![]() This is the initial treatment for most patients and involves making an incision in the nose (sphenoid sinus) to allow access to the pituitary adenoma. Surgical removal of the pituitary adenoma is usually performed via transsphenoidal surgery. ![]() The goal of management is to normalise hormone levels and remove the pituitary adenoma (if possible). ![]() MRI pituitary: to investigate for a pituitary adenoma.Relevant imaging for acromegaly include: 2 Serum growth hormone is not routinely used due to GH pulses throughout the day and at times of stress Imaging Pituitary assessment (prolactin, cortisol, thyroid function tests, FSH/LH, oestradiol and testosterone): to assess pituitary function.Blood glucose, calcium, phosphate and triglycerides: these may be raised in acromegaly.In acromegaly, GH will not be suppressed after an OGTT. Oral glucose tolerance test (OGTT): this is used to confirm a diagnosis.Relevant laboratory investigations include: 1,2 Visual field examination: a pituitary adenoma impacting the optic chiasm will cause bitemporal hemianopia.Relevant bedside investigations include: 2 Other signs: galactorrhoea, hypertension, signs of heart failure.Visual field defects: bitemporal hemianopia due to pituitary adenoma.Effects on hands: tight rings on fingers, signs of carpal tunnel syndrome.Changes in appearance: frontal bossing (prominent forehead), macroglossia (large tongue), prognathism (protruding lower jaw), interdental separation, enlarged hands & feet, skin thickening.Typical clinical findings in acromegaly include: 1,4 Family history: multiple endocrine neoplasia type 1 (MEN-1), McCune-Albright syndrome and Carney complex.Other important areas to cover in the history include: Symptoms due to prolactin: amenorrhoea, galactorrhoea, erectile dysfunction, reduced libido, infertility.Systemic symptoms: change in appearance, weight gain, fatigue, snoring, joint pain, voice changes, skin tags.Symptoms due to tumour: headache, visual changes.Typical symptoms of acromegaly include: 1,4 The growth hormone axis Clinical features History In the case of acromegaly, the negative feedback loop is broken leading to increasing levels of GH. 3įor more information, see the Geeky Medics guide to the pituitary gland. ![]() IGF-1 mediates the effects of GH and has a negative feedback effect to inhibit GH secretion by producing somatostatin and acting on somatotrophs (Figure 1). Rarely, pituitary hyperplasia may also result in elevated GH. AetiologyĪcromegaly is usually caused by a growth hormone (GH)-secreting pituitary adenoma. Monitoring and treatment of the comorbidities associated with acromegaly are essential for improving patient quality of life.You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics. Normalisation of plasma insulin-like growth factor 1 (IGF-1) and a decrease of plasma GH to below 1 microgram/L (1 nanogram/mL) bring the mortality rate to normal. Modern surgical and pharmacological modalities are associated with improved outcomes. Must be screened for in the presence of pituitary adenoma, profuse sweating, acral growth, coarsening of facial features, and when suspected in conjunction with commonly associated conditions, such as carpal tunnel syndrome, arthralgia, glucose intolerance or diabetes mellitus, amenorrhoea, hypertension, and sleep apnoea. Early recognition and appropriate treatment are crucial for reducing the potentially debilitating complications of the disease. It is associated with increased morbidity and premature mortality if not appropriately treated. Acromegaly is a rare, chronic disease caused by excessive secretion of growth hormone (GH), usually due to a pituitary somatotroph adenoma.
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