Pathology: Increased growth hormonefollowing puberty after epiphyseal plate closure
Aetiology: Benign pituitary adenoma(95%), Excess growth hormone releasing hormone, tumours releasing growthhormone.
Symptoms: General change in appearance,excess sweating, headaches, visual changes, change in shoe/ring size, jointpains, sleep apnoea, symptoms of diabetes
Signs: Prognathism,frontal bossing, enlarged nose, deep voice, macroglossia, coarse skin texture, enlargementof hands and feet, nerve entrapment, multiple skin tags, goitre
Investigations: Bloods:Fasting growth hormone and IGF-1 levels, glucose, U&E, lipid profile,
pituitary profile
OralGlucose Tolerance Test: No suppression of growth hormone in response
to glucose load
Imaging: MRI pituitary
ECG: To assess for cardiac abnormalities
Special Tests: Skin thickness,photographs from the past, cancer screen
.
Treatment: Medical: Somatostatin analogues – inhibit growth hormone release,growth
hormone receptor antagonists ordopamine agonists
Surgical: Trans-sphenoidalsurgery
Complications: Hypertension, heart failure, carpaltunnel syndrome, sleep apnoea, diabetes osteoarthritis, colonic polyps andcancer
Prognosis: 90% cured by surgery. If leftuntreated mortality rate is double the rate for the
generalpopulation.
Figure 5.7 Signs of Acromegaly
