Acromegaly

Question 1

What is acromegaly?

Answer 1

Endocrine disorder caused by excessive secretion of growth hormone (GH) from the pituitary gland.

Question 2

Most common cause of acromegaly?

Answer 2

Excessive GH 2ary to pituitary adenoma (95%)

Question 3

Features of acromegaly?

Answer 3

• coarse facial appearance, spade-like hands, increase in shoe size
• large tongue, prognathism, interdental spaces
• excessive sweating and oily skin: caused by sweat gland hypertrophy
• features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
• raised prolactin in 1/3 of cases → galactorrhoea

Question 4

1st line investigation in acromegaly?

Answer 4

Serum IGF-1 levels

Question 5

1st line mx of acromegaly?

Answer 5

Trans-sphenoidal surgery

Question 6

What medication is used 1st line in acromegaly?

Answer 6

Somatostatin analogue e.g. octreotide

Question 7

Role of somatostatin analogues in acromegaly?

Answer 7

directly inhibits the release of growth hormone

Question 8

Complications of acromegaly?

Answer 8

1) HTN

2) Diabetes

3) Cardiomyopathy

4) Colorectal cancer

Question 9

How can pituitary adenomas present?

Answer 9

1) Excess secretion of hormone:
- GH & acromegaly
- ACTH & Cushing’s
- Prolactin & amenorrhoea/galactorrhoea

2) Depletion of hormone(s):
- generalised hypopituitarism (due to compression of normal pituitary gland)

3) Stretching of the dura within/around the pituitary fossa (causing headaches)

4) Compression of the optic chiasm (causing a bitemporal hemianopia)

Question 10

What imaging is indicated in pituitary adenoma?

Answer 10

MRI brain with contrast

Question 11

1st line medical mangement of GH-secreting adenomas?

Answer 11

somatostatin analogues (e.g., octreotide, lanreotide)

Question 12

What will women with hypothyroidism need to increase their thyroid hormone replacement dose by in pregnancy?

Answer 12

by up to 50% as early as 4-6 weeks of pregnancy