Acromegaly

Question 1

what is acromegaly?

Answer 1

• a condition caused by elevated levels of growth hormone (GH) over a prolonged period
• occurs post-epiphyseal fusion

Question 2

what is the aetiology of acromegaly?

Answer 2

• pituitary adenoma (e.g. GH)
• ectopic secretion of GHRH (e.g. SCLC)
• genetic (e.g. MEN1)

Question 3

what are the symptoms of acromegaly?

Answer 3

• headache
• visual disturbance
• change in appearance
• weight gain
• fatigue
• snoring
• arthralgia
• voice changes
• skin tags
• hyperprolactinaemia (e.g. amenorrhoea, galactorrhoea, erectile dysfunction, reduced libido, infertility)

Question 4

what are the signs on examination of acromegaly?

Answer 4

• frontal bossing
• macroglossia
• prognathism
• interdental separation
• enlarged hands + feet
• skin thickening
• tight rings on fingers
• CTS
• bitemporal hemianopia
• galactorrhoea
• hypertension

Question 5

what are the investigations for acromegaly?

Answer 5

• visual field examination (e.g. bitemporal hemianopia)
• IGF-1 ↑
• OGTT (e.g. GH will not be suppressed)
• plasma glucose ↑
• plasma calcium ↑
• plasma phosphate ↑
• plasma triglycerides ↑
• pituitary assessment (e.g. prolactin, cortisol, TFTs, FSH, LH, oestradiol, testosterone)
• MRI pituitary

Question 6

what is the management of acromegaly?

Answer 6

• transsphenoidal
• somatostatin analogue (e.g. octreotide, lanreotide)
• pegvisomant (e.g. inhibits the synthesis of IGF-1 by acting as a growth hormone receptor antagonist)
• bromocriptine, cabergoline (e.g. bind to dopamine receptors in the pituitary which suppresses GH secretion)
• ? stereotactic radiotherapy

Question 7

what are the long-term complications of acromegaly?

Answer 7

• CVD (e.g. hypertension, congestive cardiac failure, stroke)
• T2DM
• obstructive sleep apnoea
• colonic polyps
• malignancy (e.g. thyroid)
• hypopituitarism
• CTS
• OA