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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

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 

Complications

  • Impaired glucose tolerance (40%) and diabetes mellitus 
  • Cardiomyopathy
  • Colon cancer (colonoscopy surveillance)
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