Acromegaly

Question 1

Presentation

Answer 1

Large, sweaty hands - broad palms
Face - prominent supraorbital ridges, enlarged nose and lips, prognasthism
Interdental separation and enlarged tongue
Hypertrichosis and gynaecomastia

Question 2

Associated features

Answer 2

Biltemporal hemianopia
Optic atrophy
Carpal tunnel syndrome
Hypertension
Cardiomegaly
Diabetes
Arthropathy
Goitre
Proximal myopathy

Question 3

Pathophysiology

Answer 3

Excess growth hormones - most commonly due to GH secreting adenoma of the anterior pituitary - 75% macroadenomas

Question 4

Complications

Answer 4

Hypertension
Cardiomegaly
Arthritis
Impaired glucose tolerance
Visual field defects
CN palsies
Tumours - colonic polyps

Question 5

Investigations

Answer 5

oral glucose tolerance test - rise in GH
Insulin-like Growth Factor - raised
Determine source of excess GH - MRI of the pituitary

Question 6

Management

Answer 6

Transsphenoidal hypophysectomy

Question 7

Medical management

Answer 7

Somatostatin analogues - octreotie or lanreotide - inhibit GH release