Acromegaly

AETIOLOGY-
1. GH hypersecretion in adult life after epiphyseal closure result in acromegaly
2.comman - pituitary tumor
   rare - pancreatic islet tumor,
          bronchial carcinoid,
         small cell lung carcinoma

CLINICAL FEATURE -
1. Soft tissue changes -
    -thickening of skin
-increased skin tags
-acanthosis nigricans
-increased sweat & sebum resulting in moist & oily skin
- enlargment of lips, nose & tongue
- increased heel sad thickness
- visceral enlargment

2. Bone changes - large spade like hands
-large feet
-prognathism
-prominent supraorbital ridges
-wide spacing of teeth
- arthropathy
- kyphosis
- metabolic effects - glucose intolerance
-pressure effects -pituitary tumor
-cardiac effects- coronary heart disease, cardiomyopathy

INVESTIGATION -
1. Investigation of pituitary tumor
2. Elevated level of IGF-I levels.
3. GH levels measured during oral GTT - failure of supperssion or a paradoxical rise of GH indicates acromegaly.
4. Demo of GH rise after TRH administration.

TREATMENT-
1.Trans-sphenoidal surgical removal of adenoma
2. Medical treat - dopamine agonist- bromocriptine, carbergoline
3. External radiotherapy or implantation of yttrium into gland