Acromegaly Flashcards
1
Q
Causes
A
Pituitary acidophil adenoma in 99%
Hyperplasia from GHRH secreting carcinoid tumour
GH stimulates bone and soft tissue growth through ↑IGF1
2
Q
Symptoms
A
Acroparaesthesia Amenorrhoea, ↓libido Headache Snoring Sweating Arthralgia, back ache Carpal tunnel (50%) increased shoe size
3
Q
Hand signs
A
Spade-like Thenar wasting Boggy sweaty palms (if active) ↑ skin fold thickness Carpal tunnel: ↓ sensation + thenar wasting
4
Q
Face signs
A
Prominent supraorbital ridges Scalp folds: cutis verticis gyrata Coarse face, wide nose and big ears Prognathism: look from side Macroglossia Widely-spaced teeth Goitre
5
Q
Other signs
A
Puffy, oily, darkened skin skin
Proximal weakness + arthropathy
Pituitary mass effects: bitemporal hemianopia
6
Q
Endocrine complications
A
Impaired glucose tolerance (40%)
DM (15%)
7
Q
CVS complications
A
↑BP
LVH
Cardiomyopathy
↑ IHD and ↑ stroke
8
Q
Neoplastic complications
A
↑ risk of CRC
9
Q
Ix
A
↑IGF1 ↑ glucose, ↑Ca, ↑PO4 Glucose tolerance test GH fails to suppress ̄c glucose in acromegaly Visual fields and acuity MRI brain
10
Q
Rx
A
1st line: trans-sphenoidal excision
2nd line: somatostatin analogues – octreotide
3rd line: GH antagonist – pegvisomant
4th line: radiotherapy
