Acromegaly

Clinical features

• Excessive soft tissue growth;
  • Growth of hands and feet – increased ring size, coarse spade like hands, increased show size
  • Coarsening of facial features, prominent supraorbital ridge, large tongue
  • Headache, excess sweating, hoarse voice, obstructive sleep apnoea
  • Arthralgia, osteoarthritis, proximal muscle weakness, carpal tunnel syndrome
• Features of a pituitary tumour;
  • Hypopituitarism, features of mass effect

Complications

• Impaired glucose tolerance
• Vascular – raised BP, left ventricular hypertrophy, cardiomyopathy. Increased risk fo IHD and stroke due to insulin resistance and raised BP
• Malignancy – increased risk of colonic polyps and development of colon cancer
• Mortality increased 2-3 fold due to cardiovascular risk

Investigations

• Don’t take random GH as GH increases in stress, sleep and puberty and decreases in pregnancy
• Serum IGF-1 is a useful screening test
• Definitive test is OGTT – GH is normally inhibited by a rise in glucose and should be undetectable. In acromegaly there is failure to suppress GH  (FP occur in pregnancy, puberty, hepatic and renal disease, anorexia nervosa and DM
• MRI of pituitary fossa
• Test pituitary function
• Visual fields and acuity
• ECG and Echo
• Obtain old photos if possible

Treatment

• Transphenoidal surgery
• Medical therapy
• Somatostatin analogues e.g octeotide
• Radiotherapy

Follow up

• Yearly GH and IGF-1 measurements
• Visual fields, cardiovascular assessment, clinical photos
• Aim for a serum GH<5mU/L to reverse mortality risk