Acromegaly

Question 1

Definition

Answer 1

Excess growth hormone production

Question 2

Clinical features

Answer 2

Very tall during growth phase
After growth phase, thickened soft tissues (skin, jaw, lips) 
Change in appearance 
Increased shoe size 
Excessive sweating
Extreme tiredness
Headaches - due to rapid blood flow 
Sleep apnoea 
Visual defects

Question 3

Investigations

Answer 3

Measure growth hormone levels
(if levels are low, rule out acromegaly)
Measure IGF-1 levels
(increased in acromegaly)
Need a suppression test - glucose tolerance test
(in normal patients, glucose will suppress GH production)
(in acromegaly patients, GH production will remain unchanged)
MRI pituitary

Question 4

Management

Answer 4

Pituitary surgery

External radiotherapy to pituitary fossa

Question 5

Follow up after management

Answer 5

Perform GGT and if GH levels are over 1.0ug/L then drug therapy is needed

• dopamine agonist (cabergoline)
• somatostatin analogue
• GH antagoniset (pegrisomant)