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Year Two - Endocrine System > Acromegaly > Flashcards

Acromegaly Flashcards

1
Q

What is acromegaly?

A

It is defined as a condition that results from excessive production of growth hormone (GH) after fusion of the epiphyseal plates in bone

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2
Q

What is gigantism?

A

It is defined as a condition that results from excessive production of growth hormone (GH) before fusion of the epiphyseal plates in bone

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3
Q

What are the four risk factors of acromegaly?

A

Pituitary Adenoma

Pancreatic Cancer

Lung Cancer

Multiple Endocrine Neoplasia One

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4
Q

What is the most common risk factor of acromegaly?

A

Pituitary Adenoma

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5
Q

How does pituitary adenoma result in acromegaly?

A

GH is produced in the anterior pituitary and therefore the formation of an adenoma tumour would result in the unregulated production of this hormone

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6
Q

How does cancer cause acromegaly?

A

They can result in the production of ectopic GH or GHRH

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7
Q

What are the nine clinical features associated with acromegaly?

A

Tissue Overgrowth

Frontal Bossing

Macroglossia

Prognathism

Interdental Spaces

Excessive Sweating

Carpal Tunnel Syndrome

Bitemporal Hemianopia

Galactorrhoea

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8
Q

What is frontal bossing?

A

It is defined as a prominent forehead and brow

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9
Q

What is macroglossia?

A

It is defined as an increased tongue size

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10
Q

What is proganthism?

A

It is defined as a protruding jaw

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11
Q

How does acromegaly result in carpal tunnel syndrome?

A

The enlargement of soft tissue within the wrists causes compression of the nerves within the carpal tunnel

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12
Q

What is bitemporal hemianopia?

A

It is defined as the loss of vision on the outer half of both eyes

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13
Q

How does acromegaly result in bitemporal hemianopia?

A

In most cases, acromegaly is associated with pituatary adenomas

Due to the fact that the pituitary gland is situated below the optic chiasm, when tumour formation occurs in this gland it leads to compression of the optic chiasm

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14
Q

How does acromegaly result in galactorrhoea?

A

In most cases, acromegaly is associated with pituatary adenomas

In some cases, this results in increased prolactin levels

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15
Q

What are the three investigations used to diagnose acromegaly?

A

Blood Tests

MRI Scan

Visual Field Tests

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16
Q

What two blood tests are used to diagnose acromegaly?

A

Insulin Growth Factor-1 (IGF-1)

Oral Glucose Tolerance Test + Serial Growth Hormone Levels

17
Q

When is IGF-1 used to diagnose acromegaly?

A

It is the first line investigation used to diagnose acromegaly

18
Q

What IGF-1 result indicates acromegaly?

A

Increased IGF-1 Levels

19
Q

How is IGF-1 used to diagnose acromegaly?

A

Growth hormone results in the production of insulin growth factor-1

There is a negative feedback system, in which increased insulin growth factor-1 levels inhibits the production of growth hormone

In acromegaly, there is loss of this negative feedback inhibition and therefore the body continues to produce growth hormone, regardless of increased insulin growth factor-1 levels

20
Q

When is the oral glucose tolerance test with serial growth hormone levels used to diagnose acromegaly?

A

It is the second line investigation used to diagnose acromegaly, which is conducted following a positive IGF-1 test

21
Q

What oral glucose tolerance test with serial growth hormone result indicates acromegaly?

A

Hyperglycaemia which is precipitated through the oral glucose tolerance test results in growth hormone levels > 1mu/L

22
Q

How is an oral glucose tolerance with serial growth hormone levels test used to diagnose acromegaly?

A

Growth hormone results in the production of glucose

There is a negative feedback system, in which hyperglycaemia inhibits the production of growth hormone – usually suppressing levels to < 1 mu/L

In acromegaly, there is loss of this negative feedback inhibition and therefore the body continues to produce growth hormone, regardless of hyperglycaemia

23
Q

Why are growth hormone levels not measured to diagnose acromegaly?

A

Growth hormone levels fluctuate during the day and therefore cannot provide diagnostic information

24
Q

What are the two electrolyte disturbances associated with acromegaly?

A

Hypercalcaemia

Hyperphosphotaemia

25
Q

How are MRI scans used to diagnose acromegaly?

A

They can be used to identify pituatary adenomas, which is the most common cause of acromegaly

26
Q

How are visual field tests used to diagnose acromegaly?

A

They can be used to identify bitemporal hemianopia, which is a complication of pituatary adenomas - most common cause of acromegaly

27
Q

What are the three pharmacological management options of acromegaly?

A

Somatostatin Analogues

Dopamine Agonists

Growth Hormone Receptor Antagonists

28
Q

When are somatostatin analogues used to manage acromegaly?

A

They are the first line pharmacological option

29
Q

What is the mechanism of action of somatostatin analogues?

A

They directly inhibit the release of growth hormone

30
Q

Name two somatostatin analogues used to manage acromegaly

A

Octreotide

Lanreotide

31
Q

What is the mechanism of action of dopamine agonists?

A

They indirectly inhibit the release of growth hormone

32
Q

Name a dopamine agonist used to manage acromegaly

A

Bromocriptine

33
Q

What is the mechanism of action of growth hormone receptor antagonists?

A

They prevent dimerization of the growth hormone receptor

34
Q

Name a growth hormone receptor antagonist used to manage acromegaly

A

Pegvisomant

35
Q

What is the surgical management option of acromegaly?

A

Transsphenoidal Surgery

36
Q

When is transsphenoidal surgery used to manage acromegaly?

A

It is the first line management option

37
Q

What is transsphenoidal surgery?

A

It involves removal of the pituitary adenoma through the sphenoid sinus

38
Q

What are the six complications associated with acromegaly?

A

Hypertension

Type Two Diabetes Mellitus

Cardiomyopathy

Colorectal Cancer

Osteoarthritis

Sleep Apnoea

Year Two - Endocrine System (17 decks)

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