ACROMEGALY AND GIGANTISM Flashcards
INVESTIGATIONS
- use IGF- 1 - not GH
- glucose test
- mri - looks for tumour
when are gh levels high
sleeping
effect of glucose on GH
inhibitory so will be low after eating
stimualtary substances of GH
ghelin (hormone stomach produces to let ur brain eat)
gHRH- from hypothalamus
deep sleep
exercise
sex hormones
how can we divide the symtoms of acromegaly
due to the GH secretion and due to the tumours
specific sign on x ray
spade phalanx - the distal phalanx becomes spade shape
ocreattide what is it and what conditons do we use it for
somatostatin agonist (mimics it)
acromegaly, carcinoid tumours (vipomas etc)
pegvisomat
GH antognoisy( if somatostatin doesn’t work )
it stops the production of IGF - production in the liver
remission criterra
Complete disappearance of hyperhidrosis - clinical marker of remission
GH < 1
IGF LEVELS ARE NORMAL
most common cause of acromegaly
pituatary adenoma
cause of it
excessive GH
whats the relationship between GH and iGF
its the GH that causes the IGF TO BE PRODUCED
types of igf
1 and 2
1 is associated with cancer
relationship between somatostatin and HG
Physiologically, growth hormone should be suppressed by somatostatin
why is excess gH a problem
it causes diabetes because of insulin resistance
symptoms
Large hands and feet
Outward growth of the jaw and head with increased inter dental spacing and macroglossia
Headaches
Erectile dysfunction
Voice change
Increased sweating
Mood disturbances
Fatigue.
why dont we use GH levels for diagnosis
because they vary so much within the day its not reliable. even in somone without acromegaly
tx
first line transphenoidal surgery
if CI
octreotide then unsuccessful pegvisomat
tx
first line transphenoidal surgery
if CI
octreotide then unsuccessful pegvisomat
complications
Visual problems due to optic chiasm
- arthritis
- hypertension
- hyperhydrosis
- carpal tunnel syndrome
- type 2 diabtes
7.Increased risk of colonic polyps which can become malignant - cardiac failur
complications
Visual problems due to optic chiasm
- arthritis
- hypertension
- hyperhydrosis
- carpal tunnel syndrome
- type 2 diabtes
7.Increased risk of colonic polyps which can become malignant - cardiac failur
why does the heart get affected
GH causes lv hypertophy
what triggeres release of prolactin
Thyrotropin releasing hormone(hypothalamus)
effect of dopmine on prolactin
inhibitory
what causes elevated levels of prolactin
preganancy
breastfeeding
sleep, stress
after sexual
where is dopamine made
hypothalamus
symptoms of high prolactin
galactorrhea
menstrual cycle disturbances - oligo/amen
chronic anovulation - infertility
men: hypogonadism,erectile dysfucntion, decreased libido
what metabolic distrubances can be observed
weight gain, pre diabetes,(insulin resistance dyslipidemia
what meds can increase prolactin levels
antipsychotic (decrease dopamine)
antidepressants
antihypertensives
h2 blockers
what is one of the most common reasons for hyperprolactinemia
primary hypothryoisim
