Acromegaly Flashcards
What is acromegaly?
Increased secretion of GH
What causes 99% of acromegaly cases?
Pituitary tumour
What does GH do?
Stimulate bone and soft tissue growth through increased secretion of insulin-like growth factor 1
What are some symptoms of acromegaly?
Large hands, box jaw, thick skin, arthritis, sight problems
What are some signs of acromegaly?
HTN, insulin resistance, bitemporal hemiopia
Why shouldn’t you rely on random serum GH?
Secretion is pulsatile. During peaks, normal and acromegaly levels can overlap. GH also increases in stress, sleep, puberty, pregnancy.
What other investigations could you do?
MRI of pituitary fossa, visual fields and acuity, look at old photos, ask about changes in ring/shoe size
What is the first line management?
Trans-sphenoidal surgery
What are the second line managements?
Somatostatin analogues, dopamine agonists, radiotherapy
What is the third line management?
GH antagonist
What are some issues with GH antagonists?
It suppresses IGF-1 but GH may rise and pituitary tumour can increase in size
What are some potential complications of acromegaly?
Diabetes, sleep apnoea, heart disease, gigantism
Give an example of a dopamine agonist
Cabergoline
Give an example of a somatostatin analogue
Octreotide
Give an example of a GH receptor antagonist
Pegvisomant
