Acromegaly
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Introduction
Incidence of 3-4 cases/million each year.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pituitary adenomas are behind 95% of cases of acromegaly. Other causes include:
- hypothalamic tumours such as gliomas, hamartomas
- ectopic pituitary remnamts
- paraneoplastic effects of adenocarcinomas such as breast
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
- coarse features and deep voice
- headaches
- fatigue
- sweating
- sleep apnea
- decreased libido
- impotence
- menstrual problems
- visual impairment
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Suppression test can be used.
Random GH, if low, can exclude acromegaly, but is not useful as a routine test.
IGF-1 and IGFBP-3 can also be useful.
Diagnostic Imaging
Differential Diagnosis
Treatments
surgery
radiotherapy
somatostatin analogues
DA agonists
GH receptor antagonists
Consequences and Course
Cardiovascular disease accounts for over half of acromegaly deaths.
Conditions that can also occur include:
- acral growth
- carpal tunnel syndrome
- diabetes mellitus, impaired glucose tolerance
- arthritis
- congestive heart failure
- hypertension
- goitre and organomegaly
Resources and References
Topic Development
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