Endocrinology - Acromegaly Flashcards

1
Q

What is acromegaly? Causes?

A

Clinical manifestation of excessive growth hormone

Most commonly caused by pituitary adenoma

Rarely, can also be secondary to cancer releasing ectopic growth hormone releasing hormone (GHRH) or growth hormone. (e.g. lung or pancreatic cancer)

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2
Q

Presentation of acromegaly

A

Pituitary SOL symptoms:

  • Headache
  • Bitemporal hemianopia

Overgrowth of tissues:

  • Prominent forehead and brow (“frontal bossing”)
  • Large nose
  • Large tongue (“macroglossia”)
  • Large hands and feet
  • Large protruding jaw (”prognathism”)
  • Arthritis from imbalanced growth of joints
  • Development of new skin tags

Organ dysfunction:

  • Hypertrophic heart
  • Hypertension
  • T2DM
  • Colorectal cancer
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3
Q

Investigations in suspected acromegaly

A

Insulin-like Growth Factor 1 (IGF-1) is the initial screening test (raised)

Oral glucose tolerance test whilst measuring growth hormone (high glucose normally suppresses growth hormone)

MRI brain for the pituitary tumour

Refer to ophthalmology for formal visual field testing

Can also measure BP and glucose/HbA1c to test for hypertension/T2DM

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4
Q

Treatment of acromegaly

A

Trans-sphenoidal removal of pituitary is definitive treatment, or surgical removal of pancreatic/lung cancer causing ectopic secretion

Interim medications to block GH e.g.:

  • Pegvisomant (GH antagonist given subcutaneously and daily)
  • Somatostatin analogues to block GH release (e.g. ocreotide)
  • Dopamine agonists to block GH release (e.g. bromocriptine)
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