Acromegaly Flashcards
What is the epidemiology of acromegaly?
Uncommon - 40-60million people worldwide
M:F equally affected
30-50yrs
What is the aetiology and pathophysiology of acromegaly?
Occurs due to a hypersecretion of growth hormone (GH)
GH released by anterior pituitary:
- Increased by GHrH
- Decreased by somatostatin
Stimulates soft tissue and skeletal growth by stimulating insulin-like growth factor (IGF-1) synthesis in the liver
Mostly caused by a pituitary tumour:
- Mostly a benign adenoma
How does acromegaly present?
Increase in the size of hands + feet
Increased interdental spacing, macroglossia
Corsening of facial features e.g. prominent supra-orbital ridges and lower jaw
Carpal tunnel syndrome
Proximal muscle weakness
Hoarse voice
Bilateral hemianopia, heacache (from tumour)
Sweating
Oligo/amenorrhoea, infertility
If GH hypersecretion ocurs before the epiphyses have fused = gigantism, after = acromegaly
What are some complications of acromegaly?
Diabetes
Cardiomyopathy, heart failure, IHD, stroke
Osteoporosis
Obstructive sleep apnoea
How do you investigate acromegaly?
Random GH measurements
GH is secreted in a pulsatile manner and more in sleep, stress and puberty and less in pregnancy:
- Repeated high levels needed to confirm diagnosis
Serum IGF-1:
- Mostly correlates with GH secretion; can be used for screening
Oral glucose tolerance test/OGTT:
- Diagnostic test for acromegaly as rising levels of glucose normally inhibit GH secretion so during this
test GH levels should be undetectable – will be however as GH secretion is in excess in acromegaly
MRI:
- Pituitary fossa - to detect tumour
How do you treat acromegaly?
Medical:
- Somatostatin analogues i.e. lanreotide, octreotide (IM)
Surgical:
- Trans-sphenoidal surgery to remove tumour
- Can also have radiotherapy as an adjuvant
- High cure rate; pituitary function tests required after to assess need for treatment for
hypopituitarism or further surgery/medical options
Yearly for GH measurements and cardiovascular assessment
How does growth hormone deficiency present?
Low mood, low energy, poor sleep
MORE
