Acromegaly

Question 1

excess […] […] ([…]) results in excessive production of […] […] […] […] ([…])

Answer 1

excess growth hormone (GH) results in excessive production of insulin like growth factor (IGF-1)

Question 2

Physiologically, growth hormone should be suppressed by […].

Answer 2

Physiologically, growth hormone should be suppressed by somatostatin.

Question 3

Associated with […]

Answer 3

Associated with T2DM

Question 4

Features

[…] hands and feet
Outward growth of the […] and head with increased […] […] spacing and […]
Headaches
[…] dysfunction
Voice change
Increased […]
Mood disturbances
Fatigue.

Answer 4

Features

Large hands and feet
Outward growth of the jaw and head with increased inter dental spacing and macroglossia
Headaches
Erectile dysfunction
Voice change
Increased sweating
Mood disturbances
Fatigue.

Question 5

Invx
[…]
If raised –> […] and measure […]
If GH suppressed –> confirmed diagnosis –> […]

Answer 5

Invx
IGF1
If raised –> OGTT and measure GH
If GH suppressed –> confirmed diagnosis –> MRI

Question 6

Management

First line treatment for acromegaly is […] […] surgery

Other options for refractory cases or for patients who cannot undergo surgery:
[…] receptor […] (SLR) such as e.g. […]
Pegvisomant ( […] analogue)
Cabergoline ( […] agonist)
Radiotherapy

NB: Post-operatively, IGF-1 and random growth hormone should be measured after at least 3 […]months and repeat imaging.

Answer 6

Management

First line treatment for acromegaly is trans-sphenoidal surgery.

Other options for refractory cases or for patients who cannot undergo surgery:
Somatostatin receptor ligands (SLR) such as Octreotide
Pegvisomant (GH analogue)
Cabergoline (Dopamine agonist)
Radiotherapy
NB: Post-operatively, IGF-1 and random growth hormone should be measured after at least 3 months and repeat imaging.

Question 7

Complications

[…] […] defect
[…]pituitarism
[…] sleep […]
Type two diabetes mellitus
Arthritis
Carpal tunnel syndrome
Hyperhidrosis
Hypertension
Increased risk of […] polyps which can become malignant
Ischaemic heart disease
Cerebrovascular disease
[…] […] failure
Increased prevalence of […] […] heart disease

Answer 7

Complications

Visual fields defect
Hypopituitarism
Obstructive sleep apnoea
Type two diabetes mellitus
Arthritis
Carpal tunnel syndrome
Hyperhidrosis
Hypertension
Increased risk of colonic polyps which can become malignant
Ischaemic heart disease
Cerebrovascular disease
Congestive cardiac failure
Increased prevalence of regurgitant valvular heart disease

Question 8

The follow up of patients long term post-surgery is required as GH over exposure in excess can have […] […] […]

1. […] as they are at risk of […] / […] 2. […] every 5 years –> bowel polyps that may turn cancerous.

Answer 8

The follow up of patients long term post-surgery is required as GH over exposure in excess can have long term sequelae. For example patients require follow up echocardiography as they are at risk of cardiomegaly / LVH and a colonoscopy every 5 years to monitor for bowel polyps that may turn cancerous.