Acromegaly

Question 1

What is acromegaly

Answer 1

a clinical condition caused by chronic excessive circulating levels of growth hormone in adults

Question 2

What can excessive GH secretion before epiphyseal fusion result in

Answer 2

gigantism

Question 3

At what age are patients with acromegaly mostly diagnosed

Answer 3

between 40-60 years

Question 4

What sex is more affected by acromegaly

Answer 4

both the same

Question 5

What are the majority of cases caused by

Answer 5

a GH secreting pituitary adenoma

Question 6

What might a patient present with in acromegaly

Answer 6

local compression of the optic apparatus resulting in visual field defects
Hypopituitarism

Question 7

When is pituitary gigantism suspected

Answer 7

hone increased growth velocity is seen without manifestation of premature puberty

Question 8

What are some of the clinical presentations of acromegaly

Answer 8

increased sweating, headache, fatigue, lethargy
couarse features of the face frontal bossing, enlarged nose, deep nasolabial furrows,
enlarged hands/ feet, carpal tunnel syndrome
oily skin, skin tags
Coronary artery disease, impaired glucose tolerance, type 2 diabetes
obstructive sleep apnoea
colonic polyps
osteoarthritis, arthralgia
goitre, deep voice, hypercalcaemia, oligomenorrhoea / amenorrhoea

Question 9

What are the most useful investigation for acromegaly

Answer 9

IGF-1 levels (raised in acromegaly)

Question 10

If the IGF-1 levels are raised, what is the next step

Answer 10

serum GH should be measured after a 75mg oral glucose tolerance test (OGTT)

Question 11

What is indicative of acromegaly after an OGTT

Answer 11

When there is a failure of GH suppression to less than hug/L

Question 12

In what situations might there be a false positive of acromegaly

Answer 12

anorexia nervosa
malnutrition
adolescence
chronic liver and renal failure 
diabetes 
opiate addiction

Question 13

What should be performed once acromegaly is biochemically confirmed

Answer 13

pituitary MRI

Question 14

Give an overview of the treatment for acromegaly

Answer 14

Referred to a centre with endocrinologists, neurosurgeons and radiotherapists
Trans-sphenoidal surgery is 1st line for adenomas that are fully resectable or are causing visual impairment
Somatostatin analogues for those unsuitable for surgery
Radiotherapy or repeat surgery for pituitary adenomas still increasing in size after medical therapy

Question 15

How do somatostatin analogues work

Answer 15

They bind to somatostatin receptors - 2 and -5 on somatrotrophs and inhibit GH secretion

Question 16

What is used for patients with acromegaly headache

Answer 16

short acting octreotide

Question 17

What are side effects of octreotide

Answer 17

nausea
diarrhoea
gallstones

Question 18

What should be involved in the follow-up and monitoring of a patient with acromegaly

Answer 18

pituitary function tests and an OGTT every 4-6 weeks post op
Pituitary function annually
formal visual field assessment annually
MRI repeated yearly for the first few years and less often thereafter

Question 19

Describe the prognosis of acromegaly

Answer 19

Life expectancy is reduced by approximately 10 years
Mortality is twice that of the normal population if untreated
Joint symptoms persist after treatment