acromegaly

Question 1

define acromegaly?

Answer 1

constellation of signs and symptoms caused by hypersecretion of GH in adults

Question 2

what is excess GH in children called?

Answer 2

gigantism

Question 3

what is the main cause of acromegaly?

Answer 3

GH-secreting pituitary adenoma

Question 4

what sometimes causes acromegaly?

Answer 4

ectopic GHRH or GH production from tumours

Question 5

what is the epidemiology of acromegaly?

Answer 5

RARE

ages 40-50

Question 6

what are the presenting symptoms of acromegaly?

Answer 6

- onset is gradual 
•	Rings and shoes becoming tight  
•	Increased sweating and oily skin caused by sweat gland hypertrophy   
•	Features of a pituitary tumour = 
o	Hypopituitarism  
o	Headaches 
o	Bitemporal hemianopia 
•	Raised prolactin 
o	 galactorrhoea

Question 7

signs of acromegaly on the hands?

Answer 7

o Large spade-like hands
o Thick greasy skin
o Carpel tunnel syndrome signs
o Premature osteoarthritis

Question 8

signs of acromegaly on the face?

Answer 8

o	Prominent eyebrow ridge  
o	Prominent cheeks  
o	Broad nose bridge  
o	Prominent nasolabial folds  
o	Thick lips  
o	Increased gap between teeth 
o	Large tongue  
o	Prognathism 
o	Husky resonant voice

Question 9

what visual changes might there be?

Answer 9

o Bitemporal hemianopia

Question 10

what changes might there be in the neck?

Answer 10

o Multinodular goitre

Question 11

what might happen to the feet?

Answer 11

o Enlarged

Question 12

what is the first line investigation for acromegaly?

Answer 12

• Serum IGF-1

- this is because GH stimulates IGF-1 secretion

Question 13

what is the confirmatory investigation for acromegaly?

Answer 13

Oral Glucose Tolerance Test

75g of oral glucose

Question 14

what other investigations might be done?

Answer 14

• pituitary function tests

- MRI of the brain

Question 15

first line treatment for acromegaly?

Answer 15

trans-sphenoidal surgery is FIRST LINE

Question 16

what might be the first line medical treatment of acromegaly?
how does this work?

Answer 16

Somatostatin Analogues
eg. octreotide
• Directly inhibits the release of growth hormone

Question 17

what might be the medical treatment of prolactinomas?

Answer 17

o Oral Dopamine Agonists

bromocriptine, cabergoline

Question 18

how do GH antagonists work?

Answer 18

• Prevents the dimerization of the GH receptor

Question 19

how can acromegaly be monitored?

Answer 19

• GH and IGF1 levels can be used to monitor disease control

Question 20

what are the CVS complications of acromegaly?

Answer 20

o	Cardiomegaly  
o	Hypertension 
o	cardiomyopathy 
o	left ventricular hypertrophy 
o	arrhythmia

Question 21

what are the resp complications of acromegaly?

Answer 21

o Obstructive sleep apnoea

Question 22

what are the GI complications of acromegaly?

Answer 22

o Colonic polyps

Question 23

what are the reproductive complications of acromegaly?

Answer 23

o Hyperprolactinaemia

Question 24

what are the metabolic complications of acromegaly?

Answer 24

o	Hypercalcaemia 
o	Hyperphosphataemia 
o	Renal stones  
o	Diabetes mellitus  
o	Hypertriglyceridaemia

Question 25

what are the psychological complications of acromegaly?

Answer 25

o Depression

Question 26

prognosis for patients with acromegaly?

Answer 26

• GOOD with early diagnosis and treatment

* Physical changes are irreversible