Acromegaly

Question 1

Define acromegaly.

Answer 1

A rare, chronic disease caused by excessive secretion of growth hormone (GH), usually due to a pituitary somatotroph adenoma.

Question 2

Explain the aetiology/risk factors of acromegaly.

Answer 2

Certain familial conditions can increase the risk of getting acromegaly.

Question 3

Summarise the epidemiology of acromegaly.

Answer 3

The prevalence of acromegaly is 5 per million. It usually presents between the ages of 30-50 years old.

Question 4

Recognise the presenting symptoms of acromegaly. Recognise the signs of acromegaly on physical examination.

Answer 4

Coarsening of facial features
Soft-tissue and skin changes
Carpal tunnel syndrome
Joint pain and dysfunction
Snoring
Alterations in sexual functioning
Fatigue
Hypertension, arrhythmias
Organomegaly
Increased appetite, polyuria/polydipsia
Headaches

Question 5

Identify appropriate investigations for acromegaly and interpret the results.

Answer 5

Test for IGF-1 in blood

Oral glucose tolerance test (OGTT)

Random serum growth hormone (GH)

Question 6

Generate a management plan for acromegaly.

Answer 6

Transsphenoidal surgery: Treatment of choice. This is really effective. After surgery, there will be yearly follow ups by an endocrine clinic.

External irradiation: This is usually done as a follow up to a failed surgery and is more common in older patients.

Somatostatin analogue e.g. Octreotide

Question 7

Identify the possible complications of acromegaly and its management.

Answer 7

Organomegaly
Increased risk of DM2
Hypertension
Colon polyps
Osteoarthritis
Carpal tunnel syndrome
Hypopituitarism

Question 8

Summarise the prognosis for patients with acromegaly.

Answer 8

Acromegaly is associated with serious complications and premature death. Prior to recent years with the routine implementation of more effective treatment modalities, the mean mortality estimate for acromegaly was 2- to 3-fold the expected level in the general population.