Acromegaly

Question 1

What is acromegaly?

Answer 1

Clinical manifestation of excessive growth hormone

Question 2

Causes of acromegaly

Answer 2

Unregulated growth hormone secretion by a pituitary adenoma

RARE: secondary to a cancer, such as lung or pancreatic cancer

Question 3

Consequences of pituitary tumour on eyesight

Answer 3

Pressure on the optic chiasm will cause bitemporal hemianopia

Question 4

Investigations for acromegaly

Answer 4

Insulin-like Growth Factor 1 (IGF-1) is the initial screening test (raised)
Oral glucose tolerance test whilst measuring growth hormone (high glucose normally suppresses growth hormone)
MRI brain for the pituitary tumour
Refer to ophthalmology for formal visual field testing

Question 5

What medicines block GH

Answer 5

Pegvisomant (GH antagonist given subcutaneously and daily)
Somatostatin analogues to block GH release (e.g. ocreotide)
Dopamine agonists to block GH release (e.g. bromocriptine)

Question 6

Treatment

Answer 6

Trans-sphenoidal removal fo pituitary tumour

Question 7

Manifestation of SOL

Answer 7

Headaches

Visual field defect (“bitemporal hemianopia”)

Question 8

Presentation of acromegaly

Answer 8

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

Hypertrophic heart
Hypertension
Type 2 diabetes
Colorectal cancer

New skin tags
Profuse sweating