Acromegaly

Question 1

What is it?

Answer 1

Excess growth hormone secretion in adulthood

Question 2

Causes

Answer 2

Pituitary adenoma
Carcinoid/small cell tumours
Hypothalamic tumours

Question 3

How might it present?

Answer 3

Sweating
Headaches
Sleep apnoea
Uncontrolled HTN or diabetes

Question 4

What would you ask patient?

Answer 4

HPC:
Headaches
Loss of vision
Sweating
Change in ring or shoe size or dentures
Change in appearance from old photos
Snore

PMH: HTN, diabetes

Question 5

How would you examine a patient with suspected acromegaly?

Answer 5

Hands
Sweaty - active disease
Acanthosis nigracans
Supraorbital ridges
Macroglossia
Interdental separation

Visual fields
Fundoscopy
Carpel tunnel

BP
HF
blood glucose monitoring
Proximal myopathy

Question 6

How is it diagnosed?

Answer 6

IGF-1 to screen and monitor disease activity
OGTT and GH level 2hrs after
MRI brain
Tests for complications

Question 7

How is it treated?

Answer 7

Transphenoidal hyperphisectomy
Somatastatin analogues: octreotide
Dopamine agonists: bromocriptine, cabergoline

Question 8

Complications of sleep apnoea

Answer 8

Visual field defects
Sleep apnoea
HTN
cardiomégaly
Diabetes
Carpel tunnel and arthritis
Proximal myopathy
Colonic and uterine tumours