1. Acromegaly Treatment
GH hypersecretion from pituitary hormone. Usually presents between 30-50 YO. Trans-sphenoidal surgery
External irradiation – for failed surgery or older patients
Medical therapy – dopamine agonist (eg bromocriptine), somatostatin analogues (eg
Features
octreotide)
Symptoms
Treatment of hypopituitarism – esp steroid replacement, which is life saving
Headaches Carpal tunnel syndrome Oligomenorrhoea /
Visual field defects Paraesthesia amenorrhoea
Hyperhidrosis SOB (heart failure) Galactorrhoea Common cause of death
Facial / acral changes Arthritis Impotence Cardiac failure
Sleep apnoea Tumour expansion (mass effect & hemorrhage)
Effects of HPT
Signs Degenerative vascular disease
Prominent supraorbital ridge Thick spade-like hands Goitre
Large nose & lips Large feet Cardiomegaly & Differential Dx of excess GH
Large tongue Proximal myopathy Progressive heart failure MEN I: PTH hyperplasia, pituitary tumours & gut tumours
Interdental separation Paraesthesia due to Gynaecomastia & McCune-Albright syndrome: polyostotic fibrous dysplasia, sexual precocity & café-au-lait
Prognathism carpal tunnel syndrome galactorrhoea spots
Deep voice Arthropathy: Hepatosplenomegaly Carney complex
Bitemporal hemianopia due osteoarthrosis, Increased sweating
to mass efx of pit. tumour chondrocalcinosis Coarse oily skin
Optic atrophy Kyphosis Axilla: skin tags
(molluscum fibrosum) &
acanthosis nigricans (black
velvety papillomas)
* Insidious onset, therefore compare current features with old photos.
* May be a/w features of hypopituitarism: eg oligomenorrhoea / amenorrhea, galactorrhoea,
impotence
Complications
Visual field defect
Hypopituitarism
DM
HPT
Cardiomyopathy / heart failure
Large bowel tumours (benign or malignant)
Carpal tunnel syndrome
Arthritis: hip, knee, spine
Spinal stenosis causing cord compression
Investigations
Digitally signed by DR WANA HLA SHWE
OGTT with GH measurement: no GH suppression in acromegaly ) DN: cn=DR WANA HLA SHWE, c=MY, o=UCSI
Serum IGF-1: elevated by excessive GH secretion, pregnancy or puberty ) DM University, School of Medicine, KT-Campus,
ECG, CXR (cardiomegaly) Terengganu, ou=Internal Medicine Group,
email=wunna.hlashwe@gmail.com
hands & feet X-ray (terminal phalangeal ‘tufting’) Reason: This document is for UCSI year 4
MRI/CT pituitary fossa students.
Date: 2009.02.24 14:03:18 +08'00'
Visual field and acuity testing—bitemporal hemianopia
Inx for hypopituitarism: TFT, LH/FSH, Testosterone, prolactin, short Synacthen test (for
ACTH deficiency), triple stimulation test.
Exclude MEN I syndrome: Ca levels