Acromegaly Flashcards
Define Acromegaly?
Constellation of signs and symptoms caused by hypersecretion of GH in adults
What does Excess GH before puberty result in?
Gigantism
What is the aetiology of Acromegaly?
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
What is the epidemiology of Acromegaly?
RARE
5/1,000,000
Age affected: 40-50 yrs
What are the presenting symptoms of Acromegaly?
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
What are some Hypopituitary symptoms related to Acromegaly?
Hypogonadism
Hypothyroidism
Hypoadrenalism
What are the visual disturbances related to Acromegaly caused by?
Due to compression of optic chiasm by tumour
What are the Hyperprolactinaemia-related symptoms with Acromegaly?
Irregular periods
Decreased Libido
Impotence
What are the signs of acromegaly on the hands?
Large spade-like hands
Thick greasy skin
Carpel tunnel-syndrome signs
Premature osteoarthritis
What are the signs of Acromegaly on the face?
Prominent eyebrow ridge Prominent cheeks Broad nose bridge Prominent Nasolabial Folds Thick lips Increased gap between teeth Large tongue Prognathism Husky resonant voice
What is the husky resonant voice due to in Acromegaly?
Thickening of vocal cords
What is Visual Field Loss due to in Acromegaly?
Bitemporal superior quadrantopia progressing to bitemporal hemianopia
What are the signs of Acromegaly on physical examination related to neck?
Multinodular goitre
What are the signs of Acromegaly on physical examination related to feet?
Enlarged
What investigations do you do for Acromegaly?
Serum IGF-1
Oral Glucose Tolerance Test (OGTT)
Pituitary Function Tests
MRI of Brain
Why would we do a Serum IGF-1 for Acromegaly?
Useful screening test
GH stimulates IGF-1 secretion
What could a Oral Glucose Tolerance Test (OGTT) be used for Acromegaly?
Positive result: failure of suppression of GH after 75 g oral glucose load
What pituitary function tests would you do for Acromegaly?
9am cortisol Free T4 and TSH LH and FSH Testosterone Prolactin
Why would you do an MRI of the brain for Acromegaly?
Visualise the pituitary adenoma
What is the surgical management plan for Acromegaly?
Trans-sphenoidal hypophysectomy
Radiotherapy adjunctive to surgery
When do we do Medical treatment for Acromegaly?
If surgery is contraindicated or refused
What drugs would you prescribe for Medical treatment for Acromegaly?
Subcutaneous Somatostatin Analogues
Oral Dopamine Agonists
GH antagonist
What are some examples of Subcutaneous Somatostatin Analogues?
Octreotides
Lanreotide
What are some common side effects of Subcutaneous Somatostatin Analogues?
Abdominal Pain
Steatorrhoea
Glucose Intolerance
Gallstones
What are some examples of Oral Dopamine Agonists?
Bromocriptine
Cabergoline
What are some side effects of Oral Dopamine Agonists?
Nausea Vomiting Constipation Postural Hypotension Psychosis (RARE)
What is an example of GH antagonist?
Pegvisomant
What would you to do monitor disease control?
GH and IGF1 levels
What are some CVS complications of Acromegaly?
Cardiomegaly
Hypertension
What is a respiratory complication of Acromegaly?
Obstructive Sleep Apnoea
What is a GI complication of Acromegaly?
Colonic Polyps
What is a Reproductive complication of Acromegaly?
Hyperprolactinaemia (in 30% of cases)
What are some metabolic complications of Acromegaly?
Hypercalcaemia Hyperphosphataemia Renal Stones Diabetes Mellitus Hypertriglyceridaemia
What are some psychological complications of Acromegaly?
Depression Psychosis (from dopamine agonists)
What are some complications of Surgery for Acromegaly?
Nasoseptal Perforation Hypopituitarism Adenoma recurrence CSF leak Infection
What is the prognosis for patients with Acromegaly?
Good with early diagnosis and treatment
Physical changes are irreversible
