DR Medhat MRCP

Investigations :
1) GH level in the blood is high.
2) Insulin-like Growth Factor-1 (IGF-1): is an excellent test for evaluation of GH
hypersecretion.
3) CT & MRI /brain .
Treatment :
1) Surgical : trans-sphenoidal hypophysectomy
2) Medical :
- Somatostatin analogs, such as octreotide (Sandostatin) and long-acting
lanreotide (Somatuline Depot), which reduce GH release
- GH antagonist, pegvisomant (Somavert), which blocks the effects of GH
- Dopamine agonists, such as bromocriptine (Cycloset, Parlodel) and cabergoline
(Dostinex), which reduce GH release
- Sex hormone therapy, such as estrogen and testosterone, which may inhibit
the growth of long bones
3) Radiotherapy on pituitary gland.
Acromegaly
- i.e Clinical disorder resulting from hypersecretion of GH
Aetiology :
1) Pituitary adenoma (95% of cases).
2) Ectopic GHRH or GH production by tumours e.g. pancreatic tumours.
Clinical features :
- Usually starts at 3 rd or 4 th decade with progressive disfigurements or disabilities
which go unnoticed & diagnosis may be delayed.
o Skin :
- Coarse oily skin.
- Sweating (due to sweat gland hypertrophy)
o Ape-like face :
- Big skull ,enlarged face.
- Increased bony prominents e.g supra
orbital margins.
- Enlarged tongue (macroglossia), OSA.
- Prognathism (protruded jaw).
- Inter-dental spaces (due to transverse
growth of mandible).