ACROMEGALY Flashcards
WHAT IS THE CAUSE OF ACROMEGALY?
GH secreting pituitary tumour
WHAT ARE THE SIGNS OF ACROMEGALY?
1) Increase size of hand and feet
2) Coarse facial features
3) Frontal bossing of forehead (protruding forehead and brow furrow)
4) Protrusion of chin
5) Widely spaced teeth
6) Enlargement of tongue and soft palate
7) Puffiness of hand
WHAT ARE THE SYMPTOMS OF ACROMEGALY?
1) Sweating
2) Headache
3) Hypertension
4) Diabetes mellitus
3) Sleep apnoea
WHAT ARE THE INVESTIGATIONS OF ACROMEGALY?
1) Oral glucose tolerance test and IGF-1
2) Serum prolactin - elevated as it is co- released with GH
3) Pituitary MRI
4) Serum IGF-1 - elevated
5) Random serum GH
WHAT ARE THE RESULTS OF OGTT AND IGF-1 IN ACROMEGALY?
- failure to suppress growth hormones and elevated levels of IGF-1.
WHAT IS THE TREATMENT OF CHOICE FOR ACROMEGALY?
- surgery
WHAT IS THE MEDICAL TREATMENT FOR ACROMEGALY?
1) Somatostatin analogues (monthly injections)- improve symptoms and control GH and IGF-1 levels
2) GH receptor blockades - control IGF-1 in refractory acromegaly
3) Dopamine agonists - control GH
4) Stereotactic radiotherapy - targeted treatment at higher dose but only suitable for lesions away from optic chiasm.
WHAT ARE THE SIDE EFFECTS OF RADIOTHERAPY?
1) gradual onset hypopituitarism
2) cerebrovascular disease
HOW DO YOU MONITOR DISEASE ACTIVITY?
1) Repeat OGTT after surgery to see if there is persistent disease.
2) Long term follow up to ensure adequate control of GH and IGF-1 and exclude recurrence
3) Periodic screening colonoscopy - risk of neoplasia
WHAT IS THE PURPOSE BEHIND THE OGTT?
- In hypoglycaemia, GH is released which acts on liver to release IGF-1
- In hyperglycaemia, physiological secretion of GH is inhibited.
- In acromegaly, GH secretion is autonomous and doesn’t suppress and may paradoxically rise with hyperglycaemia.
