Acromegaly Flashcards
1
Q
Define what acromegaly is
A
The clinical state caused by ↑GH secretion from;
- Pituitary tumour 99% or hyperplasia
GH stimulates bone & soft tissue growth through ↑secretion of insulin-like growth factor.
2
Q
Outline the symptoms and signs of acromegaly
A
ABCDEFGH
- Arthopathy, acroparasthesia
- BP high
- Carpel tunnel syndrome
- Diabetes mellitus
- Enlarged hands, jaw, feet, tongue
- Field defects
- Gynocomastia, galactorrhoea, greasy skin, goitre
- Hypertension
Symptoms
- Acroparaesthesia (akron = extremities)
- Amenorrhoea
- Low libido
- Headache
- Inc sweating
- Snoring
- Arthralgia
- Backache
Signs
- Inc growth of hands, jaw & feet
- Coarsening face, wide nose
- Big supraorbital ridges
- Macroglossia (big tongue)
- Widely spaced teeth
- Puffy lips, lids, skin (oily and large pored), skin tags
- Scalp folds (cutis verticis gyrate)
- Skin darkening
- Acanthosis nigricans
- Laryngeal dyspnoea
- Obstructuve sleep apnoea
- Goitre (inc thyroid vascularity)
- Proximal weakness + arthropathy
- Carpel tunnel signs (50%)
- Signs from any pituitary mass
3
Q
Outline some complications of acromegaly
A
- Impaired glucose tolerance (40%)
- DM (15%)
- Vascular; <-
- Inc BP
- Left vent. Hypertrophy
- Cardiomyopathy
- Arrhythmias
- Inc risk of IHD & stroke
- Due to ↑BP, insulin resistance, GH-induced fribrinogen & ↓ in protein S
- Neoplasia; inc. colon cancer risk (may need colonoscopy)
4
Q
Outline the investigations for acromegaly
A
- ↑ Glucose
- ↑ Ca2+
- ↑ PO
- GH levels: fluctuate anyway, so useless. ↑GH in stress, sleep, puberty, pregnancy. ↑ glucose causes ↓ GH.
- Basal serum GH >0.4ug/L or ↑IGF-I, an oral glucose tolerance test with GH suppression is needed
- IF GH during OGTT is above 1ug/ L Acromegaly confirmed
- MRI scan of pituitary fossa
- Look for hypopituitarism
- Visual fields & acuity
- ECG, echo
- Old photos
5
Q
Outline the treatment of acromegaly briefly
A
- Surgical removal of tumour
- Somatostatin analogues (SSAs)
