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 

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Try some questions

Try an acromegaly OSCE station

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