Acromegaly ALSANGEDY

 Excess growth hormone

(GH) after the growth plates
BULLETS
have closed
FOR PACES
 Tall stature FOR EASY PASSING PACES FROM
 Enlargement of the hands, THE 1ST ATTEMPT
feet, nose, lips and ears Dr. Ibrahim Alsangedy
MRCP-UK, MRCEM-UK, MRCPE, AMC
 General thickening of the CAT (AU), IDHA (USA), M.SC (ICU),
ADDM, HCQM
skin
 Cardiomegaly
 Thick deep voice
 Frontal bossing
 Prognathism
 Macroglossia
 Teeth spacing
 Acrochordon (skin tags)
 Carpal tunnel syndrome
 Bitemporal hemianopia
 Hypertension
 DM
 Acanthosis nigricans
Workup
 Laboratory Studies
 Insulinlike growth factor I
(IGF1)
 GH suppression test
following an oral glucose
load will confirm the
diagnosis
 Imaging Studies
 MRI of the sella turcica
 CT scanning to localize
tumors causing ectopic
secretion of GH or GHRH If
MRI findings of the sella
are negative
 Histological test
 Surgical specimens from
pituitary tumors
 Skin biopsy demonstrate
dense glycosaminoglycan
deposit
Differential diagnosis Management
 Familial tall stature  Major goals of therapy
 Exogenous obesity
 A glucose-suppressed GH
 Cerebral gigantism
concentration of less than
 McCune-Albright syndrome
2 ng/mL
 Pachydermoperiostosis
 Normalization of (IGF-I)
syndrome
concentration
Etiology
 The stepwise approach
(1) Pituitary adenoma 98% of
cases  Transphenoidal Surgical
removal of the pituitary
(2) Tumors of the pancreas, lungs, gland tumor is the
and adrenal glands. they produce primary treatment
GH themselves or, more frequently,  Somatostatin analogues,
because they produce GHRH Dopamine agonists and
Growth hormone receptor
antagonists (Pegvisomant
Pseudoacromegaly or Somavert)
 Radiation therapy
combined with surgery or
Acromegaloidn features in the
drugs
absence of elevated levels of GH or
insulinlike growth factor I (IGF-I) in
 Patients evaluated for
damage caused by the
patients with severe insulin
pituitary tumor and for
resistance
hypopituitarism