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Flashcards in Acromegaly Deck (16)
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1

What is gigantism?

Excessive growth hormone production in children before the fusion of the epiphyses of the long bones

2

What is acromegaly?

Excess growth hormone production in adults

3

What are the two hormones secreted by the hypothalamus that control growth hormone production?

- Growth hormone releasing hormone
- Somatostatin

4

Aside from the hormones produced from the hypothalamus, what other factors can influence GH production?

- High glucose inhibits the release of GH
- Ghrelin stimulated the release of GH

5

How does growth hormone have indirect effects?

It induces insulin-like growth factor which is synthesised in the liver and other tissues.

6

What does ILGF do?

- Promotes cellular metabolism
- Prevents cell death
- Helps cells divide and differentiate in the body

7

How does GH impact tissues directly?

Induces metabolic changes in the liver muscle, bone etc.
- Stimulates osteoclasts for example

8

What is acromegaly caused by in almost all cases?

Benign pituitary GH-producing adenoma

9

Apart from the release of excessive growth hormone what else other effect can a benign pituitary GH-producing adenoma have?

Tumour expansion can result in compression of surrounding structures causing headaches and visual field loss

10

What are some signs of acromegaly?

- Skin darkening
- Coarsening face with a wide nose
- Prognathism
- Big supraorbital ridge
- Deep voice
- Carpel tunnel syndrome
- Large tongue
- Interdental separation

11

What are the symptoms of acromegaly?

- Headaches
- Acral enlargement
- Excessive sweating
- Visual deterioration
- Snoring
- Wonky bite
- Increased weight
- Decrease labido
- Amenorrhea
- Arthralgia and backache
- Acroparaesthesia
- Fatigue

12

What investigations would you do in Agcromegaly?

1. Plasma GH levels - not diagnostic as pulsatile throughout the day
2. Glucose tolerance test - Normally glucose would inhibit GH release
3. Insulin-like growth factors - this fluctuates less and is always elevated in someone with acromegaly = DIAGNOSTIC

13

What co-morbidities are associated with acromegaly?

- Impaired glucose tolerance
- Diabetes mellitus
- Sleep apnea
- Hypertension
- Colon cancer
- Arthritis

14

What is the first line treatment in acromegaly?

Trans-sphenoidal surgery - to remove the tumour and correct any compression around surrounding structure - e.g optic chiasm

15

What three types of drugs can be used if surgery fails to treat the increase in GH?

- Somatostatin analogues - Inhibits GH release
- GH receptor antagonists - stops GH binding to target tissues
- Dopamine agonists

16

What is stereotactic radiotherapy?

Radiotherapy that is more accurate than conventional and provides better tumour localisation and irradiation