ACROMEGALY AND GIGANTISM

Question 1

INVESTIGATIONS

Answer 1

1. use IGF- 1 - not GH
2. glucose test
3. mri - looks for tumour

Question 2

when are gh levels high

Answer 2

sleeping

Question 3

effect of glucose on GH

Answer 3

inhibitory so will be low after eating

Question 4

stimualtary substances of GH

Answer 4

ghelin (hormone stomach produces to let ur brain eat)

gHRH- from hypothalamus

deep sleep

exercise

sex hormones

Question 5

how can we divide the symtoms of acromegaly

Answer 5

due to the GH secretion and due to the tumours

Question 6

specific sign on x ray

Answer 6

spade phalanx - the distal phalanx becomes spade shape

Question 7

ocreattide what is it and what conditons do we use it for

Answer 7

somatostatin agonist (mimics it)

acromegaly, carcinoid tumours (vipomas etc)

Question 8

pegvisomat

Answer 8

GH antognoisy( if somatostatin doesn’t work )

it stops the production of IGF - production in the liver

Question 9

remission criterra

Answer 9

Complete disappearance of hyperhidrosis - clinical marker of remission

GH < 1
IGF LEVELS ARE NORMAL

Question 10

most common cause of acromegaly

Answer 10

pituatary adenoma

Question 11

cause of it

Answer 11

excessive GH

Question 12

whats the relationship between GH and iGF

Answer 12

its the GH that causes the IGF TO BE PRODUCED

Question 13

types of igf

Answer 13

1 and 2
1 is associated with cancer

Question 14

relationship between somatostatin and HG

Answer 14

Physiologically, growth hormone should be suppressed by somatostatin

Question 15

why is excess gH a problem

Answer 15

it causes diabetes because of insulin resistance

Question 16

symptoms

Answer 16

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 17

why dont we use GH levels for diagnosis

Answer 17

because they vary so much within the day its not reliable. even in somone without acromegaly

Question 18

tx

Answer 18

first line transphenoidal surgery

if CI
octreotide then unsuccessful pegvisomat

Question 19

tx

Answer 19

first line transphenoidal surgery

if CI
octreotide then unsuccessful pegvisomat

Question 20

complications

Answer 20

Visual problems due to optic chiasm

2. arthritis
3. hypertension
4. hyperhydrosis
5. carpal tunnel syndrome
6. type 2 diabtes
   7.Increased risk of colonic polyps which can become malignant
7. cardiac failur

Question 21

complications

Answer 21

Visual problems due to optic chiasm

2. arthritis
3. hypertension
4. hyperhydrosis
5. carpal tunnel syndrome
6. type 2 diabtes
   7.Increased risk of colonic polyps which can become malignant
7. cardiac failur

Question 22

why does the heart get affected

Answer 22

GH causes lv hypertophy

Question 23

what triggeres release of prolactin

Answer 23

Thyrotropin releasing hormone(hypothalamus)

Question 24

effect of dopmine on prolactin

Answer 24

inhibitory

Question 25

what causes elevated levels of prolactin

Answer 25

preganancy
breastfeeding
sleep, stress
after sexual

Question 26

where is dopamine made

Answer 26

hypothalamus

Question 27

symptoms of high prolactin

Answer 27

galactorrhea
menstrual cycle disturbances - oligo/amen

chronic anovulation - infertility

men: hypogonadism,erectile dysfucntion, decreased libido

Question 28

what metabolic distrubances can be observed

Answer 28

weight gain, pre diabetes,(insulin resistance dyslipidemia

Question 29

what meds can increase prolactin levels

Answer 29

antipsychotic (decrease dopamine)
antidepressants
antihypertensives
h2 blockers

Question 30

what is one of the most common reasons for hyperprolactinemia

Answer 30

primary hypothryoisim