Acromegaly Flashcards
define
excess of GH
presentation
- giant if before epiphyseal function in children (gigantism)
- thickened soft tissues e.g. skin, large jaw (prognathism), sweaty, large hands, snoring/sleep apnoea (thickened nasopharynx), carpal tunnel
- hypertension (heart- increased free fatty acids), cardiac failure, early CV death
- headaches (vascular)
- DM (gluconeogenesis)
- visual defects
- hypopituitarism
- colonic polyps and colon cancer
buzzwords for acromegaly presentation
increased shoe size
spade hands
wedding ring too tight
diagnosis of acromegaly (TOO MUCH)
- IGF1 (age and sex matched)
- GTT
- visual fields, CT, MRI
- hyperprolactinaemia
- PFTs (rule out DI)
why do you measure IGF1 and not GH?
IGF1 has a long-stable half life whereas GH does not
secretion in GH which may lead to IGF1 being repeated?
GH secretion is pulsatile so a low IGF1 may have to be repeated
describe the GTT (glucose tolerance test)
75g of oral glucose and check GH 0, 30, 60, 90 and 120 minutes (suppression test)
normal is <0.4ug/l after glucose, but in acromegaly the GH is unchanged/paradoxical rise
management of acromegaly
transsphenoidal pituitary surgery
radiotherapy
pharmacological
cancer surveillance for colonic and tubule-villous adenoma
manage cardiovascular risk factors (BP, lipids and glucose)
sleep apnoea management
describe transphenoidal pituitary surgery
cannot remove the whole pituitary
macro adenoma more likely to grow back
when is radiotherapy used
on its own or as an add on after surgery
what is radiotherapy on the pituitary likely to lead to?
hypopituitarism so hormone replacement therapy needed
example of pharmacological management options
somatostatin analogues
dopamine agonists
GH antagonists
examples of somatostatin analogues
sandostatin LAR IM
lanreotide SC
octreotide IM
role of somatostatin analogues
reduce GH
tumour shrinkage
used in pre-op as relieves headache in 1 hours
adverse of somatostatin analogues
local stinging flatulence diarrhoea abdominal pain long-term risk of gallstones
