acromegaly and prolactinomas Flashcards
define acromegaly
abnormal growth of hands, feet and face due to overproduction of GH.
what are the co-morbidities you can get with acromegaly ?
-Hypertension and heart disease
-Cerebrovascular events and headache
-Arthritis
-Sleep apnoea
-Insulin – resistant diabetes
what is the diagnosis of acromegaly dependent on?
- Clinical features
-GH - IGF-1 levels
what are the presenting clinical features of acromegaly
-Acral enlargement
-Arthralgias
-Maxillofacial changes
-Excessive sweating
-Headache
-Hypogonadal symptoms
when is acromegaly excluded in diagnosis?
- GH <0.4 ng/ml and normal IGF-I
If either the GH or IGF-1 is abnormal, what do you do?
75gm glucose tolerance test (GTT)
when is acromegaly excluded in the glucose tolerance test? (GTT)
IGF-I normal and GTT nadir GH <1 ng/ml
What are the 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
what are the options for treatment of acromegaly?
-Pituitary surgery
- Medical therapy
- Radiotherapy
what determines the success of pituitary surgery?
Size of the tumour and the surgeon determine the success of the surgery
what Is used in medical therapy as a treatment option for acromegaly?
-Dopamine agonists e.g. cabergoline
-somatostatin analogues
-growth hormone receptor antagonist
what are the two types of radiotherapy?
- conventional
-stereostatic
-gamma knife
-LINAC
-proton beam
describe conventional radiotherapy
multi-fractional
describe stereostatic radiotherapy
single fraction
less radiation to surrounding tissues
what are the 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
