Acromegaly

“Increased growth hormone eg due to Adenoma (in children would cause gigantism)”

Pathophysiology

1. Pituitary adenoma
2. Increased Growth hormone secretion
3. Acromegaly (disproportional skeletal, tissue and organ growth)

Clinical Presentation

• Coarse facial appearance
• Spade like hands
• “Wedding ring doesn’t fit anymore” or “Change in shoe size”
• Sweating and oily skin
• Headaches

Investigations

• Bloods:
  • IGF screening (normal Growth factor not useful)
• Imaging:
  • MRI or CT + visual field tests to determine size and position of adenoma
• Special:
  • Oral glucose GH suppression testing to confirm the diagnosis
    • if normal GH concentration falls with oral glucose but in Acromegaly remains high

Management

• 1^st line – surgery
• 2^nd line – Medical treatment
  • Somatostatin analogues (octreotide) injections reduce Growth hormone secretions
  • Dopamine agonists to inhibit Growth hormone release from tumour

Complications

• Diabetes
• Cardiomyopathy
• Heart Failure
• IHD
• Hypertension
• Carpal-Tunnel Syndrome
• Kyphosis
• Neoplasia especially colorectal
• Obstructive Sleep Apnea