Acromegaly Flashcards
What is it
Syndrome that results from excessive growth hormone production after fusion of the epiphyseal plates
What is gigantism
Excess growth hormone production BEFORE epiphyseal plate fusion
Most common cause of acromealy
Pituitary adenoma
Causes of acromegaly
Pituitary adenoma
GH releasing hormone (GHRH) production from bronchial carcinoid
Clinical presentation of acromegaly
MIL CIA Macroglossia Increased jaw size Lower pitch of voice Carpal tunnel syndrome Increased hand size Ask to see old photographs of the patient and note changes in appearance
Investigations
Bloods
Radiology
ECG and ECHO
Visual field testing
Blood tests done for acromegaly
FBC U/Es Creatinine LFTs Glucose Lipid levels GH levels Glucose tolerance test Insulin-like growth factor (IGF-1) levels raised Prolactin levels
Radiology tests done for acromegaly
CXR
CT and MRI scan
What do ECG and ECHO stand for and why are they investigations of acromegaly
Electrocardiogram
Echocardiogram
Assess for cardiac complications e.g. cardiomyopathy
What visual field anomaly could present with acromegaly (due to a pituitary tumour)
Bilateral hemianopia
compression of optic chiasm
Conservative treatment of acromegaly
Patient education
Inform patient that bone changes will not revert after treatment
Medical treatment of acromegaly
Somatostatin analogue
Dopamine agonist
GH receptor antagonist
Give an example of a:
Somatostatin analogue
Dopamine agonist
GH receptor antagonist
Somatostatin analogue = OCTREOTIDE
Dopamine agonist = CABERGOLINE
GH receptor antagonist = PEGVISOMANT
SO DC GP
Surgical treatment of acromegaly
Trans-sphenoidal surgical excision of the adenoma
Complications of acromegaly
HID PIE Hypertension Increased CVS disease Diabetes mellitus Postsurgical e.g. infection, cerebrospinal fluid leak Increased risk of colon cancer Erectile dysfunction
