Acromegaly

Question 1

What is the most common cause of acromegaly?

Answer 1

Pituitary adenoma secreting growth hormone and this occurs in adulthood after bone plate has fused

There is higher gluconeogenesis, lipolysis and insulin resistance

Question 2

What are the features of headaches in acromegaly?

Answer 2

Worst first thing in the morning

-> increased space between teeth, organomegaly, deeper voice symptoms of diabetes

Question 3

Which conditions are at risk with acromegaly?

Answer 3

They are at risk of Acanthodii’s nigricans and osteoarthritis and carpal tunnel syndrome

Question 4

What is the first line investigation?

Answer 4

IGF1 test

Question 5

What is first INR treatment?

Answer 5

Transphenoidal surgery

Question 6

What is alternative to surgery?

Answer 6

Somatostatin receptor ligand
Growth hormone antagonists and dopamine agonists like cabergoline and bromocriptine can be used

Question 7

Which cancers are at greater risk in acromegaly?

Answer 7

Bowel malignancy

Question 8

What is prognathism?

Answer 8

Jaw protrudes creating an underbite appearance

Question 9

What is the confirmation test for acromegaly?

Answer 9

Where IGF-1 levels are high, Confirmatory test is oral glucose tolerance and serial growth hormone test

Growth hormone should reduce with hyperglycaemia but if t says the same or increases, indicates acromegaly