Acromegaly and Prolactinoma Flashcards
Co-morbidities of acromegaly
- Hypertension and heart disease
- Cerebrovascular events and headaches
- Arthritis
- Sleep apnoea
- Insulin-resistant diabetes
Clinical presentation of acromegaly
- Acral enlargement (toes and fingers)
- Arthralgia
- Maxillofacial changes
- Excessive sweating
- Headache
- Hypogonadal symptoms
How does IFT-1 secretions vary during the day compare dot a normal person
- Pulsatile but less frequent and reach successive peaks during the day
Result of 75 gm oral glucose intolerance test for acromegaly
- IGF-1 is unaffected (stays high)
In normal, it should hit 0
Criteria for the diagnosis of acromegaly
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
How do we treat acromegaly
- Pituitary surgery
- Medical therapy
- Radiotherapy
What radiotherapy do we do for acromegaly
- Multi-Fractional
- Stereotactic
- Gamma knife
- Proton beam
Disadvantages of radiotherapy
- Rare visual defects
2. Secondary tumours
Medical treatment for acromegaly
- Dopamine agonist
- Somatostatin analogues
- GH receptor antagonist
Name a dopamine agonist used in acromegaly
CABERGOLINE
Advantages of cabergoline
- No hypopituitarism caused
- Orally done
- Rapid onset
When are dopamine agonists particularly successful
In GH/prolactin co-secreting tumours
Role of somatostatin analogies
- Inhibit hormone production
How are somatostatin analogues delivered
Injection
Name a somatostatin analogue
- SC PEGVISOMANT (GH analogue)
Clinical presentation of prolactinoma
- headache
- Visual field defect (bi-temporal hemianopia)
- CSF leak
How does prolactin effect males
Lowers libido and testosterone
Effects of excess prolactin in females
- galactorrhea
- Menstrual irregularity
- Amenorrhoea
Two types of prolcatomas
- Macroprolactinoma
2. Microprolactinoma
What causes non-functioning pituitary tumour of prolactin
Compression of pituitary stalk
How is prolactinoma treated
- CABERGOLINE (once or twice a week for micro adenoma)
2. Shrinkage of macro adenoma
What inhibits GH
High glucose
Somatostatin
How is acromegaly commonly caused
Benign GH-producing pituitary tumour
