Other Endocrine Disorders

Question 1

What happens in acromegaly?

Answer 1

Excess growth hormone secondary to pituitary adenoma in >95% of cases

Question 2

What are the features of acromegaly?

Answer 2

Spade like hands
Coarse facial appearance
Increase in shoe size
Large tongue
Excessive sweating and oily skin
Hypopituitarism, headaches, bitemporal hemianopia
Galactorrhoea

Question 3

What are the complications of acromegaly?

Answer 3

Hypertension
Diabetes
Cardiomyopathy
Colorectal cancer

Question 4

What is the main investigation for acromegaly?

Answer 4

Serum IGF-1

OGTT
In normal patients the glucose level is suppressed to <2 with hyperglycaemia
There is no suppression of GH in patients with acromegaly

A pituitary MRI may show a tumour

Question 5

What is the management of acromegaly?

Answer 5

Trans sphenoidal surgery is first line

Somatostatin analogue: octreotide
Dopamine analogue: bromocriptine
Pegvisomant (GH receptor antagonist- very effective). Once daily S/C injection

Question 6

What are the features of excess prolactin in women and men?

Answer 6

Women: amenorrhoea, galactorrhoea
Men: impotence, loss of libido, galactorrhoea

Question 7

What is the commonest type of pituitary tumour?

Answer 7

1) Prolactinoma
2) Non secreting adenoma
3) GH secreting tumour
4) ACTH secreting tumour

Question 8

What is the treatment of prolactinomas?

Answer 8

1) Dopamine agonist (cabergoline, bromocriptine)

2) Trans sphenoidal surgery

Question 9

What is the treatment of central diabetes insipidus?

Answer 9

Desmopressin

IV fluid management

Question 10

What cardiac issue is acromegaly associated with?

Answer 10

Cardiomyopathy