Endocrine System >
Acromegaly
“Increased growth hormone eg due to Adenoma (in children would cause gigantism)”
Pathophysiology
- Pituitary adenoma
- Increased Growth hormone secretion
- 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
- Oral glucose GH suppression testing to confirm the diagnosis
Management
- 1st line – surgery
- 2nd 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