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Flashcards in Acromegaly Deck (16):
1

what is this due to

increased secretion of growth hormone from pituitary tumour or hyperplasia

2

where could ectopic GH releasing hormone come from

carcinoid tumour

3

what does GH stimulate bone and soft tissue growth via

insulin like growth factor-1

4

symptoms

acroparaesthesia (of digits), amenorrhoea, decr libido, headache, incr sweating, snoring, arthralgia, backache

5

signs

incr growth of hands, jaw and feet; coarsening face, wide nose; big supraorbital ridges; macroglossia; widely spaced teeth; puffy lips, eyelids and skin; scalp folds; skin darkening; acanthosis nigricans; laryngeal dyspnoea; OSA; goitre; proximal weakness and arthropathy; carpal tunnel signs

6

complications

may present with CCF or ketoacidosis. impaired glucose tolerance; vascular- incr bp, LVH, cardiomyopathy, arrhythmias, IHD, stroke. neoplasia- incr colon cancer risk, colonoscopy

7

tests

incr glucose, incr calcium, incr phosphate.

8

why can you not rely on random GH

because secretion is pulsatile and during peaks there is overlap

9

when can GH increase

stress, sleep, puberty, pregnancy

10

what happens normally with a high glucose

suppression of GH and GH hardly detectable. in acromegaly GH fails to suppress

11

when is an oral glucose tolerance test needed

if basal GH >0.4ug/L and/or IGF-1 incr

12

when is acromegaly confirmed with oral glucose tolerance test

if lowest GH during the test is >1ug/L then acromegaly is confirmed

13

what is the method in OGTT

collect samples for GH glucose at 0,30,60,90,120,150 min

14

when can you get false positives

pregnancy, puberty, hepatic and renal disease, anorexia nervosa, DM

15

other tests

MRI of pituitary fossa, look for hypopituitarism, visual fields and acuity, ECG, echo

16

treatment

1. trans sphenoidal surgery. 2. somatostatin analogues and or radiotherapy eg octreotide or laneotide. 3. GH antagonist- pegvisomant