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Acromegaly

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Acromegaly focussed examination covered here!

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 

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 and Salenave (Acromegaly. Orphanet Journal of Rare Diseases 3:17), licensed under the Creative Commons Attribution 2.0 Generic license

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