Acromegaly

Question 1

Acromegaly

Answer 1

Clinical manifestation of excessive growth hormone

Question 2

Most common cause

Answer 2

Unregulated GH secretion by pituitary adenoma

Question 3

Presentation SOL

Answer 3

Headaches

Bitemporal hemianopia

Question 4

Presentation due to overgrowth of tissues

Answer 4

Prominent forehead and brow

Large nose

Large tongue

Large hands and feet

Large protruding jaw

Arthritis from imbalanced growth of joints

Question 5

Organ dysfunction caused by GH

Answer 5

Hypertrophic heart

HTN

T2DM

Colorectal cancer

Question 6

Investigations

Answer 6

Raised insulin-like growth factor 1

OGTT (normally GH is suppressed with hyperglycaemia)

MRI brain for pituitary tumour

Question 7

First line treatment

Answer 7

Trans-sphenoidal surgery

Question 8

Treatment if inoperable or surgery unsuccessful

Answer 8

Somatostatin analogue

Pegvisomant

Dopamine agonists

Question 9

Somatostatin analogue

Answer 9

Directly inhibits release of GH

Octreotide

Question 10

Pegvisomant

Answer 10

GH receptor antagonist

Once daily SC administration

Doesn’t reduce tumour volume so surgery still needed if mass effect

Question 11

Dopamine agonists

Answer 11

Bromocriptine

Effective only in minority of patients