Table of Contents
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)
