Acromegaly

Exam Cram

• Pathophysiology: excess growth hormone, usually caused by pituitary adenoma

• Presentation: macroglossia, headaches, joint pains, sweating, HTN, hyperglycaemia

• Investigations: IGF-1 levels

• Management: octreotide

Outline

Background

• Acromegaly is caused by excessive levels of growth hormone

• Resulting in excessive bone growth

• Which reduces life expectancy by 10 years without treatment (with treatment this is almost nullified)

Assessment

Presentation

• Headaches

• Lack of peripheral vision- crashing/ clumsiness

Examination

• Increased height

• Large hands with Osteoarthritis 

• Forehead bossing

• Large tongue (macroglossia)

• Bitemporal hemianopia

• Peripheral neuropathy (carpal tunnel syndrome)

Observations

• Hypertension

• Height, Weight, BMI

Diagnosis

Diagnostic pathway

1. IGF-1 raised

2. Growth hormone not suppressed by glucose

3. MRI Pituitary- pituatary growth

Complications

4. Blood sugar/ HbA1c- Diabetes Mellitus

5. ECHO- Cardiomyopathies

6. Overnight pulse oximetry- Obstructive Sleep Apnea (OSA)

Management

Medical 

• Anti-glycaemics for diabetes

• Antihypertensives for HTN

• CPAP for OSA

Surgical

• Surgery to remove source of Growth hormone, e.g. pituitary

Med Reg Notes

Growth hormone released in pulsatile manner

IGF-1 used to measure tumour re-occurrence

Diagnosis if MRI Pituitary normal

MRI Pituitary can be normal because the pituitary adenoma can be too small to be seen on the MRI. Alternatively the a CTCAP can be used to look for another source of growth hormone productions ectopically- e.g. lung or colon cancer. 

Resources and References

Page written in 2024.