glucose suppresses GH).If after 2 hours GH conc. is >1ng/mL, Acromegaly is diagnosed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what additional tests need to be done to diagnose acromegaly?

A

Plasma Prolactin: Prolactin levels may be raised in Acromegaly (Stalk compression, inhibits dopamine)

17
Q

what should be done once acromegaly is diagnosed?

A
  • A pituitary MRI should be completed once Acromegaly is diagnosed.
18
Q

after diagnosis, if there’s a visible mass on the pituitary MRI, what should you? ( in acromegaly)

A

-Visible mass: Proceed to treatment

19
Q

after diagnosis, if there’s not a visible mass on the pituitary MRI, what should you? ( in acromegaly)

A

If not, a CT of the chest or abdomen should be done with serum GHRH measurement.

20
Q

what is the age of incidence of acromegaly?

A

; Men = 40, Women = 45

21
Q
A