acromegaly and prolactinomas Flashcards
(33 cards)
define acromegaly
abnormal growth of hands, feet and face due to overproduction of GH.
what are the co-morbidities you can get with acromegaly ?
-Hypertension and heart disease
-Cerebrovascular events and headache
-Arthritis
-Sleep apnoea
-Insulin – resistant diabetes
what is the diagnosis of acromegaly dependent on?
- Clinical features
-GH - IGF-1 levels
what are the presenting clinical features of acromegaly
-Acral enlargement
-Arthralgias
-Maxillofacial changes
-Excessive sweating
-Headache
-Hypogonadal symptoms
when is acromegaly excluded in diagnosis?
- GH <0.4 ng/ml and normal IGF-I
If either the GH or IGF-1 is abnormal, what do you do?
75gm glucose tolerance test (GTT)
when is acromegaly excluded in the glucose tolerance test? (GTT)
IGF-I normal and GTT nadir GH <1 ng/ml
What are the objectives of therapy in acromegaly
-restoration of basal GH and IGF-I to normal levels
-relief of symptoms
- reversal of visual and soft tissue changes
- prevention of further skeletal deformity
-normalization of pituitary function
what are the options for treatment of acromegaly?
-Pituitary surgery
- Medical therapy
- Radiotherapy
what determines the success of pituitary surgery?
Size of the tumour and the surgeon determine the success of the surgery
what Is used in medical therapy as a treatment option for acromegaly?
-Dopamine agonists e.g. cabergoline
-somatostatin analogues
-growth hormone receptor antagonist
what are the two types of radiotherapy?
- conventional
-stereostatic
-gamma knife
-LINAC
-proton beam
describe conventional radiotherapy
multi-fractional
describe stereostatic radiotherapy
single fraction
less radiation to surrounding tissues
what are the problems of radiotherapy
-Loss of pituitary function in the long-term
-Potential damage to local structures – e.g. eye nerves
Control of tumour growth / excess hormone secretion not always achieved
advantages of dopamine agonists
No hypopituitarism
Oral administration
Rapid onset
disadvantages of dopamine agonists
Relatively ineffective
Side effects
define prolactinomas
lactotroph cell tumour of the pituitary
who’s more likely to get prolactinomas?
women
what is a micro adenoma?
tumour <1cm
what is a macro adenoma?
tumour >1cm
what is a microprolactinoma?
virtually always stays small
what is a macroprolactinoma?
can be massive
what is the local effect of tumour- macro adenoma?
-Headache
-Visual field defect (bi-temporal hemianopia)
-CSF leak (rare)
