Acromegaly

Acromegaly

·        Usually presents between 30 – 50 years.  Rare (3/million/year)

·        Symptoms: insidious onset (look at old photos), coarse oily skin, large tongue, bossing of supraorbital ridge, ­shoe size and teeth spacing, spade-like hands, carpel tunnel syndrome, progressive heart failure, goitre

·        Symptoms due to: periosteal growth (gigantism if the condition starts before closure of the bony epiphyses), fibrous tissue growth (® skin thickening), organomegaly (eg cardiomegaly, hepatomegaly, splenomegaly, testicular enlargement), cartilaginous growth (­ears, nose, costochondral junctions), neurological overgrowth (® peripheral neuropathy, exacerbated by the soft tissue swelling)

·        Complications: DM, ­BP, cardiomyopathy, ­lipids, hypopituitarism

·        Tests:

o  GH (highly variable – normally undetectable, spikes 10 times a day, mainly during deep sleep), ­IGF-1 (insulin like growth factor) indicates GH secretion over the previous 24 hrs.

o  Oral glucose tolerance test. If GH doesn‟t fall then acromegaly, anorexia nervosa, poorly controlled DM, or Cushing‟s.

o  Tests as for pituitary tumour

·        Treatment: trans-sphenoidal surgery if young. External irradiation for elderly. Somatostatin (Octreotide) if patient is not a good operative risk

·        GH deficiency in children ® growth retardation. One high GH level excludes deficiency. Take after sleep or exercise