Acromegaly

Two weU-known pathological conditions are the result of an excess or a deficiency of this hormone. The condition in which the body produces an excess of hGH is known as acromegaly or giantism. The condition in which too Httle is produced is dwarfism. 

No effect on prolactin release in normal subjects, but diminishes increased prolactin levels in acromegaly... 

Insulin is a powerful anabolic hormone but it is unlikely that insulin deficiency causes skeletal muscle atrophy by direct action on muscle fibers (as opposed to neurogenic atrophy) except in chronic untreated cases. There is however a close parallel between the catabolic states induced by glucocorticoid excess and by insulin deficiency. Moreover, impaired insulin action is implicated in other endocrine myopathies as a contributory cause of muscle wasting. Both acromegaly and thyrotoxicosis are associated with insulin resistance due to a postreceptor defect, and secondary hyperparathyroidism due to hypophosphatemia also gives rise to insulin insensitivity. 

Identify the clinical features of patients with acromegaly. 

Discuss the role of surgery and radiation therapy for patients with acromegaly. 

Select appropriate pharmacotherapy for patients with acromegaly based on patient-specific factors. 

Somatostatin analogs are the mainstay of pharmacotherapy for the treatment of acromegaly when surgery and radiation are contraindicated or have failed. 

Prolonged exposure to elevated growth hormone and insulin-like growth factor I levels can lead to serious complications in patients with acromegaly. Aggressively manage... 

Acromegaly affects both genders equally the average age of presentation is 44 years. Approximately 50 to 70 people per... 

Patients with acromegaly experience a two- to three-fold increase in mortality rate.8 Normalization of GH and IGF-I levels reverses the mortality risk and alleviates significant comorbid complications, especially cardiovascular, pulmonary, and metabolic abnormalities. Reduction of IGF-I levels alone does... 

Without obvious pituitary tumor but proven acromegaly, measurement of GHRH may be helpful to detect ectopic tumors. 

Given this information, what signs and symptoms does EB have for acromegaly ... 

Adapted from AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocr Pract. 2004 1 0(3) 21 3-225, by permission of publisher, AACE Corp. 

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

TABLE 43-4. Assessment of Acromegaly Complications at Diagnosis and Follow-Up8... 

Assess patient s clinical signs and symptoms to determine severity of acromegaly. 

Review the biochemical disease markers to assess severity of acromegaly. 

Identify any significant comorbidities associated with acromegaly that require immediate treatment or early diagnosis. 

Routinely assess acromegaly complications, including blood pressure, glucose tolerance, fasting lipid profile, cardiac evaluations (if clinically indicated), colonoscopy, dual-energy x-ray absorptiometry (DEXA) scan (hypogonadal only), evaluation of residual pituitary function, and evaluation of sleep apnea. 

Biochemical assessment and long-term monitoring in patients with acromegaly Statement from a joint consensus conference of the Growth Hormone Research Society and the Pituitary Society. I Clin Endocrinol Metab 2004 89(7) 3099—3102. 

Giustina A, Casanueva FF, Cavagnini F, et al. Diagnosis and treatment of acromegaly complications. ] Endocrinol Invest 2003 26(12) 1242-1247. 

Acromegaly A pathologic condition characterized by excessive production of growth hormone during adulthood after epiphyseal (long bone) fusions have completed. 

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