Acromegaly

Acromegaly is a disorder caused by excess growth hormone. Over 99% of cases are due to a growth hormone-secreting pituitary macroadenoma.

Clinical features

Pituitary enlargement symptoms

• Hypopituitarism
• Bitemporal hemianopia
• Headache

Excessive soft tissue growth

• Increased hand and feet size
• Coarsening of facial features
• Prognathism, macrognathia, wide spaces between teeth, macroglossia
• Hoarse voice
• Osteoarthritis and arthralgia 
• Carpal tunnel syndrome

Active acromegaly signs

• Excessive sweating
• Hypertension

Acromegalic hand

Mandibular prognathism

Wide spaces between teeth

Investigations

• Confirm acromegaly
  • Insulin-like growth factor 1 – initial screening test
  • Failure to suppress growth hormone during glucose tolerance test – diagnostic test
• Pituitary function tests and serum prolactin: to rule out coexistent hypopituitarism
• MRI pituitary: to visualise tumour

Management

• Transsphenoidal resection 
• Second line options
  • Somatostatin analogues (e.g. octreotide)
  • Growth hormone receptor antagonist (e.g. pegvisomant)
  • Radiotherapy 

Try some questions

What are some possible complications of acromegaly?

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Which hormones are secreted from the anterior pituitary gland?

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Which hormones are secreted from the posterior pituitary gland?

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Try an acromegaly OSCE station

1. Acromegaly focussed exam
2. There’s lots more focussed examinations to try

Picture references

Face acromegaly photos: 2008 Chanson P and Salenave S (Acromegaly. Orphanet Journal of Rare Diseases 3:17 doi:10.1186/1750-1172-3-17), licensed under the Creative Commons Attribution 2.0 Generic license (https://creativecommons.org/licenses/by/2.0/deed.en). Sourced from: https://commons.wikimedia.org/wiki/File:Acromegaly_prognathism.JPEG