Acromegaly

Question 1

Define acromegaly

Answer 1

Excess growth hormone secretion

Question 2

What causes acromegaly?

Answer 2

Pituitary tumours (99%)

Ectopic secretion for tumour (rare)

Question 3

What are the symptoms of acromegaly?

Answer 3

Sweating
Headache (due to local pressure)
Increase size of hands and feet (increase ring and shoe size)
Oligo/amenorrhoea 
Infertility
Proximal muscle weakness

If in childhood will result in gigantism

Question 4

What are the signs of acromegaly?

Answer 4

Coarsening of facial features 
Prominent supra-orbital ridges
Prognathism (prominent lower jaw)
Increased interdental spacing
Macroglossia (enlarged tongue)
Doughy spade like hands
Carpel tunnel syndrome
Hoarse voice
Raised BP/JVP (Cardiomegaly)
Displaced apex beat (Cardiomegaly)

Question 5

What are the investigations for acromegaly?

Answer 5

OGTT (GOLD)

• With glucose administration = GH inhibition so levels undeteactble
• In acromegaly failure to suppress GH

Serum IGF-1 – This can be used as a screening test, In most cases serum IGF-1 levels correlate with GH secretion over the past 24 hrs

IMAGING

• MRI of pituitary fossa
• ECG/echo of heart for cardiomegaly

Question 6

What is the treatment for acromegaly?

Answer 6

Somatostatin analogues, e.g. lanreotide, octreotide (IM injections)

Surgery/chemo for tumours