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 (egFeatures 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 HPTSigns 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,impotenceComplications 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 compressionInvestigations 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@example.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 +0800 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
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