Acromegaly

• The most common cause of acromegaly is a pituitary adenoma - leading to excessive release of growth hormone
• Growth hormone is released by the anterior pituirary
• Very rarely, acromegaly can be secondary to a cancer such as lung or pancreatic - tumour secretes GHRH or GH
• Presentation of acromegaly:

  • Space occupying pituitary tumour can cause headaches and bitemporal hemianopia
  • Frontal bossing - prominent forehead and brow
  • Coarse sweaty skin
  • Large nose
  • Macroglossia - large tongue
  • large hands and feet
  • Large protruding jaw
• Complications:

  • Hypertension
  • Type 2 diabetes
  • Carpal tunnel syndrome - bilateral and often first symptom
  • Arthritis
  • Colorectal cancer
• Investigations:

  • Insulin-like growth factor -1 : will be raised
  • Growth hormone suppression test - glucose should suppress GH
  • MRI of the pituitary
• Treatment:

  • Trans-sphenoidal surgery to remove the pituitary tumour (first line)
  • Removal of tumour releasing GHRH/GH
  • GH receptor antagonist, somatostatin analogues and dopamine agonists
• Acromegaly occurs post-epiphyseal fusion

  Gigantism occurs prior to epiphyseal fusion
• It is normally a sporadic condition seen in middle-aged adults with equal distribution between males and females.
• Rarer familial causes can present in younger patients - MEN-1
• Symptoms due to prolactin:

  • Amenorrhoea
  • Galactorrhoea
  • Erectile dysfunction
  • Reduced libido
  • Infertility