Acromegaly Flashcards
1
Q
Define acromegaly
A
Hypersecretion of growth hormone in adults
Excess GH in children -> gigantism
2
Q
What are the causes/risk factors of acromegaly?
A
Excess GH
• GH secreting pituitary adenoma (99%)
Excess GHRH -> somatotroph hyperplasia
• Hypothalamic ganglioneuroma
• Bronchial carcinoid tumour
• Pancreatic tumour
3
Q
What are the symptoms of acromegaly?
A
Insidious onset • Fatigue • Rings and shoes too tight • Increased sweating • Headache • Carpal tunnel syndrome • Visual disturbances • Snoring/sleep apnoea
Diabetes mellitus/impaired glucose tolerance
• Polyuria
• Polydipsia
• Increased appetite
Hyperprolactinaemia • Reduced libido • Amenorrhoea/oligomenorrhoea • Galactorrhoea • Erectile dysfunction
Hypopituitarism
4
Q
What are the signs of acromegaly?
A
- Deep, husky voice
- Frontal bossing
- Enlarged nose
- Jaw enlargement
- Prognathism
- Separation of teeth
- Macroglossia
- Enlarged spade-like hands and feet
- Hypertension
- Arrhythmias
- Arthropathy
- Organomegaly e.g. goitre, prostate
- Cranial nerve palsies
5
Q
What investigations are carried out for acromegaly?
A
• Serum IGF-1 – elevated (also ↑ in puberty and pregnancy) • Oral glucose tolerance test – failure of GH suppression • Pituitary function test - 9am cortisol - Free T4/TSH - LH/FSH, testosterone – may be low - Prolactin – often elevated • Visual field testing • MRI brain – pituitary tumour
6
Q
What is the management for acromegaly?
A
- Transsphenoidal surgery
- Radiotherapy
- Somatostatin analogues e.g. octreotide
- Dopamine agonists e.g. cabergoline
- GH receptor antagonist e.g. pegvisomant (££)
Monitoring • GH and IGF-1 • Pituitary function tests • Echocardiography • Colonoscopy • Blood glucose
7
Q
What are the complications of acromegaly?
A
- Cardiomyopathy
- Hypertension
- OSAS
- Colonic polyps
- Hyperprolactinaemia
- Hypercalcaemia
- Hyperphosphataemia
- Renal stones
- Diabetes mellitus
- Depression
