Endocrine

Question 1

Acromegaly is due to and excess of what hormones?

Answer 1

Growth hormone

Insulin-like-growth-factor 1 (IGF-1)

Question 2

What age is acromegaly usually diagnosed?

Answer 2

3rd decade life with mean age diagnosis usually between 40-45yos

Question 3

Cause of Acromegaly?

Answer 3

Benign growth hormone-secreting pituitary adenoma

Question 4

Physiology of GH and IGF-1

Answer 4

Physiology of GH and IGF-1
Hypothalamus secretes GHRH → ↑ secretion of GH → GH induces IGF-1 synthesis → ↑ serum IGF-1 :
→ binds to IGF-1 and insulin receptors → stimulation of cell growth and proliferation, inhibits programmed cell death
Proliferative effects especially on bone, cartilage, skeletal muscle, skin, soft tissue, and organs
Pathological glucose tolerance caused by binding to insulin receptors

Question 5

Main clinical features of acromegaly

Answer 5

Tumor mass effects
soft tissue effects
Skeletal affected
Organ enlargement: especially kidneys and thyroid gland
Effects of diabetes mellitus (up to 50% of cases)

Question 6

Tumor mass effects of acromegaly

Answer 6

Headache, vision loss (bitemporal hemianopsia), cranial nerve disorders
♀: Oligomenorrhea, secondary amenorrhea, galactorrhea, vaginal atrophy
♂: Erectile dysfunction, decreased libido, ↓ testicular volume

Question 7

Soft tissue effects of acromegaly

Answer 7

Doughy skin texture, hyperhidrosis (excessive sweating)
Deepening of the voice, macroglossia, obstructive sleep apnea
Carpal tunnel syndrome

Question 8

skeletal effects of acromegaly

Answer 8

Large skull, coarsened features: enlarged nose, forehead, and jaw (macrognathia) with diastema
Widened hands, fingers, and feet
Painful arthropathy (ankles, knees, hips, spine)

Question 9

Diagnostic test for acromegaly

Answer 9

Increase IGF-1 serum

MRI of the pituitary

Question 10

Tx of Acromegaly

Answer 10

Surgery: transsphenoidal adenomectomy

Danger of hypopituitarism following surgery or radiotherapy!