Acromegaly Flashcards
What are features of Acromegaly
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Acanthosis nig
BP raised
CTS
DM
Enlarged organs - malignant risk
Field defect – BTH
Goitre
HF and hirsuitism
IGF-1
Joints
Kyphosis
Lacramation
Myopathy
Features of the face that change
Prominent supra orbital ridge
Bitemp hemianopia
Large ears and nose
Lip swelling
Marcoglossia
Prognathism
Widely spaced teeth
Investigations for acromegaly
IGF-1 - if raised
OGTT with GH measurements
Other investigations
ECG/ECHO
HBA1C
TFTs and pituitary screen (LH/FSH?testosterone/ACTH)
Consider investigating malignancy
MRI pituitary with contrast
Visual field assessment
Epworth sleep score - >11 indicates apnoea
Management of acromegaly
Transphenoidal surgery
Octreotide (somatostatin analogue)
Dopamine agonists e.g. cabergoline
GH receptor antagonists e.g. pregnisomant
Causes of macroglossia
Acromegaly
Hypothyroidism
Down syndrome
What are causes of acanthosis nigricans
Diabetes mellitus
Ectopic ACTH production
Cushings syndrome
Gastric cancer
Post trans sphenoidal surgery complications
meningitis
Diabetes insipidus
Haemorrhage
CSF leak
Headache
Pan.hypo.pituituarism
What are signs of active disease in acromegaly?
Sweating
skin tags
Raised BP
Bitemporal hemianopia
why would you check calcium in acromegaly
as part of MEN screen
MEN 1 -
Pancreas
Parathyroid
Pituitary adenoma
Obstructive sleep apnoea occurs in Acromegaly - what are some risks of OSA?
Stroke
Cor pulmonale
T2RF
Why do you measure IGF-1 in acromegaly
1) GH is secreted in a pulsatile way and has. a short half life - so difficult to obtain true levels
2) IGF 1 correlates with GH secretion in the last 24hrs and is a static measurement
Management of acromegaly
Surgery - transsphenoidal
Gamma knife if unfit for surgery
Octreotide
Dopamine agonsists e..g cabergoline/bromocuptine
GH receptor antagonists - Pegvisomant
Stop driving
