Acromegaly

Overview

Acromegaly is caused by growth hormone (GH) secretion from a pituitary tumour, commonly macroadenoma. Growth hormone stimulates skeletal and soft tissues growth. High level of growth hormone cause gigantism in children (if acquired before epiphyseal fusion) and acromegaly in adult.Overall incidence is approximately 3–4/million per year

Signs and Symptoms

Prominent supraorbital ridge, Interdental separation, Large tongue, Hirsutism, Thick greasy skin, Increase size of hands and feet, Deep voice, Headache, Excessive sweating, Weight gain, Tiredness, Muscular weakness, Joint pains, Galactorrhea, Poor libido, Polyuria, Polydipsia, Obstructive sleep apnea, Darkening of skin

Common Causes

Pituitary tumour, Non pituitary tumour, Multiple endocrine neoplasia type 1 (MEN1) Syndrome

Investigation Techniques

Full blood count, Growth hormone (GH) level - may exclude acromegaly if undetectable but a detectable value is non-diagnostic to be taken alone. Normal adult levels are <0.5 μg/L for most of the day except during stress, Screening for colonic neoplasm, Tumour markers, Oral glucose tolerance test - is diagnostic if there is nosuppression of GH, IGF-1 levels, Visual field examination, Pituitary function test, MRI scan of pituitary fossa, Compare patient with old photos

Treatment and Prevention

Surgery - Transphenoidal surgery (first line treatment), External radiotherapy (second line treatment), Medical -Somatostatin analogues (such as octreotide or lanreotide) can be administered as slow-release injections every few weeks

Psychological Issues

Hallucinations, Delusion, Anxiety, Depression