DR Medhat MRCP

o Hands & feet :
- Spade-like hands, in shoe size.
- Arthralgia, carpal tunnel syndrome
o Features of pituitary tumours :
- Headache
- Visual disturbance (bitemporal hemianopia)
- Hypopituitarism (later)
‣ Amenorrhoea
‣ Loss of libido.
‣ Erectile dysfunction.
o Raised prolactin in 1/3 of cases galactorrhoea
o 6% of patients have MEN-1.
o Complications :
سؤال pulmonaryHTN). - Hypertension (systemic rather than
سؤال resistance) - Diabetes (>10%) (insulin
سؤال acromegaly) - Cardiomyopathy/LVF ( most common cause of death in
- Colorectal cancer
- Pseudogout
- Hyperphosphatemia
- Goiter
Macroglossia
Interdental spaces
Investigations :
1) Oral glucose tolerance (OGTT) with serial GH levels (= GH suppression test ):
سؤال test. - The definitive
- In normal patients GH is suppressed to < 2 mu/L with hyperglycemia
- In acromegaly there is no suppression of GH
2) GH level/blood : not diagnostic as it varies during the day.
3) Serum IGF-1 : may be used as screening test or monitoring of the disease.
4) MRI/brain.
5) Visual acuity.