clinical presentation of acromegaly result from:
1-excess growth hormone.
2-pituitary tumour (bitemporal hemianopia & headache)
3-compression of adjacent normal putuitary (hypoputuitrism due to diminshed ant pit production corticotropins,gonadotropins and thyrotropins))
- Generalized coarse features of the face
- Soft tissue enlargement of nose ,tounge and ears
- Promenant supraorbital ridges
- Increase interdental space
- Husky voice
- Spade like fingers
- Moist rubbery skin
What other physicl signs that may be present?
increase foot/hat size
multiple skin tag
What are the indications of disease activity?
- Exessive sweating
- Skin tag
- ↑Loss of visual field
what are the investigations?
GTT→failure to suppress GH
Ca (to exclude MEN I in 5% of patients)
Basal and Dynamic pit function test(ACTH,TSH and LH/FSH)
MRI od pit fossa
Formal Goldman perimetry
What are the line of management?
1-Trans sphenoidal surgery: first line therapy
2-Irradiation: slow biochemical response
somatostatin analogues →octeriotide
Dopamine agonist →bromocriptine
growth hormone antagonist→Pegvisomant
What are the most common cause of death?
Tumour expansion (mass effect and bleed)
degenerative vascular disease
what are the complcations?
Impaired glucose tolerance
Visual field defect
Large bowel tumour (10 fold increased risk)