Acromegaly Flashcards
what causes acromegaly?
pituitary acidophil adenoma secretes growth hormone, which causes secretion of insulin-like growth factors
acromegaly - features
arterial muscle hypertrophy → HTN anti-insulin effect → diabetes/IGT soft tissue growth → big tongue, lips, boggy palms, cardiomyopathy, CRC sweat gland hypertrophy → sweating++ bone growth → typical facies
acromegaly - examination
HANDS larger than yours wasting thenar eminence - carpal tunnel check median sensation sweating + bogginess - active skin fold thickness - active
FACE prominent supraorbital ridges big nose, lips, ears prognathism + wide teeth separation VFs - bitemporal hemi
EXTRAS
stand from chair armless
glucose
BP, pulse, JVP
WOULD ALSO
axillary + pubic hair - exclude hypopituitarism
serial photos from past
goitre - just from enlargement from GH
acromegaly - mnemonic of features
palms boggy + sweaty - active (vs inactive post-treatment)
Arthropathy BP Carpal tunnel Diabetes Enlarged tongue, heart, thyroid Fields - bitemporal hemi
acromegaly - diagnosis
1) OGTT - failure of suppression of GH levels (GH is an insulin antagonist - normally suppressed by glucose)
2) average hourly GH level
3) insulin-like growth factor levels
acromegaly - management
1) medical - prep for or instead of surgery: reduce GH with bromocryptine or more often, somatostatin analogues (ocreotide)
2) neurosurgery to remove tumour - best definitive treatment (risk infertility - gonadotrophin damage)
3) ± radiotherapy - post-op as adjunct to reduce recurrence, or if surgery fails to control GH levels
colonoscopy screening from 40y
acromegaly - history
headaches?
vision problems?
tingling in hands at night? (carpal tunnel)
tingling in feet? (diabetic neuropathy)
sweat easily?
sexual problems - problems getting an erection?
slow increase in shoe/glove/hat size?
acromegaly - investigations
lateral skull xray + tomograms of pituitary fossa
CT/MRI - is tumour confined to fossa or does it extend to optic chiasma?
perimetry - formal VF test
