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
- Prognathism
- Nasal sinus enlargement
- Increased heel pad thickness
- Widened space between lower incisor teeth & defect in mandible
- Enlargement of hands & feet
- Carpel tunnel syndrome
- Osteoarthritis
- Hyperhidrosis
- Muscle hypertrophy
- Cardiomegaly, macroglossia & thyroid gland enlargement
- 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
- Prognathism
- Nasal sinus enlargement
- Increased heel pad thickness
- Widened space between lower incisor teeth & defect in mandible
- Enlargement of hands & feet
- Carpel tunnel syndrome
- Osteoarthritis
- Hyperhidrosis
- Muscle hypertrophy
- Cardiomegaly, macroglossia & thyroid gland enlargement
- Diabetes mellitus
Investigations-
- Screening- random serum IGF- 1 elevated
- Oral glucose tolerance test with GH measure confirms acromegaly
- Prolactin elevated
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