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Acromegaly is a rare disorder that occurs due to increased growth hormone or Insulin Like Growth factor-1 (ILGF-1) due to somatotropinomas or GH-releasing hormone tumours.

Easy fatiguability, headache, excessive sweating, carpal tunnel syndrome and sleep apnoea are some of the features. Prognathism, large extremities and elevated blood sugars also occur in acromegaly. It is of insidious onset and hence diagnosis is often delayed. Gigantism is the feature in children and gets diagnosed at early stages due to its florid manifestations.

Acromegaly causes impaired fertility due to stalk compression, hyperprolactinemia, mass-effect of the tumour and also directly by excess of growth hormone. 69% of women with acromegaly have anovulation and 31% who ovulate, have better fertility outcomes. Pre-conceptional counselling is mandatory for all acromegalic women planning a pregnancy. Most women ovulate after correcting the underlying pathology and have no complications in pregnancy.

Diagnosis

Screening for acromegaly is a serum IGF-1 estimation, applying correction for age, gender, and Tanner stages. Diagnosis is confirmed by high GH levels (>10ng/ml) after oral glucose challenge. Suppression tests are done to prognosticate response to treatment.

MRI with Gadolinium contrast can detect pituitary adenomas. CT abdomen can identify tumours of ovary, pancreas or adrenal, which may be the source of GH.

Treatment

Somatostatin analogs like depot octreotide or lanreotide, dopamine agonists or GH receptor antagonists are the first line of treatment and can be used in pregnant women also. However, before pregnancy and in older women, transsphenoidal surgery is recommended.

For more info, Visit : www.medlineacademics.com