Acromegaly - mx

Question 1

Step 1 - hormone analysis

Answer 1

1. Check serium IGF-1 concentration

Question 2

Step 2 - if IGF 1 is high

Answer 2

1. Conduct ‘oral glucose tolerance test’ OGTT
   with
   - Baseline GH
2. • If GH is suppressed - rule out Acromegaly

• If GH not suppressed - confirm acromegaly

Question 3

Step 3 - if GH not supressed with OGTT

Answer 3

Conduct pituitary MRI

Question 4

What is the choice of imaging for acromegaly?

Answer 4

Pituitary MRI

Question 5

First line tx for acromegaly

Answer 5

1. Transphenoidal adenomectomy - resection of the tumor

2. Radiotherapy

Question 6

Adjunct tx for acromegaly

Answer 6

1. Somatostatin analops - octreotide

2. Dopamine agonist - Bromocriptine to reduce tumor size

Question 7

Name 4 main complications of acromegaly?

Answer 7

1. CVS complications are the main cause of death
2. Cerebral aneurysm
3. Neoplastic disease
4. Hypopituitarism following surgery/radiotherapy