Acromegaly and Prolactinoma

Question 1

Co-morbidities of acromegaly

Answer 1

1. Hypertension and heart disease
2. Cerebrovascular events and headaches
3. Arthritis
4. Sleep apnoea
5. Insulin-resistant diabetes

Question 2

Clinical presentation of acromegaly

Answer 2

1. Acral enlargement (toes and fingers)
2. Arthralgia
3. Maxillofacial changes
4. Excessive sweating
5. Headache
6. Hypogonadal symptoms

Question 3

How does IFT-1 secretions vary during the day compare dot a normal person

Answer 3

1. Pulsatile but less frequent and reach successive peaks during the day

Question 4

Result of 75 gm oral glucose intolerance test for acromegaly

Answer 4

1. IGF-1 is unaffected (stays high)

In normal, it should hit 0

Question 5

Criteria for the diagnosis of acromegaly

Answer 5

Excluded if:
Random GH <0.4 ng/ml and normal IGF-1

OR

IGF-1 is normal and GTT (glucose tolerance test) GH <1 ng/ml

Question 6

How do we treat acromegaly

Answer 6

1. Pituitary surgery
2. Medical therapy
3. Radiotherapy

Question 7

What radiotherapy do we do for acromegaly

Answer 7

1. Multi-Fractional
2. Stereotactic
3. Gamma knife
4. Proton beam

Question 8

Disadvantages of radiotherapy

Answer 8

1. Rare visual defects

2. Secondary tumours

Question 9

Medical treatment for acromegaly

Answer 9

1. Dopamine agonist
2. Somatostatin analogues
3. GH receptor antagonist

Question 10

Name a dopamine agonist used in acromegaly

Answer 10

CABERGOLINE

Question 11

Advantages of cabergoline

Answer 11

1. No hypopituitarism caused
2. Orally done
3. Rapid onset

Question 12

When are dopamine agonists particularly successful

Answer 12

In GH/prolactin co-secreting tumours

Question 13

Role of somatostatin analogies

Answer 13

1. Inhibit hormone production

Question 14

How are somatostatin analogues delivered

Answer 14

Injection

Question 15

Name a somatostatin analogue

Answer 15

1. SC PEGVISOMANT (GH analogue)

Question 16

Clinical presentation of prolactinoma

Answer 16

1. headache
2. Visual field defect (bi-temporal hemianopia)
3. CSF leak

Question 17

How does prolactin effect males

Answer 17

Lowers libido and testosterone

Question 18

Effects of excess prolactin in females

Answer 18

1. galactorrhea
2. Menstrual irregularity
3. Amenorrhoea

Question 19

Two types of prolcatomas

Answer 19

1. Macroprolactinoma

2. Microprolactinoma

Question 20

What causes non-functioning pituitary tumour of prolactin

Answer 20

Compression of pituitary stalk

Question 21

How is prolactinoma treated

Answer 21

1. CABERGOLINE (once or twice a week for micro adenoma)

2. Shrinkage of macro adenoma

Question 22

What inhibits GH

Answer 22

High glucose

Somatostatin

Question 23

How is acromegaly commonly caused

Answer 23

Benign GH-producing pituitary tumour