Acromegaly Flashcards
What is acromegaly?
An excess of growth hormone
Where is growth hormone produced?
Anterior pituitary gland
What is the most common cause of acromegaly?
A pituitary adenoma
What are the other causes of acromegaly?
Secondary to cancer (GHRH or GH secreting tumours)
What visual field defect can occur with a pituitary adenoma?
Bitemporal hemianopia
What is the presentation of acromegaly?
Prominent forehead
Coarse, sweaty skin
Large nose
Large tongue
Large hands and feet
Large protruding jaw
A space occupying pituitary tumour can also cause:
- Headaches
- Bitemporal hemianopia
What conditions are associated with acromegaly?
Hypertrophic heart
Hypertension
Type 2 diabetes
Carpal tunnel syndrome
Arthritis
Colorectal cancer
What is the first line investigation for acromegaly?
Serum IGF-1 levels
What investigation will confirm acromegaly?
OGTT
What OGTT results will be seen in a patient with acromegaly?
Growth hormone will not be suppressed after OGTT
How is a OGTT for acromegaly carried out?
A 75g glucose drink is consumed, and growth hormone levels are tested at baseline and 2 hours following the drink
What is the first line treatment of acromegaly?
Trans-sphenoidal resection of pituitary adenoma
What medications can be used to manage acromegaly?
Somatostatin analogue - ocreotide (first line medical management)
GH receptor antagonists - pegvisomant
Dopamine agonists - bromocriptine
What is somatostatin?
Growth hormone-inhibiting hormone. It is secreted by the brain, GI tract, and pancreas
