Home
Keys to Success in Medicine
Cardiovascular System
Respiratory System
Locomotor System
Endocrine and Metabolic System
Kidneys and Urinary System
Gastrointestinal Tract
Central Nervous System
Haematological System
Integumental System
Reproductive and Genital System
Recommended Reading
Forum
Links

amazon astore

ydr

aces for paces

Acromegaly

Title

Ñ    Acromegaly

Definition

Ñ    Metabolic state resulting from excess growth hormone (GH)

Pathogenesis

Causes

Ñ    Pituitary tumour

Ñ    GHRH induced hyperplasia:

Very rare

Pathophysiology

Growth hormone stimulates soft tissue and skeletal growth resulting in:

Ñ    Children:

Gigantism

Ñ    Adults:

Acromegaly

Clinical Features

History

E&M

Ñ    Change in appearance

Ñ    Weight gain

Ñ    Tiredness

Ñ    Goitre

IS

Ñ    Excessive sweating

RS

Ñ    Deep voice

Ñ    Obstructive sleep apnoea:

Macroglossia

KUS

Ñ    Polyuria, polydypsia

RAG

Ñ    Galactorrhoea

Ñ    Impotence

Ñ    Decreased libido

Ñ    Amenorrhoea or oligomenorrhoea

CNS

Ñ    Headache

Ñ    Visual disturbances

Ñ    Muscular weakness

LMS

Ñ    Joint pains

Ñ    Tight rings on fingers

Examination

E&M

Ñ    Increased height:

Proportionate tall stature

IS

Ñ    Hirsutism

Ñ    Thick skin

Ñ    Greasy skin

CVS

Ñ    Hypertension

Ñ    Cardiomyopathy

Ñ    Oedema

GIT

Ñ    Prognathism

Ñ    Interdental separation

Ñ    Macroglossia

RAG

Ñ    Galactorrhoea

CNS

Ñ    Prominent supraorbital ridges:

Examination of eyes

Ñ    Visual field defects

Ñ    Carpal tunnel syndrome

Ñ    Proximal myopathy

RS

Ñ    Large nose

LMS

Ñ    Spade like hands

Ñ    Large feet

Ñ    Arthropathy

Investigations

Fluids

Blood

Biochemistry

Ñ    GH suppression test:

Failure to suppress GH levels following oral glucose load

Ñ    IGF-1 assay:

·          IGF-1 levels raised

Screening test

Ñ    Pituitary Function:

Partial or complete anterior hypopituitarism

Ñ    Prolactin:

Hyperprolactinaemia

Imaging

MRI

Ñ    Reveals pituitary adenoma

Management 

Control

Drugs:

Ñ    Somatostatin analogues:

Octreotide

Lanreotide    

Ñ    Dopamine agonists:

Bromocriptine

Cabergoline

Ñ    Growth Hormone Antagonists:

Pegvisomant

Surgery

Ñ    Trans-Sphenoidal surgery:

First line

Ñ    Trans-frontal surgery:

Rarely used

Radiotherapy

Ñ    External radiotherapy:

Used after surgery if GH levels fail to normalise      

[ Back ] [ Up ] [ Next ]

[Up]