Adrenal and Gonads - CS3: Hypogonadotropic/Hypogonadism

Question 1

Symptoms of Acromegaly (Case Study 3)

Answer 1

Coarse facial features (frontal bossing, enlarged nose, thick lips)

Enlarged hands and feet (shoes become tight)

Joint pain (especially in hands and knees)

Sweating and headaches

Hypertrophy of the heart (leading to heart problems)

Diabetes or glucose intolerance

Increased risk of colon cancer

Carpal tunnel syndrome

Question 2

Diagnosis of Acromegaly

Answer 2

High levels of Growth Hormone (GH) that don’t suppress after glucose tolerance test (OGTT)

Elevated IGF-1 (Insulin-like Growth Factor)

MRI to identify pituitary adenoma

GH suppression test (insulin stress test) to confirm excess GH production

CT scan may be used for further imaging

No suppression of GH after glucose

History of abnormal growth and physical symptoms

Question 3

Treatment for Acromegaly

Answer 3

Surgery (Transsphenoidal pituitary adenoma resection, removing the tumour)

Somatostatin analogs (e.g., Octreotide or Lanreotide) to inhibit GH release

GH receptor antagonists (e.g., Pegvisomant) to block the effects of GH

Radiotherapy (if surgery is unsuccessful)

Dopamine agonists (e.g., Cabergoline) used if the adenoma is responsive

Management of diabetes (via insulin or oral agents)

Question 4

Prognosis of Acromegaly

Answer 4

Good outcome with early diagnosis and treatment

Reduced life expectancy if untreated (due to cardiovascular complications or early death from heart failure)

Long-term monitoring required for remission or disease progression

Question 5

What is the key difference between Acromegaly and Gigantism?

Answer 5

Gigantism occurs in children (before the growth plates close), leading to excessive linear growth (tall stature).

Acromegaly occurs in adults (after growth plates have fused), leading to abnormal enlargement of soft tissues and bones (e.g., hands, feet, and facial features).

Both conditions are caused by excess GH secretion, typically from a pituitary adenoma.