Station 5: Acromegaly

General inspection:

- face: prominent supraorbital ridges, large lower jaw, overbiting of frontal tooth (prognathism), increase interdental space, exaggerated facial wrinkles, coarse facial features with increased soft tissue size (ie: nose, ear, lips), macroglossia (** ask patient for old photo**)
- large foot, OA signs of the joint
- sign of hirsuitsm
- voice- husky and cavernous


Hands:

- large, doughy, spade-shaped, thickened skin
- sweaty palm
- assess for carpal tunnel syndrome (tinel's and phalen's, decreased sensation at the medial nerve distribution) or previous scar


Armpit:

- check for skin tag
- acanthosis nigrican


Eye:

- bitemporal hemianopia


Other features:

- DM
- HTN
- hyperTG
- DI
- hypercalcaemia with hypercalciuria
- hypopituitarism

Symptoms:

- excessive sweating
- increase shoe, ring, denture size
- headache
- paraesthesia of the hands and feet
- visual field impairment
- arthralgia
- hypogonadism (amenorrhoea or loss of libido)
- present with DM or difficult to control HTN in clinic


Investigation:

- OGTT  with GH, lack of suppression of GH
- IGF- I
- MRI of pituitary
- test for pituitary hormone function (LH, FSH, oestradiol/testerosterone), ACTH (by using synacthen test), TFT, prolactin
- metabolic screen: fasting glucose, lipid panels, urine dipstick
- screen for malignancy:colono ( due to high risk of colonic polyp)
- visual field testing

Treatment:

Surgery:
1. Trans-sphenoidal (preferred) versus transfrontal (for larger tumour) hypophysectomy

Medical:
1. Dopamine agonist: cabergoline, bromocriptine
2. Somatostatin analogue: octreotide, lanreotide
3. GH receptor antagonist: pegvisamont

Radiotherapy:
1. Stereotactic radiosurgery
2. Conventional radiotheraphy

The end