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)

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