Acromegaly Flashcards

1
Q

What is acromegaly?

A

An excess of growth hormone

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2
Q

Where is growth hormone produced?

A

Anterior pituitary gland

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3
Q

What is the most common cause of acromegaly?

A

A pituitary adenoma

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4
Q

What are the other causes of acromegaly?

A

Secondary to cancer (GHRH or GH secreting tumours)

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5
Q

What visual field defect can occur with a pituitary adenoma?

A

Bitemporal hemianopia

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6
Q

What is the presentation of acromegaly?

A

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

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7
Q

What conditions are associated with acromegaly?

A

Hypertrophic heart
Hypertension
Type 2 diabetes
Carpal tunnel syndrome
Arthritis
Colorectal cancer

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8
Q

What is the first line investigation for acromegaly?

A

Serum IGF-1 levels

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9
Q

What investigation will confirm acromegaly?

A

OGTT

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10
Q

What OGTT results will be seen in a patient with acromegaly?

A

Growth hormone will not be suppressed after OGTT

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11
Q

How is a OGTT for acromegaly carried out?

A

A 75g glucose drink is consumed, and growth hormone levels are tested at baseline and 2 hours following the drink

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12
Q

What is the first line treatment of acromegaly?

A

Trans-sphenoidal resection of pituitary adenoma

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13
Q

What medications can be used to manage acromegaly?

A

Somatostatin analogue - ocreotide (first line medical management)
GH receptor antagonists - pegvisomant
Dopamine agonists - bromocriptine

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14
Q

What is somatostatin?

A

Growth hormone-inhibiting hormone. It is secreted by the brain, GI tract, and pancreas

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