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
