Acromegaly

Aka: Acromegaly

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II. Pathophysiology

  1. Pituitary Adenoma hypersecretion of Growth Hormone
  2. Occurs after closure of epiphyses

III. Causes

  1. Hyperplastic Pituitary Adenoma
  2. Eosinophilic Pituitary Adenoma

IV. Symptoms

  1. Headache
  2. Vision Loss
  3. Muscular weakness
  4. Back pain
  5. Limb pain
  6. Hyperhidrosis
  7. Amenorrhea
  8. Polydipsia
  9. Polyuria

V. Signs

  1. Coarse facial features
  2. Exaggerated supraorbital ridges
  3. Exophthalmos
  4. Enlargement of:
    1. Broad Hands and Feet
    2. Mandible (separation of teeth)
    3. Nose, Lips and Tongue
  5. Bitemporal Hemianopsia to blindness
  6. Weight gain
  7. Hypertension
  8. Cardiomegaly
  9. Hepatomegaly
  10. Hypertrichosis
  11. Diabetes Insipidus
  12. Hyperthyroidism
    1. Goiter
    2. Thyrotoxicosis

VI. Labs

  1. Elevated plasma Growth Hormone (in active stage)
    1. Insulin-like growth factor 1
    2. Insulin-like growth factor binding Protein 3
  2. Other findings
    1. Increased urinary 17-ketosteroids
    2. High serum inorganic Phosphate
    3. Elevated Alkaline Phosphatase
    4. Hyperglycemia and Glycosuria

VII. Imaging

  1. MRI Brain
  2. General findings
    1. Overgrowth of cancellous bone
    2. Osteoporosis
    3. Tufted phalangeal tips
    4. Osteoarthritis signs
    5. Enlarged sella turcica

VIII. Management

  1. Transphenoidal surgery
  2. Radiation Therapy
  3. Bromocriptine

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