Acromegaly

Question 1

Effects of normal GH levels

Liver

Adipose tissue

Other tissues

Answer 1

Cartilage/bone growth
Muscle/organs- protein synthesis/growth

Lipolysis, release of FA

dec glucose utilization

Question 2

Prognathism

Hand findings

tongue

Answer 2

elongation of mandible (protrudes past upper jaw)

spade like, soft tissue thickened

macroglossia

Question 3

Test to confirm

GHRH stimulates

somatostatin inhibits

GH is made by

GH secretion is

main action of GH

Answer 3

serum IGF1 level

GH secretion

GH secretion

somatotroph cells

pulsatile

stimulate hepatic synth of IGF1

Question 4

Random GH is

GH half life is

Plasma IGF1 level is

normal IGF1 level depends on

ELevated IGF1 is due to

acromegaly confirmed w

Answer 4

nondiagnostic

short

stable

gender/age

excessive GH secretion

elevated IGF1

Question 5

Additional test for acromegaly

take GH levels

in acromegaly pts, GH levels remain

in normal individuals, glucose

Answer 5

fast overnight, give glucose in morning

30 min before glucose ingestion, then every 30 min after for 2 hrs

elevated in presence of glucose

suppresses GH levels

Question 6

Acromegaly CM

Answer 6

enlarged lips/tongue/nose

HTN

Enlarged hands, arthropathy, CTS

Prominent supraorbital ridges w large frontal sinuses

Type 2 DM

Question 7

w positive test for acromegaly, next step

Tx goal for acromegaly

Answer 7

MRI to look for tumor

normalize biochemical markers- reduce IGF1/GH

Eradicate/control tumor /out harming pituitary fxn

Relieve sx

Restore life expectancy

Question 8

Surgical options

Answer 8

Endoscopic transphenoidal resection

stereotactic radiosurgery

craniotomy

Question 9

Medical tx options

Answer 9

Octreotide- Somatostatin analog