Acromegaly and Prolactinoma Flashcards
Know these What are common acromegaly co-morbidities?
Hypertension
Heart disease
Cerebrovascular events and headache
Arthritis
Insulin-resistant diabetes
Sleep apnea
Pituitary tumour produces excess GH. acts on _____ to produce IGF-1 needed for growth
liver
What 3 things are used to diagnose acromegaly?
Clinical features
GH levels
IGF-I levels
What are presenting features of acromegaly?
Acral enlargement (extremities)
Arthralgias (joint pain)
Maxillofacial changes
Excessive sweating
Headache
Hypogonadal symptoms
Life expectancy is 10 years less than general population for patients with acromegaly and…
Cardiac disease
If either a random GH test result is >0.4 ng/ml or the IGF-I levels are abnormal then what test is done?
75 mg Glucose tolerance test (GTT)
What will happen in the gold standard test of 75mg Glucose Tolerance test
In healthy subject the GH levels will fall
In a patient with acromegaly, the GH levels won’t fall after having the glucose
What does acromegaly therapy aim to do?
Restore basal GH and IGF-I to normal levels
Relieve symptoms
Reverse visual and soft tissue changes
Prevent further skeletal deformity
Normalise pituitary function
What are the 3 options for treatment of acromegaly?
Pituitary surgery (trans-sphenoidal) this is the 1st line treatment
Medical therapy, 2nd line treatment
Radiotherapy, 3rd line treatment
How large is a microadenoma?
<1cm
What is the name of a pituitary tumour that is larger than 1cm
macroadenoma
What are problems with pituitary radiotherapy?
Loss of pituitary function in the long-term
Potential damage to local structures eg eye nerves
Control of tumour growth/ excess hormone secretion not always achieved
Life-long monitoring needed for all patients
What do dopamine agonists do in medical therapy and give an example of one
Control GH and IGF-I, improve well being
Cabergoline (twice weekly)
Rapid onset, no hypopituitarism
However, relatively ineffective and has side effects
What do somatostatin analogs do in medical therapy?
Control GH and IGF-I, shrink tumour, has a short half life of 3 mins
eg Pegvisomant
Name 2 examples of somatostatin analogues
Octreotide
Lanreotide
