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Endocrinology > Acromegaly, Gigantism, and Dwarfism > Flashcards

Acromegaly, Gigantism, and Dwarfism Flashcards

1
Q

both acromegaly and gigantism will present with what levels of GH?

A

increased GH

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2
Q

excessive secretion of GH, usually due to a pituitary somatotroph

A

acromegaly

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3
Q

at the time of diagnosis, 75% of patients with acromegaly will usually present with what?

A

macroadenoma

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4
Q

what is the interval from the onset of symptoms until diagnosis of acromegaly?

A

12 years

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5
Q

a patient presents with acral and soft tissue overgrowth, skin thickening, enlarged jaw, enlarged/swollen hands and feet, coarse facial features, deepening of the voice, and hand paresthesia. what are they likely experiencing?

A

acromegaly

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6
Q

macrognathia

A

enlarged jaw

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7
Q

a patient with acromegaly will likely tell you what about them?

A

increase in shoe/glove size

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8
Q

due to pressure from the adenoma, what would a patient with acromegaly complain of? (2)

A

headaches
visual changes

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9
Q

what are 4 disease processes that a patient with acromegaly can begin to experience?

A

hypertension
sleep apnea
type 2 diabetes
musculoskeletal pain

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10
Q

what is the best test to diagnose a patient with acromegaly? and why?

A

serum IGF-1
it is stable throughout the day

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11
Q

an unequivocal or elevated serum IGF-1 should prompt us to order a …

A

oral glucose tolerance test (OGTT)

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12
Q

for testing acromegaly with an OGTT, what should happen to indicate that we have a normal response?

A

serum GH goes to 1 or less, 2 hours after ingesting 75g of glucose

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13
Q

for testing acromegaly with an OGTT, what should happen to indicate that the patient has acromegaly?

A

serum GH is greater than 1

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14
Q

if GH and glucose is not suppressed after the administration of OGTT in acromegaly, what is the next diagnostic to order?

A

pituitary MRI

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15
Q

what is the ideal treatment for acromegaly?

A

endoscopic transphenoidal surgery

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16
Q

what are 3 medications that can be used for patients with acromegaly who are not surgical candidates?

A

somatostatin analog (octreotide, lanreotide)
cabergoline
pegvisomant

17
Q

what is the treatment goal for acromegaly?

A

lower serum IGF-1 and GH concentrations

18
Q

what cannot be reversed once it has occurred, in patients with acromegaly?

A

bony changes

19
Q

if surgical and medical therapy do not work for acromegaly, what can be done?

A

radiation therapy

20
Q

GH excess that occurs before fusion of the epiphyseal growth plates in a child or adolescent

A

gigantism

21
Q

what is the most common cause of gigantism?

A

pituitary adenoma that excretes too much GH, leading to increased IGF-1

22
Q

a 13 yr old presents with large hands, feet, coarse facial features, excessive sweating, and macrocephaly. what are they likely experiencing?

A

gigantism

23
Q

what is the treatment for gigantism?

A

endoscopic transphenoidal surgery

24
Q

if surgery is not an option for a patient with gigantism, what medical therapy can we do?

A

octreotide (first line)
bromocriptine
pegvisomant

25
Q

why is radiation therapy in a patient with gigantism not recommendeded?

A

could lead to panhypopituitarism (completely kill the pituitary gland)

26
Q

a proportionate growth failure; downward deviation of growth curve across 2 major percentile curves

A

dwarfism

27
Q

a child between 2-4 yrs old should have what height velocity to be diagnosed with dwarfism?

A

less than 2.2 in/yr

28
Q

a child between 4-6 yrs old should have what height velocity to be diagnosed with dwarfism?

A

less than 2 in/yr

29
Q

a child between 6 years to puberty should have what height velocity to be diagnosed with dwarfism?

A

less than 1.6 in/yr for boys
less than 1.8 in/yr for girls

30
Q

what are 3 diagnostics used for dwarfism?

A

xray for bone age
serum IGF-1
GH provocation

31
Q

what is the treatment for a patient with dwarfism?

A

growth hormone

32
Q

what are 3 things to be monitored in patients with dwarfism?

A

height velocity q 4-6 mo
IGF-1 q 4-6 mo
bone age q 6-12 mo

Endocrinology (17 decks)

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