Acromegaly Very rare Prevalence in the order of 1 in 200000 Usually diagnosed between age 40 and 60 No difference in gender susceptibility Insidious onset Pathogenesis Most commonly caused by pituitary adenoma ID: 785062
Download The PPT/PDF document "Endocrinology Acromegaly" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Endocrinology
Acromegaly
Slide2Slide3Acromegaly
Very rare
Prevalence in the order of 1 in 200,000
Usually diagnosed between age 40 and 60
No difference in gender susceptibility
Insidious onset
Slide4Pathogenesis
Most commonly caused by pituitary adenoma
Increased secretion of growth hormone
Acts in liver to release IGF-1 (insulin-like growth factor)
Slide5So what are the symptoms?
Tumour
Growth hormone
IGF-1
Slide6Slide7Slide8On examination
Characteristic facial appearance: Coarse, Frontal bossing, ↑sinuses, ↑ tongue,
Prognathism
(jaw protrusion), separation of teeth
Deep voice
Carpal tunnel syndrome
Hand & foot enlargement
Visual fields (
bitemporal
hemianopia
)
Organomegaly
: Goitre,
Hepatosplenomegaly
Slide9Investigations
Glucose tolerance test with measurement of growth hormone level.
(Should be inhibited by glucose)
(Growth hormone secretion is episodic and so a random GH alone is unlikely to be useful)
Evidence of other pituitary involvement
MRI scan to identify adenoma
Slide10Management
Surgery: trans-
sphenoidal
adenomectomy
or craniotomy for very large tumours.
Pituitary radiotherapy: useful if tumour is not fully removed and reduces GH progressively over years.
Drugs:
Somatostatin
analogues (
octreotide
,
lanreotide
) suppress GH in 60%
Dopamine agonists (
bromocriptine
,
cabergoline
) lower but rarely normalize GH
GH receptor antagonist (
pegvisomant
) normalizes IGF-I in >90% of pts.
Slide11Bonus marks management
Management of:
↑ Cardiovascular morbidity & mortality – from HTN, impaired GTT (25%), Diabetes Mellitus (10%)
↑ Cardiac failure (heart muscle disease), ↑IHD, ↑CVD
Obstructive sleep apnoea
Arthropathy
(50%)
Osteoporosis
Colorectal cancer
Complication of treatment:
hypopituitarism