Acromegaly

Here statement 1 & 3 are wrong. It is actually a direct pick from harrison, an important topic for entrance examinations hirsutism is seen in 10% of woman. Acromegaly rarely causes hirsutism.

B i.e. Growth hormone

Tumors of somatortopes of the anterior pituitary secrete large amount of growth hormone, leading in children to gigantism and in adults to acromegaly.

Hypersecretion of GH is accompamied by hypersecretion of prolactin in 20 – 40% of patient with acromegaly.

Somatomedian: are polypeptide growth factors secreted by liver & other tissues. The effect of growth hormone on growth, cartilage and protein metabolism depend on interaction between GH & somatomedian.

Answer is A (Mental Retardation):

Hypersecretion of Growth hormone (gigantism in children; acromegaly in adults) is not associated with Mental Retardation

Growth Hormone Hypersecretion IGF-1 Hypersecretion

Acromegaly and Gigantism are clinical syndromes that result from hypersecretion of Growth Hormone (or somatamedins like IGF-1)

Acromegaly results in adults when excessive secretion of GH occurs following epiphyseal closure.

Gigantism occurs is children when excessive secretion of GH occurs prior to epiphyseal closure as a result of increased linear bone growth

The most common cause for Acromegaly is a Growth Hormone secreting pituitary adenoma⁽⁾ (somatotrope adenoma)

Clinical manifestations of Acromegaly:

Local Tumor Effects

• Visual field defects
• Cranial nerve palsy (diplopia)
• Headache

Somatic Manifestations

• Acral enlargement
• Thickening of soft tissue of the hands/feet (increased ring/shoe size)

Musculoskeletal Manifestations

• Prognathism
• Malocclusion
• Arthralgias
• Carpal tunnel syndrome
• Frontal bossing

Skin Manifestations

• Hyperhidrosis
• Skin tags

Colon Manifestations

• Polyps

Cardiovascular Manifestations

• Left ventricular hypertrophy
• Hypertension
• Congestive heart failure

Sleep Disturbances

• Sleep apnea
• Narcolepsy

Visceral Manifestations

• Macroglossia
• Hepatomegaly
• Splenomegaly
• Thyroid enlargement 

Sexual Function

• Menstrual abnormalities
• Galactorrhea (hyperprolactinemia)
• Decreased libido 

Carbohydrates

• Impaired glucose intolerance
• Insulin resistance
• Hyperinsulinemia
• Diabetes mellitus
• Lipids
• Hypertriglyceridemia

Answer is B (Glucose induced GU suppression):

The diagnosis of Acromegaly is confirmed by demonstrating the failure of GH suppression after an oral glucose load.

Diagnosis of Acromegaly

• IGF – I level

Age and gender matched serum IGF-I level are elevated in Acromegaly.

Elevated IGF-I levels are primarily used as a screening test for Acromegaly and not as a confirmatory test.

• Random GH Assay

GH secretion is episodic and serum concentrations of GH may fluctuate from undetectable levels to significantly high levels during the day. Due to pulsalilty of GH secretion, measurement of single random GH level is not useful for the diagnosis or exclusion of Acromegaly.

• GH suppression test (Failure of GH suppression in response to Glucose load)

The diagnosis of Acromegaly is confirmed by demonstrating the failure of GH suppression to hours of an oral glucose load (75g).

Infact, about 20% of patients exhibit a paradoxical rise in GH levels after glucose.

Ans. D: Muscle hypertrophy

Carpal tunnel syndrome

Decreased muscle strength (weakness), easy fatigue

Enlarged bones of the face, large fleshy nose, enlarged feet and hands Soft tissue swelling resulting in increased heel pad thickness Enlarged glands in the skin (sebaceous glands)

Enlarged jaw (prognathism) and tongue

Excessive height (when excess growth hormone production begins in childhood) Excessive sweating

Sleep apnea

Widely spaced teeth

Widened fingers or toes due to skin overgrowth with swelling, redness, and pain Other symptoms that may occur with this disease:

Excess hair growth in females

Weight gain (unintentional)

Diabetes mellitus

Coronary heart disease, cardiomyopathy with arrhythmia, hypertension are CVS effects.

Ans. Lengthened terminal phalanx