Pituitary and Hypothalamus Flashcards
What is acromegaly?
Excess growth hormone
What is the difference between acromegaly and giantisim?
Acromegaly if there is excess GH after epiphyseal fusion (adults)
Giantism if there is excess GH before epiphyseal fusion (children)
What causes acromegaly?
GH secreting pituitary adenoma
Ectopic tumour
What are the signs + symptoms of acromegaly?
Increased height -> giantism Prominent brow Increased size and pronouncement of the jaw Thickened soft tissues Thickened skin Large, sweaty, doughy hands Snoring/sleep apnoea Difficulty eating and swallowing Excessive sweating (at night) and acne Deeper voice Interdental separation Joint pain and proximal muscle weakness Lethargy Polydipsia and polyuria
What are the signs + symptoms of acromegaly related to local pituitary adenoma affects?
Headaches
Visual field defects
Hyperprolactinaemia (from the same tumour secreting PRL)
Hypopituitarism
What investigations can be done for acromegaly?
IGF1 measurement (initial screening test)
Glucose tolerance test (GH unchanged or paradoxically rises, definitive test for diagnosis)
Visual field examination
CT or MRI
Pituitary function tests (have other hormones been impacted)
Why do patients with acromegaly get diabetes?
Insulin resistance induced by growth hormone (because it increases plasma glucose levels)
What complications can arise from acromegaly?
Diabetes Hypertension Heart failure Carpal tunnel syndrome Cancer (colonic polyps and colon cancer) Early CV death
What is 1st line treatment for acromegaly?
Transsphenoidal surgery
90% cure rate in microadenoma, 50% in macroadenoma
What medicines can be used for acromegaly treatment?
Somatostatin receptor antagonists
Dopamine agonists
GH antagonists
Apart from surgery and medicines what treatment can be offered for acromegaly?
Radiotherapy
