Acromegaly Flashcards
What is acromegaly?
Signs + symptoms caused by hypersecretion of GH in adults
What is the term used for excess GH before puberty?
GIGANTISM
What causes acromegaly?
GH-secreting pituitary adenoma
RARELY caused by excess GHRH causing somatotroph hyperplasia from hypothalamic ganglioneuroma, bronchial carcinoid or pancreatic tumours
Describe the epidemiology of acromegaly
RARE
5/ 1,000,000
Age: 40-50 yrs
List 6 features of the presenting complaint in acromegaly
Rings + shoes becoming tight Increased sweating Headaches Carpal tunnel syndrome Hypopituitary symptoms Hyperprolactinaemia
How do symptoms arise in acromegaly?
Very gradual progression of symptoms over many years
What 4 signs are seen in the hands in acromegaly?
Large spade-like hands
Thick greasy skin
Carpel tunnel syndrome signs
Premature osteoarthritis
Acromegaly can give symptoms of hypopituitarism. Describe these
Hypogonadism
Hypothyroidism
Hypoadrenalism
Visual disturbances (compression of optic chiasm by tumour)
What 9 signs may be seen in the face of a patient with acromegaly?
Prominent eyebrow ridge Prominent cheeks Broad nose bridge Prominent nasolabial folds Thick lips Increased gap between teeth Large tongue Prognathism Husky resonant voice (due to thickening of vocal cords)
What 3 general signs are seen in acromegaly?
Bitemporal superior quadrantopia progressing to bitemporal hemianopia
Multinodular goitre
Enlarged feet
What investigations should be used in acromegaly?
Serum IGF-1: screening test GH stimulates IGF-1 secretion Oral Glucose Tolerance Test Pituitary Function Tests MRI of Brain: visualise pituitary adenoma
Describe the surgical treatment of acromegaly
Trans-sphenoidal hypophysectomy
with adjunctive Radiotherapy
Only curative tx
What is used to monitor acromegaly disease control?
GH + IGF1 levels
Describe the medical treatment of acromegaly
SC Somatostatin Analogues
Oral Dopamine Agonists
GH Antagonist (pegvisomant)
List 5 metabolic complications of acromegaly
Hypercalcaemia Hyperphosphataemia Renal stones Diabetes mellitus Hypertriglyceridaemia
List 5 non metabolic complications of acromegaly
Cardiomegaly HTN Obstructive sleep apnoea Colonic polyps Hyperprolactinaemia (in 30%)
What is the prognosis in acromegaly?
GOOD with early dx + tx
Physical changes are irreversible
What 5 complications may arise due to surgery in acromegaly?
Nasoseptal perforation Hypopituitarism Adenoma recurrence CSF leak Infection
What does hyperprolactinaemia cause?
Irregular periods
Decreased libido
Impotence
What is a positive result in a oral glucose tolerance test?
Failure of suppression of GH after 75 g oral glucose load
What is measured in pituitary function tests?
9am cortisol Free T4 + TSH LH + FSH Testosterone Prolactin
When is acromegaly managed medically?
if surgery is contraindicated or refused
Give an examples of subcutaneous somatostatin analogues. List 4 side effects of these medications
Octreotide Abdominal pain Steatorrhoea Glucose intolerance Gallstones
Give 2 examples of oral dopamine agonists. List 4 side effects of these medications
Bromocriptine, Cabergoline N+V Constipation Postural hypotension Psychosis (RARE)
