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Question 15 of 153

A 53 year man presents as his wife has noticed a change in his appearance. He has also noticed his hands seem
larger. On examination blood pressure is 170/94 and he is noted to have bitemporal hemianopia. What is the most
appropriate first-line treatment?

Octreotide

External irradiation

Pegvisomant

Trans-sphenoidal surgery

Bromocriptine

Trans-sphenoidal surgery is the treatment of choice in acromegaly. There is no significant evidence base supporting
the use of pre-operative octreotide

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Acromegaly: management

Trans-sphenoidal surgery is first-line treatment for acromegaly in the majority of patients

Dopamine agonists
for example bromocriptine
the first effective medical treatment for acromegaly, however now superseded by somatostatin analogues
effective only in a minority of patients

Somatostatin analogue
for example octreotide
effective in 50-70% of patients
may be used as an adjunct to surgery

Pegvisomant
GH receptor antagonist - prevents dimerization of the GH receptor
once daily s/c administration
very effective - decreases IGF-1 levels in 90% of patients to normal
doesn't reduce tumour volume therefore surgery still needed if mass effect

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External irradiation is sometimes used for older patients or following failed surgical/medical treatment

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