Acromegaly

Question 1

What is acromegaly.

Answer 1

It is due to the increased secretion of GH.

Question 2

What are the two main aetiologies of actomegaly. (2)

Answer 2

Pituitary tumour (99%). 
Hyperplasia (eg via ectopic GH releasing hormone from a carcinoid tumour).

Question 3

What is the male:female ratio of acromegaly.

Answer 3

1:1.

Question 4

What is the incidence of acromegaly in the UK.

Answer 4

3/million/year.

Question 5

What percentage of acromegaly cases are associated with MEN1.

Answer 5

5%.

Question 6

What is the mode of action of GH. (2)

Answer 6

GH stimulates soft tissue and bone growth though increased secretion of insulin like growth factor 1 (IGF1).

Question 7

What are the symptoms of acromegaly. (8)

Answer 7

Acroparaesthesia. 
Amenorrhoea. 
Decreased libido. 
Headache. 
Increased sweating. 
Snoring. 
Arthralgia. 
Backache.

Question 8

What is the result of increased GH secreton before bony epiphyses fuse.

Answer 8

Gigantism.

Question 9

How do the complications of acromegaly present. (2)

Answer 9

CCF.

Ketoacidosis.

Question 10

What are the complications of acromegaly. (8)

Answer 10

Impaired glucose tolerance (40%). 
DM (15%). 
Raised BP. 
Left ventricular hypertrophy. 
Cardiomyopathy. 
Arrhythmias. 
Increased risk of ischaemic heart disease and stroke. 
Increased risk of colon cancer.

Question 11

What is often seen on the blood test of a patient with acromegaly. (3)

Answer 11

Raised glucose.
Raised calcium.
Raised phosphate.

Question 12

How do you test for increased GH secretion.

Answer 12

In a normal patient, glucose suppresses GH secretion.

In a patient with acromegaly, it does not.

Question 13

What are the physical signs of acromegaly. (15)

Answer 13

Increased growth of hands, jaw and feet.
Coarsening of the face and widening of the nose.
Big supraorbital ridges.
Macroglossia.
Widely spaced teeth.
Puffy eyelids, lips, and skin (also skin tags).
Scalp folds.
Skin darkening.
Acanthosis nigricans.
Laryngeal dyspnoea.
Obstructive sleep apnoea.
Goitre.
Proximal weakness and arthropathy.
Carpal tunnel syndrome.
Sings from any pituitary mass (hypopituitarism and loca mass effects such as vision loss and hemianopia).