Acromegaly

Question 1

What causes acromegaly?

Answer 1

Increased secretion of GH from anterior pituitary tumour or hyperplasia

Question 2

What is the function of GH

Answer 2

Stimulates bone and soft tissue growth through increased secretion of insulin like growth factor 1

Question 3

What are symptoms of acromegaly?

Answer 3

Acroparaestheseia
Amenorrhoea
Reduced libido
Headache
Increased sweating
Snoring
ARthalgia
Back ache

Growth

Question 4

Signs of acromegaly?

Answer 4

Increased growth of hands, jaw and feet
Coarsening of facial features, wide nose
Big supraorbital rdges
Macroglossia
Wide spaced teeth
Puffy lips, eyelids and skin
Scalp folds
Acathosis nigricans
OSA
Goitre

Question 5

What are complications of acromegaly?

Answer 5

Impaired glucose tolerance, DM
Vascular - hon, LVH, cardiomyopathy, arrhythmias, CCF, IHD, stroke
Neoplasia - increase colon cancer risk

Question 6

what tests for acromegaly?

Answer 6

Increased blood glucose, calcium and phosphate.
GH secretion is pulsatile and level peaks and troughs.
GH secretion is normally inhibited by high glucose but in acromegaly GH secretion fails to suppress.
Thus OCTT - GH level to confirm acromegaly.
MRI scan of pituitary fossa
ECG
Echo
Old photos
Visual fields and acuity

Question 7

what is the treatment of acromegaly?

Answer 7

Correct or prevent tumour compression by excising the lesion and to reduce CH and IGF1 to safe level:
TRans-sophenoid surgery
Somatostatin analogue 
GH antagonist
Radiotherapy