Acromegaly

Question 1

What are the causes of Acromegaly?

Answer 1

Pituitary acidophil adenoma

Hyperplasia due to Growth hormone releasing hormone secreted from carcinoid tumour

Question 2

How does Growth hormone cause Acromegaly?

Answer 2

Stimulates excess growth of bone and soft tissue via ↑IGF1

Question 3

What are the symptoms of Acromegaly?

Answer 3

Headache
Snoring
Sweating
Amenorrhoea
Decreased libido
Arthralgia
Carpal tunnel syndrome

Question 4

What signs of Acromegaly can be seen in the hands?

Answer 4

Spade like
Thenar wasting
↑ skin fold thickness
↓ sensation + thenar wasting (due to carpal tunnel syndrome)

Question 5

What signs of Acromegaly can be seen in the face?

Answer 5

Prominent supraorbital ridges 
Coarse face
Wide nose
Big ears
Macroglossia
Widely spaced teeth
May have goitre

Question 6

What are some of the other signs of Acromegaly? Excluding hands/face

Answer 6

Puffy, oily, darkened skin
Proximal weakness
Arthropathy
Bitemporal hemianopia due to pituitary mass

Question 7

What are some of the complications of Acromegaly?

Answer 7

Endocrine - Impaired glucose tolerance, DM
CVS - ↑BP, LVH, Cardiomyopathy, ↑risk of IHD + stroke
Neoplasia - ↑ risk of colorectal Ca

Question 8

What investigations can be done in a patient with suspected Acromegaly?

Answer 8

Bloods - ↑IGF1, ↑Glucose, ↑PO4, ↑Ca2+
MRI brain
Visual acuity/fields
Glucose tolerance test - in a healthy patient glucose negatively feedsback on GH. When being secreted in excess, levels won’t drop after glucose being given

Question 9

What is the management of Acromegaly?

Answer 9

**Trans-sphenoidal excision
Somatostatin (GH inhibitor) analogues
GH antagonists
Radiotherapy