Acromegaly Flashcards
How does excess growth hormone manifest? Think about th main mediator of its function
Adenoma secreting excessive GH ⇒ GH results in excess IGF1. This leads to:
Hypertrophy:
- Arteriolar smooth muscle ⇒ HTN
- Soft tissue ⇒ lips, boggy palms, tongue, cardiomyopathy
- Bone ⇒ facies e.g. prominent supraorbital ridge, prognathism
- Sweat glands ⇒ excessive sweating
Insulin resistance ⇒ IGT or DM
Vision - bitemporal hemianopia
What additional questions in someone with ?acromegaly?
- Any excessive sweating?
- Any change in vision?
- Headaches?
- Change in shoe/hat/glove size?
- Funny sensation in feet - peripheral neuropathy?
- Erectile dysfunction?
How would you go about examining someone with acromegaly?
- Hands* - size, skin folds, ? boggy, sweaty?, median nerve for CTS
- Arms* - BP, shoulder AbD for prox myo
- Face* - facies, tongue, prognathism
- Neck* - goitre, JVP
- Visual* fields
- Cardiovascular* if have time
Stand from chair wihtout using arms
To finish - Urine dip, photos from past
HOw confirm diagnosis of acromegaly, other than on clinical basis?
- OGTT - in normal individual, glucose will suppress GH - this is not the case in acromegaly
- Hourly GH measurement
- Measure IGF1
What treatment options are available for acromegaly?
really important to treat because…
Neurosurgery - transphenoidal if confined to sella, if suprasellar extension then may need transfrontal craniotomy
External beam radiotherapy as adjunct
Medical treatment pre-op to increase response e.g. high dose bromocriptone. Modern somatostatin analogues are better e.g. octreotide
May consider in someone wanting to have child as surgery may knock out gonadotrophic function
Cardiovascular morbidity - die 10 years younger due to DM, HTN and cardiomyopathy
Define hypopituitarism
What must be ruled out as cause?
Treatment in general?
Lack of ≥1 pituitary hormone, due to trauma, surgery, infection, radaition, pregnancy (Sheehan’s). Rarely casued by sarcoidosis and haemochromatosis
Malignancy becasue symptoms will be varied and slow to develop
Possibility for surgery and hormone replacement (lifelong)
