Acromegaly

clinical presentation of acromegaly result from:

1-excess growth hormone.

2-pituitary tumour (bitemporal hemianopia & headache)

3-compression of adjacent normal putuitary (hypoputuitrism due to diminshed ant pit production corticotropins,gonadotropins and thyrotropins))

on examination:

1. Generalized coarse features of the face
2. Soft tissue enlargement of nose ,tounge and ears
3. Promenant supraorbital ridges
4. Proganthism
5. Increase interdental space
6. Malocclusion
7. Kyphosis
8. Husky voice
9. Spade like fingers
10. Moist rubbery skin

What other physicl signs that may be present?

increase foot/hat size

bowed legs

rolling gate

goitre

gynaecomastia

galactorrhea

large testicles

multiple skin tag

acanthosis nigricans

OA

Carpel tunnel

What are the indications of disease activity?

1. Headache
2. Exessive sweating
3. Skin tag
4. Glycosurea
5. ↑BP
6. ↑Loss of visual field

what are the investigations?

Biochemical:

GTT→failure to suppress GH

Plasma IGF-1

Ca (to exclude MEN I in 5% of patients)

Basal and Dynamic pit function test(ACTH,TSH and LH/FSH)

Radiological:

MRI od pit fossa

Skull X-ray

Other:

Formal Goldman perimetry

Compare photo’s

What are the line of management?

1-Trans sphenoidal surgery: first line therapy

2-Irradiation: slow biochemical response

3-Medical:

somatostatin analogues →octeriotide

Dopamine agonist →bromocriptine

growth hormone antagonist→Pegvisomant

What are the most common cause of death?

Cardiac failuer

Tumour expansion (mass effect and bleed)

↑BP

degenerative vascular disease

what are the complcations?

Cardiomyopathy

BP

Impaired glucose tolerance

Artheritis

Visual field defect

Large bowel tumour (10 fold increased risk)

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