Acromegaly

Question 1

What is acromegaly?

Answer 1

Increased secretion of growth hormone (GH)

Question 2

What is the difference between acromegaly and gigantism? (2)

Answer 2

Acromegaly = occurs in adults AFTER fusion of epiphyseal plates

Gigantism = occurs in children BEFORE bony epiphyses fuse

Question 3

How does growth hormone cause increased bone and soft tissue growth?

Answer 3

Through increased secretion of IGF-1 (insulin-like growth factor-1)

Question 4

How does acromegaly present?

Answer 4

Very slow insidious onset over many years

Question 5

What similarities are there between acromegaly and gigantism?

Answer 5

Both involve increased production of GH

Question 6

What is the main cause of acromegaly?

Answer 6

Pituitary adenoma (benign)

Question 7

What are the symptoms of acromegaly? (5)

Answer 7

Acroparesthesia
Arthralgia
Excess sweating
Decreased libido
Headache

Question 8

What are the signs of acromegaly? (7)

Answer 8

Massive growth of hands, feet, jaw
Big tongue, widely spaced teeth
Obstructive sleep apnoea
Deep voice
Puffy lips, eyelids, skin
Skin darkening
Protrusion of forehead

Question 9

How would you investigate acromegaly? (2)

Answer 9

• Oral glucose tolerance test: GH still raised

- MRI head: pituitary adenoma

Question 10

How would you treat acromegaly? (3)

Answer 10

Transsphenoidal surgery (remove adenoma)
Somatostatin analogues - octreotide(limit GH production)
Pegvisomant (GH receptor antagonist)