Table of Contents
Learn the focussed examination too…
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
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
