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Endocrine > Acromegaly > Flashcards

Acromegaly Flashcards

1
Q

Define Acromegaly?

A

Constellation of signs and symptoms caused by hypersecretion of GH in adults

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2
Q

What does Excess GH before puberty result in?

A

Gigantism

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3
Q

What is the aetiology of Acromegaly?

A

Most cases are caused by a GH-secreting pituitary adenoma
Rarely caused by excess GHRH causing somatotroph hyperplasia from hypothalamic ganglioneuroma, bronchial carcinoid or pancreatic tumours

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4
Q

What is the epidemiology of Acromegaly?

A

RARE
5/1,000,000
Age affected: 40-50 yrs

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5
Q

What are the presenting symptoms of Acromegaly?

A 
Very gradual progression of symptoms over many years
Rings and shoes becoming tight 
Increased sweating
Headaches 
Carpal Tunnel Syndrome
Hypopituitary Symptoms
Visual Distrubances 
Hyperprolactinaemia-related symptoms
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6
Q

What are some Hypopituitary symptoms related to Acromegaly?

A

Hypogonadism
Hypothyroidism
Hypoadrenalism

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7
Q

What are the visual disturbances related to Acromegaly caused by?

A

Due to compression of optic chiasm by tumour

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8
Q

What are the Hyperprolactinaemia-related symptoms with Acromegaly?

A

Irregular periods
Decreased Libido
Impotence

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9
Q

What are the signs of acromegaly on the hands?

A

Large spade-like hands
Thick greasy skin
Carpel tunnel-syndrome signs
Premature osteoarthritis

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10
Q

What are the signs of Acromegaly on the face?

A 
Prominent eyebrow ridge
Prominent cheeks
Broad nose bridge
Prominent Nasolabial Folds
Thick lips
Increased gap between teeth 
Large tongue 
Prognathism
Husky resonant voice
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11
Q

What is the husky resonant voice due to in Acromegaly?

A

Thickening of vocal cords

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12
Q

What is Visual Field Loss due to in Acromegaly?

A

Bitemporal superior quadrantopia progressing to bitemporal hemianopia

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13
Q

What are the signs of Acromegaly on physical examination related to neck?

A

Multinodular goitre

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14
Q

What are the signs of Acromegaly on physical examination related to feet?

A

Enlarged

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15
Q

What investigations do you do for Acromegaly?

A

Serum IGF-1
Oral Glucose Tolerance Test (OGTT)
Pituitary Function Tests
MRI of Brain

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16
Q

Why would we do a Serum IGF-1 for Acromegaly?

A

Useful screening test

GH stimulates IGF-1 secretion

17
Q

What could a Oral Glucose Tolerance Test (OGTT) be used for Acromegaly?

A

Positive result: failure of suppression of GH after 75 g oral glucose load

18
Q

What pituitary function tests would you do for Acromegaly?

A 
9am cortisol
Free T4 and TSH
LH and FSH
Testosterone
Prolactin
19
Q

Why would you do an MRI of the brain for Acromegaly?

A

Visualise the pituitary adenoma

20
Q

What is the surgical management plan for Acromegaly?

A

Trans-sphenoidal hypophysectomy

Radiotherapy adjunctive to surgery

21
Q

When do we do Medical treatment for Acromegaly?

A

If surgery is contraindicated or refused

22
Q

What drugs would you prescribe for Medical treatment for Acromegaly?

A

Subcutaneous Somatostatin Analogues
Oral Dopamine Agonists
GH antagonist

23
Q

What are some examples of Subcutaneous Somatostatin Analogues?

A

Octreotides

Lanreotide

24
Q

What are some common side effects of Subcutaneous Somatostatin Analogues?

A

Abdominal Pain
Steatorrhoea
Glucose Intolerance
Gallstones

25
Q

What are some examples of Oral Dopamine Agonists?

A

Bromocriptine

Cabergoline

26
Q

What are some side effects of Oral Dopamine Agonists?

A 
Nausea
Vomiting
Constipation
Postural Hypotension
Psychosis (RARE)
27
Q

What is an example of GH antagonist?

A

Pegvisomant

28
Q

What would you to do monitor disease control?

A

GH and IGF1 levels

29
Q

What are some CVS complications of Acromegaly?

A

Cardiomegaly

Hypertension

30
Q

What is a respiratory complication of Acromegaly?

A

Obstructive Sleep Apnoea

31
Q

What is a GI complication of Acromegaly?

A

Colonic Polyps

32
Q

What is a Reproductive complication of Acromegaly?

A

Hyperprolactinaemia (in 30% of cases)

33
Q

What are some metabolic complications of Acromegaly?

A 
Hypercalcaemia
Hyperphosphataemia 
Renal Stones
Diabetes Mellitus 
Hypertriglyceridaemia
34
Q

What are some psychological complications of Acromegaly?

A 
Depression
Psychosis (from dopamine agonists)
35
Q

What are some complications of Surgery for Acromegaly?

A 
Nasoseptal Perforation
Hypopituitarism
Adenoma recurrence 
CSF leak
Infection
36
Q

What is the prognosis for patients with Acromegaly?

A

Good with early diagnosis and treatment

Physical changes are irreversible

Endocrine (29 decks)

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