acromegaly and prolactinoma Flashcards
define acromegaly
abnormal growth of hands, feet and face due to overproduction of GH
co-morbidities of acromegaly
- Hypertension and heart disease
- Cerebrovascular events and headache
- Arthritis
- Sleep apnoea
- Insulin – resistant diabetes
what is diagnosis of acromegaly dependent on
on the clinical features, GH and IGF-I levels.
presenting clinical features of acromegaly
- Acral enlargement
- Arthralgias
- Maxillofacial changes
- Excessive sweating
- Headache
- Hypogonadal symptoms
criteria for diagnosis of acromegaly
Acromegaly is excluded if:
GH <0.4 ng/ml and normal IGF-I
If either abnormal proceed to:
75gm glucose tolerance test (GTT)
Acromegaly excluded if:
IGF-I normal and GTT nadir GH <1 ng/ml
objectives of therapy in acromegaly
restoration of basal GH and IGF-I to normal levels
relief of symptoms
reversal of visual and soft tissue changes
prevention of further skeletal deformity
normalization of pituitary function
treatment options for acromegaly
Pituitary surgery
Size of the tumour and the surgeon determine the success of the surgery
Medical therapy
Dopamine agonists e.g. cabergoline
Radiotherapy
problems of radiotherapy
Loss of pituitary function in the long-term
Potential damage to local structures – e.g. eye nerves
Control of tumour growth / excess hormone secretion not always achieved
determinants of efficacy of conventional radiotherapy
GH level
tumor extension
summary of acromegaly
- Significant morbidity and mortality
- Often insidious onset
- Effective treatment essential
- Pituitary surgery mainstay of therapy
- Medical management improving
define prolactinoma
lactotroph cell tumour of the pituitary
are women more likely to ger prolactinoma or men
women
microadenoma size
tumour <1cm
macroadenoma size
tumour >1cm
microprolactinoma –
virtually always stays small
macroprolactinoma
can be massive
clinical features of acromegaly
Local effect of tumour – macroadenoma
Headache
Visual field defect (bi-temporal hemianopia)
CSF leak (rare)
Effect of prolactin -
Menstrual irregularity/ amenorrhoea
Infertility
Galactorrhoea
Low libido
Low testosterone in men
managment of prolactinoma
management is medical rather than surgery – use dopamine agonists such as cabergoline.
Remarkable shrinkage usual with macroadenoma – sight saving
Microadenoma – usually respond to small doses of cabergoline just once or twice per week
prolactinoma summary
- Cause of infertility and hypogonadism
- Galactorrhoea
- Careful drug history
- Mainstay of management is medical
