Pituitary Disease - Acromegaly

Question 1

What is Acromegaly?

Answer 1

Clinical manifestation of excessive GH.

Question 2

Aetiology of Acromegaly.

Answer 2

Unregulated GH secretion by a Pituitary Adenoma or rarely Ectopic GHRH or GH secretion.

Question 3

Eye Defect in Acromegaly.

Answer 3

1. Optic Chiasm sits just above Pituitary Gland.

2. Compression of Optic Chiasm - Bitemporal Hemianopia.

Question 4

Clinical Features of Acromegaly - Space Occupying Lesions (2).

Answer 4

1. Headaches.

2. Visual Field Defect - Bitemporal Hemianopia.

Question 5

Clinical Features of Acromegaly - Overgrowth of Tissues (6).

Answer 5

1. Frontal Bossing (Prominent Forehead and Brow).
2. Large Nose.
3. Large Tongue - Macroglossia.
4. Large Hands and Feet.
5. Large Protruding jaw - Prognathism.
6. Arthritis - Imbalanced Joints.
7. Excessive Sweating/Oily Skin (Sweat Gland Hypertrophy).

Question 6

Clinical Features of Acromegaly - Organ Dysfunction (4).

Answer 6

1. Hypertrophy of Heart.
2. Hypertension.
3. Type II Diabetes.
4. Colorectal Cancer.

Question 7

Clinical Features of Acromegaly - Active Raised GH (2).

Answer 7

1. Development of Skin Tags.

2. Profuse Sweating.

Question 8

Investigations of Acromegaly.

Answer 8

1. Initial Screening Test - IGF1 (Insulin-Like Growth Factor).
2. OGTT - High Glucose suppresses GH.
3. MRI Brain - Pituitary Tumour.
4. Ophthalmology - Visual Field Testing.

Question 9

Definitive Management of Acromegaly.

Answer 9

Trans-sphenoidal surgical removal of pituitary tumour.

Question 10

Medical Management of Acromegaly (3).

Answer 10

1. Pegvisomant - GH Antagonist SC Daily.
2. Somatostatin Analogues - Block GH Release (more potent than #3).
3. Dopamine Agonists - Block GH Release e.g. Bromocriptine.

Question 11

Example of Somatostatin Analogue.

Answer 11

Ocreotide - Long-Acting.

Question 12

Mechanism of Action of Somatostatin Analogue.

Answer 12

1. Growth Hormone Inhibiting Hormone normally secreted by the brain, GI tract and pancreatic D cells to block GH, Insulin and Glucagon release.

Question 13

Indications of Somatostatin Analogues.

Answer 13

1. Acute - Variceal Haemorrhage.
2. Acromegaly.
3. Carcinoid Syndrome.
4. VIPomas.
5. Refractory Diarrhoea.
6. Complications Post-Pancreatic Surgery.

Question 14

Adverse Effects of Somatostatin Analogues.

Answer 14

Gallstones (Biliary Stasis).