Acromegaly

Question 1

What is acromegaly?

Answer 1

Clinical manifestation of excessive growth hormone (GH)

Question 2

What causes acromegaly?

Answer 2

Pituitary adenoma (most common)
Rarely, secondary to cancer e.g. lung, pancreas --> secretes ectopic GHRH or GH

Question 3

How can the features of acromegaly be classified?

Answer 3

Space occupying lesion
Overgrowth of tissues
Organ dysfunction
Symptoms of active raised GH

Question 4

What are the features associated with a SOL?

Answer 4

Headaches

Bitemporal hemianopia

Question 5

What are the acromegaly features due to overgrowth of tissues?

Answer 5

Prominent forehead + brow (frontal bossing)
Large nose
Large tongue (macroglossia)
Large hands + feet
Large protruding jaw (prognathism)
Arthritis from imbalanced growth of joints

Question 6

What are the acromegaly features due to organ dysfunction?

Answer 6

Hypertrophic heart
Hypertension
Type 2 diabetes
Colorectal cancer

Question 7

Which symptoms suggest active raised growth hormone?

Answer 7

Development of new skin tags

Profuse sweating

Question 8

What is the initial screening test for acromegaly?

Answer 8

Insulin-like growth factor 1 (IGF-1) –> will be raised

Question 9

Which other investigations should be done for acromegaly?

Answer 9

OGTT whilst measuring growth hormone (high glucose normally suppresses GH)
MRI brain for pituitary tumour
Refer to ophthalmology for visual field testing

Question 10

What is the definitive treatment for acromegaly?

Answer 10

Trans-sphenoidal removal of pituitary adenoma

Removal of cancer secreting ectopic hormones

Question 11

Which drugs can be used to block growth hormone in acromegaly?

Answer 11

Pegvisomant (GH antagonist)
Somatostatin analogues e.g. ocreotide
Dopamine agonists e.g. bromocriptine