Acromegaly

Acromegaly


ACROMEGALY

  • Acromegaly is caused by GH secretion usually from a macroadenoma.

Etiology-

  • Pituitary adenoma
  • Extrapituitary tumour
  • GHRH- mediated acromegaly is most common cause is abdominal carcinoid tumour.

Clinical features-

Excessive GH secretion

  • Before closure of epiphyses- tall stature & gigantism
  • After closure of epiphysis- acromegaly
  1. Prognathism
  2. Nasal sinus enlargement
  3. Increased heel pad thickness
  4. Widened space between lower incisor teeth & defect in mandible
  5. Enlargement of hands & feet
  6. Carpel tunnel syndrome
  7. Osteoarthritis
  8. Hyperhidrosis
  9. Muscle hypertrophy
  10. Cardiomegaly, macroglossia & thyroid gland enlargement
  11. Diabetes mellitus

Investigations-

  • Screening- random serum IGF- 1 elevated
  • Oral glucose tolerance test with GH measure confirms acromegaly
  • Prolactin elevated

Treatment-

  • Surgical- Trans- sphenoidal surgery- first line of treatment
  • Radiotherapy is the second line of treatment.
  • Drugs- somatostatin ananlogues (lanreotide)- lowers GH levels
  • Dopamine agonist (Cabergoline)

Exam Important

  • Acromegaly is caused by GH secretion usually from a macroadenoma.

Clinical features-

Excessive GH secretion

  • Before closure of epiphyses- tall stature & gigantism
  • After closure of epiphysis- acromegaly
  1. Prognathism
  2. Nasal sinus enlargement
  3. Increased heel pad thickness
  4. Widened space between lower incisor teeth & defect in mandible
  5. Enlargement of hands & feet
  6. Carpel tunnel syndrome
  7. Osteoarthritis
  8. Hyperhidrosis
  9. Muscle hypertrophy
  10. Cardiomegaly, macroglossia & thyroid gland enlargement
  11. Diabetes mellitus

Investigations-

  • Screening- random serum IGF- 1 elevated
  • Oral glucose tolerance test with GH measure confirms acromegaly
  • Prolactin elevated
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