Growth Hormone disorder (Acromegaly) (Gigantism) (↓GH)

Question 1

growth hormone normal functions?

-5

Answer 1

grows muscles & bones
stimulates IGF release
GH has glucose sparing effect
↑lipolysis

Question 2

IGF effects?

-4

Answer 2

grows muscle + bones
protects bone
protects cartilage

Question 3

which cells make growth hormone?

where are they located?

Answer 3

somatotrophs

Ant. pituitary gland

Question 4

somatotrophs make up & wise how much on the endocrine cells in Ant. pituitary gland?

Answer 4

50%

Question 5

problem with measuring growth hormone?

so what can you measure instead to give you a decent idea?

Answer 5

GH serum levels fluctuate a lot in the day

measure IGF

Question 6

other name for growth hormone?

Answer 6

somatotropin

Question 7

IGF released where?

Answer 7

liver

Question 8

main cause for ↑GH in adult?

% wise how many times is this the cause?

Answer 8

Pituitary adenoma

95%

Question 9

↑GH in adult called what?

Answer 9

Acromegaly

Question 10

other causes of ↑GH (aside from Pituitary adenoma)?

-2

Answer 10

ectopic tumour

multiple endocrine neoplasia

Question 11

ectopic tumour at which organ can commonly ↑GH levels?

Answer 11

pancreas

Question 12

Acromegaly features around the face and mouth?

-3

Answer 12

Thick lips + tongue
Big gap between teeth
Protruding jaw

Question 13

Thick tongue medical name?

Answer 13

macroglossia

Question 14

Protruding jaw medical name?

Answer 14

prognathism

Question 15

Acromegaly features/symptoms?

-7

Answer 15

Big hands
Big feet
Thick lips + tongue – macroglossia 
Big gap between teeth
Protruding jaw – prognathism 
Sweaty skin
Oily skin

Question 16

sign on eye examination?

why?

Answer 16

bitemporal hemianopia

pituitary adenoma hits on optic chiasm

Question 17

what happens to blood glucose?

Answer 17

↑BG

Question 18

Suspect Acromegaly,

1st line Ix?

+ve result?

Answer 18

Serum Insulin growth factor (IGF-1)

↑↑

Question 19

Suspect Acromegaly.
Insulin growth factor (IGF-1) is up.

next Ix to confirm diagnosis?

Answer 19

Oral Glucose Tolerance Test

Question 20

Suspect Acromegaly.
Insulin growth factor (IGF-1) is up.
Oral Glucose Tolerance Test is abnormal.

next Ix?

why do you do this Ix?

Answer 20

MRI head

look for pituitary adenoma

Question 21

which blood test basically look at the all/most of the hormones that come from the pituitary?

Answer 21

Pituitary hormone screen

Question 22

in acromegaly, along with high GH, what other hormone can be high?

how often is it high in acromegaly pts %?

Answer 22

prolactin

20%

Question 23

main Ix to look for ectopic tumour causing acromegaly?

Answer 23

CT

Question 24

which blood test to check for high prolactin?

Answer 24

Pituitary hormone screen

Question 25

pt has confirmed acromegaly. 1st line Mx? method used to get to the pituitary?

Answer 25

resect pituitary trans sphenoidal - up nose

Question 26

pt has confirmed acromegaly. what do you give to combat high prolactin?

Answer 26

give Dopamine

Question 27

pt has confirmed acromegaly. surgery done, but still growth hormone is raised. 1st line drug to combat high GH? -name

Answer 27

octreotide

Question 28

1st line drug to combat high GH? -name this drug is analogue of what hormone?

Answer 28

octreotide somatostatin

Question 29

somatostatin effect on growth hormone?

Answer 29

suppression/inhibition

Question 30

2nd line drug to combat high GH? - name why is this drug used less than octreotide?

Answer 30

pegvisomant expensive

Question 31

pegvisomant class?

Answer 31

GH receptor antagonist – blocks GH

Question 32

is surgery usually curative or not?

Answer 32

usually curative

Question 33

Prognosis for acromegaly?

Answer 33

decent - Life expectancy near normal once disease treated

Question 34

define gigantism?

Answer 34

high GH in a child

Question 35

usual cause of gigantism?

Answer 35

Pituitary adenoma

Question 36

extra features/ symptoms of gigantism not seen in acromegaly?

Answer 36

tall + delayed puberty

Question 37

why does gigantism cause increased height but acromegaly does not?

Answer 37

epiphyseal growth places not closed

Question 38

why is there delayed puberty in gigantism? | -step by step

Answer 38

↑GH in child > -ve feedback on HPA axis > less GnRH > hypogonadal > delayed puberty

Question 39

Growth Hormone Deficiency. | what happens to GH levels?

Answer 39

↓GH

Question 40

Diagnostic test for growth hormone deficiency? | result?

Answer 40

IGF blood test low IGF

Question 41

1st line Mx for growth hormone deficiency?

Answer 41

give Synacthen (growth hormone)