Acromegaly Flashcards
What is acromegaly?
Acromegaly is a condition caused by excess growth hormone (GH) production, typically due to a pituitary adenoma, leading to tissue overgrowth and metabolic effects.
What are the common symptoms of acromegaly?
Enlarged hands and feet, coarsened facial features, joint pain, fatigue, headaches, and visual disturbances.
What are the main causes of acromegaly?
Most commonly caused by a growth hormone-secreting pituitary adenoma. Rare causes include ectopic GH or GHRH secretion by tumours.
What is the pathophysiology of acromegaly?
Excess GH stimulates the liver to produce insulin-like growth factor 1 (IGF-1), leading to abnormal growth of bones and soft tissues.
How does acromegaly present on physical examination?
Enlarged hands and feet, coarse facial features, frontal bossing, prognathism, widened interdental spaces, and thickened skin.
What is the difference between acromegaly and gigantism?
Acromegaly occurs after epiphyseal plate closure in adults, while gigantism occurs in children before the plates close, causing excessive linear growth.
What are the metabolic effects of acromegaly?
Insulin resistance, hyperglycaemia, and increased risk of diabetes mellitus.
What are the cardiovascular complications of acromegaly?
Hypertension, left ventricular hypertrophy, cardiomyopathy, and increased risk of cardiovascular disease.
What are the respiratory complications of acromegaly?
Obstructive sleep apnoea due to soft tissue overgrowth and upper airway obstruction.
How does acromegaly affect the musculoskeletal system?
Joint pain, osteoarthritis, and carpal tunnel syndrome.
What investigations are used to diagnose acromegaly?
Serum IGF-1 levels, oral glucose tolerance test (OGTT) with GH measurement, and pituitary MRI.
What is the role of the oral glucose tolerance test (OGTT) in acromegaly diagnosis?
GH levels normally suppress during an OGTT; failure to suppress indicates acromegaly.
What imaging is used to identify the cause of acromegaly?
MRI of the pituitary gland to detect adenomas.
What are the main differential diagnoses for acromegaly?
Hypothyroidism, Paget’s disease, and other causes of facial or soft tissue changes.
What is the first-line treatment for acromegaly?
Transsphenoidal surgical resection of the pituitary adenoma.
What medications are used to treat acromegaly if surgery is not possible or effective?
Somatostatin analogues (e.g., octreotide, lanreotide), GH receptor antagonists (e.g., pegvisomant), and dopamine agonists (e.g., cabergoline).
What is the role of radiotherapy in acromegaly management?
Radiotherapy is used in patients with residual or recurrent tumour growth after surgery or when medical therapy is ineffective.
What are the complications of untreated acromegaly?
Cardiovascular disease, diabetes, respiratory complications, joint problems, and increased risk of malignancies, particularly colorectal cancer.
How does acromegaly affect the gastrointestinal system?
Increased risk of colorectal polyps and colorectal cancer.
How does acromegaly affect vision?
Bitemporal hemianopia due to compression of the optic chiasm by the pituitary adenoma.
What is the role of IGF-1 in diagnosing acromegaly?
Elevated IGF-1 levels are a sensitive marker of excess GH activity and are used for initial screening and monitoring.
How is disease activity monitored in acromegaly?
By measuring serum IGF-1 levels and assessing GH suppression during an OGTT.
What lifestyle advice should be given to patients with acromegaly?
Regular monitoring for complications, healthy diet to manage weight and blood sugar, and physical therapy for joint pain.
What are the dental manifestations of acromegaly?
Prognathism, widened interdental spaces, and malocclusion due to jaw overgrowth.
What is the long-term prognosis for patients with acromegaly?
With early diagnosis and effective treatment, many complications can be managed, improving quality of life and reducing morbidity.
