Acromegaly

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Introduction

Incidence of 3-4 cases/million each year.

 

 

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

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Causes and Risk Factors

 

Pituitary adenomas are behind 95% of cases of acromegaly. Other causes include:

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Pathophysiology

 

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Signs and Symptoms

 

  • history
  • physical exam

History

  • coarse features and deep voice
  • headaches
  • fatigue
  • sweating
  • sleep apnea
  • decreased libido
  • impotence
  • menstrual problems
  • visual impairment

Physical Exam

 

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

Suppression test can be used.

Random GH, if low, can exclude acromegaly, but is not useful as a routine test.

IGF-1 and IGFBP-3 can also be useful.

Diagnostic Imaging

 

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Differential Diagnosis

 

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Treatments

 

surgery

 

radiotherapy

 

somatostatin analogues

 

DA agonists

 

GH receptor antagonists

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Consequences and Course

Cardiovascular disease accounts for over half of acromegaly deaths.

Conditions that can also occur include:

 

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Resources and References

 

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Topic Development

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