Endo - acromegaly

Question 1

What are the typical features of the history for acromegaly?

Answer 1

1. Headache - SOL features (blurred vision, vomiting, worse in the morning)
2. VF changes (tunnel vision)
3. Physical appearance changes
4. Loss of libido/lactation

Question 2

What physical appearance changes may a patient /relative notice?

Answer 2

Sweaty
Coarse skin
Hirsuitism
Prominent supra-orbital ridge
Prognathism
Widely spaced teeth + macroglossia
Spade like hands
Growth of feet

Question 3

What are the complications of acromegaly?

Answer 3

HTN
DM
Visual field defect
Goitre + enlarged organs
Heart failure
Acanthosis nigricans
Nerve compression (CTS)
Joint arthropathy, kyphosis
Proximal myopathy
Colonic polyps = ^risk of CRC

Question 4

What is the investigation for Acromegaly ?

Answer 4

OGTT - lack of suppression of GH
IGF1 serum level
Pituitary profile + bone profile (raised Ca ?MEN)
CBG + HbA1c
MRI pituitary - adenoma

Question 5

What is in a pituitary profile blood test?

Answer 5

ACTH
FSH/LH, oestradiol/testosterone
PRL
IGF1
TSH, T4

Question 6

How would you investigate the complications of acromegaly?

Answer 6

CXR - cardiomegaly
ECG - ischaemia (DM, CCF, HTN)
Visual field testing including Humphrey’s
OSA screen (50% due to macroglossia)

Question 7

Management options for acromegaly

Answer 7

1. TS surgery
   (complications post-op: meningitis, DI, hypopituitarism)
2. Medical SST analog - octreotide
3. RT as adjunct/alternative to surgery

Question 8

Follow-up of acromegaly?

Answer 8

Annual pituitary function
ECG, CXR
CT Head
VF testing
Colonoscopy (3-5Y, polyps)