Acromegaly And Prolactinoma 12.12.23

Question 1

Define acromegaly

Answer 1

Abnormal growth of hands, feet and face due to overproduction of GH

Question 2

What are 5 acromegaly co-morbidities

Answer 2

Hypertension and heart disease

Cerebrovascular events and headache

Arthritis

Sleep apnoea

Insulin-resistant diabetes

Question 3

What are criteria for diagnosing acromegaly?

Answer 3

Acromegaly excluded if:

GH <0.4ng/ml and normal IGF-1

If abnormal do 75gm glucose tolerance test (GTT)

Acromegaly excluded if IGF-1 normal and GTT nadir GH <1ng/ml

Question 4

What are the 3 treatment options for acromegaly?

Answer 4

Pituitary surgery (size of tumour and surgeon determine the success of surgery)

Medical therapy (dopamine agonists e.g. cabergoline)

Radiotherapy

Question 5

Define prolactinoma

Answer 5

Lactotroph cell tumour of the pituitary

Question 6

Define size of a microadenoma

Answer 6

Tumour <1cm

Question 7

Define size of a macroadenoma

Answer 7

tumour >1cm

Question 8

Define size of a microprolactinoma

Answer 8

Virtually always stays small

Question 9

Define size of a macroprolactinoma

Answer 9

Can be massive

Question 10

What are the 3 local effects of tumour (macroadenoma)

Answer 10

Headache
Visual field defect (bi-temporal hemianopia)
CSF leak (rare)

Question 11

What are 5 effects of prolactin

Answer 11

Amenorrhoea/ menstrual irregularity
Infertility
Galactorrhoea
Low libido
Low testosterone in men

Question 12

What is prolactinoma management

Answer 12

Medical - use dopamine agonists such as cabergoline