Acromegaly

• Vital signs: BP
  
  
• Weight,
  Height
  
  
• Typical face:
  
  
  • Frontal bossing
    
    
  • Prognathism
    
    
  • Macroglossia
    
    
  • Coarse
    faces
    
    
  • Thickening
    of the nose
    
    
• Cutis vertices gyrate
  
  
• Thyroid gland: enlarged,
  MNG
  
  
• Skin:
  skin
  tags, Oily skin, acanthosis
  nigrican
  
  
• Wide and spread
  hands.
  
  
• Carpal tunnel syndrome
  
  
• Heart: Cardiomegaly
  
  
• Abd: Hepatomegaly
  
  
• Nervous system:
  
  
  • VF
    
    
• Osteoarthritis
  
  
• Galactorrhea
  
  

 

IGF-1

• Screening test
  
  
• Higher than same age
  
  

• 75 g OGTT
  
  
  • GH
    > 1 ug/L
    
    
• Goal
  
  
  • GH
    < 1ug/L
    
    
  • Normalized IGF-1
    
• Modalities
  
  
  • Surgery
    
    
  • Radiation
    
    
  • Medication
    
    
    • Dopamine
      agonist
      
      
    • Somatostatin
      analog
      

Prolactinoma

• Galactorhea
  
  
• Amenorhea
  
  
• Infertile
  
  
• Mass
  

Approach

History

• drug
  use
  
  
• menstruation
  
  
• Pituitary
  function
  
  
• VF
  and VA
  
  
• Hypothyroidism
  
  
• CRF
  
  
• 
   

 

• Hypothalamic-pituitary disorder
  
  
  • Tumors: craniopharyngiomas, germinomas, pituitary micro-macroadenoma
    
  • Infiltrative diseases:
    sarcoidosis, tuberculosis, histiocytosis
    
    
  • Others: Empty sella, Pituitary stalk section
    
    
• Drugs:
  
  • Neuroleptics, Receptors blockers: metoclopramide, sulpiride, domperidone, cimetidine
    
    
  • Antidepressants:
    amoxapine, imipramine, amitriptiline,
    
  • Anti HT: alpha-metildopa, reserpine, CCB (verapamil)
    
    
  • Others: Estrogens, Opiates
    
    
• Primary hypothyroidism
  
  
• Kidney of liver failure
  
• Neurogenic: chest or spine lesions, breast and nipple stimulation
  
• Idiopathic
  
• Physiological conditions: pregnancy, lactation