Acromegaly and Gigantism
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Questions and Answers

What is the most common cause of acromegaly?

  • Genetic mutations
  • Pituitary adenoma (correct)
  • Post-traumatic stress
  • Chronic kidney disease

    • At what average age is acromegaly typically diagnosed?

  • 30 to 35
  • 40 to 45 (correct)
  • 25 to 30
  • 50 to 55

    • Which of the following complications is least associated with acromegaly?

  • Erectile dysfunction
  • Obstructive sleep apnea
  • Chronic respiratory failure (correct)
  • Cardiovascular disease

    • What percentage of patients with acromegaly are associated with insulin resistance?

    <p>50%</p> Signup and view all the answers

    Which of the following is a common symptom of hypogonadism in men due to acromegaly?

    <p>Erectile dysfunction</p> Signup and view all the answers

    What is the most significant risk associated with uncontrolled acromegaly?

    <p>Increased cardiovascular disease</p> Signup and view all the answers

    Which metabolic condition is commonly associated with acromegaly?

    <p>Hyperinsulinism</p> Signup and view all the answers

    Which statement regarding the annual incidence of acromegaly is true?

    <p>It occurs in 10 out of 1 million people.</p> Signup and view all the answers

    What is the primary cause of hypogonadism in women with acromegaly?

    <p>Co-secretion of prolactin</p> Signup and view all the answers

    Which of the following statements about complications of acromegaly is accurate?

    <p>Visceral organ enlargement may occur in the thyroid.</p> Signup and view all the answers

    How does hyperphosphatemia typically occur in patients with acromegaly?

    <p>As a result of direct stimulation of renal tubular phosphate reabsorption</p> Signup and view all the answers

    In children with excess growth hormone, what condition occurs before the fusion of epiphyseal growth plates?

    <p>Gigantism</p> Signup and view all the answers

    Which complication is primarily attributed to uncontrolled acromegaly?

    <p>Increased risk of cardiovascular disease</p> Signup and view all the answers

    What is a potential metabolic consequence of uncontrolled acromegaly?

    <p>Hyperinsulinism leading to T2DM</p> Signup and view all the answers

    What is the effect of acromegaly on the left ventricular size?

    <p>Left ventricular hypertrophy</p> Signup and view all the answers

    Which statement regarding the incidence and diagnosis of acromegaly is true?

    <p>The average age of diagnosis is between 40 to 45 years.</p> Signup and view all the answers

    What is a major complication associated with uncontrolled acromegaly that affects cardiovascular health?

    <p>Hypertension</p> Signup and view all the answers

    How does acromegaly primarily affect renal function regarding phosphate levels?

    <p>Direct stimulation of renal tubular phosphate reabsorption</p> Signup and view all the answers

    Which factor is considered a strong risk factor for developing hyperinsulinism in acromegaly patients?

    <p>Insulin resistance</p> Signup and view all the answers

    What typical endocrine abnormality may occur in male patients due to hormone co-secretion in acromegaly?

    <p>Hypogonadism</p> Signup and view all the answers

    What is a potential gastrointestinal complication linked to acromegaly?

    <p>Increased risk of colonic neoplasia</p> Signup and view all the answers

    What is the primary cause of pituitary adenomas leading to acromegaly?

    <p>Hormone-secreting somatotroph adenomas</p> Signup and view all the answers

    Which change in emerging organ structure is often noted in patients with acromegaly?

    <p>Thyroid enlargement</p> Signup and view all the answers

    What could be a consequence of hypersecretion of growth hormone after epiphyseal growth plate fusion in adults?

    <p>Acromegaly</p> Signup and view all the answers

    Which condition is characterized by hypersecretion of growth hormone after the fusion of epiphyseal growth plates?

    <p>Acromegaly</p> Signup and view all the answers

    What is the likely prevalence of hyperinsulinism in patients with uncontrolled acromegaly?

    <p>About 50%</p> Signup and view all the answers

    Which of the following complications is most seriously associated with cardiovascular disease in patients with acromegaly?

    <p>Valvular disease</p> Signup and view all the answers

    In patients with acromegaly, what type of thyroid enlargement is frequently observed?

    <p>Multinodular or diffuse enlargement</p> Signup and view all the answers

    Which hormonal condition in women with acromegaly can result from the co-secretion of prolactin?

    <p>Galactorrhea</p> Signup and view all the answers

    What is a possible metabolic change seen in patients with acromegaly that can contribute to diabetes?

    <p>Insulin resistance</p> Signup and view all the answers

    What is the primary reason for death in patients suffering from uncontrolled acromegaly?

    <p>Cardiovascular disease</p> Signup and view all the answers

    Which physiological change is often noted in cardiovascular health due to acromegaly?

    <p>Left ventricular hypertrophy</p> Signup and view all the answers

    What is a significant reason for the insidious presentation of acromegaly before diagnosis?

    <p>Gradual development of symptoms over years</p> Signup and view all the answers

    Which complication is specifically associated with cardiovascular disease in acromegaly patients?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    What endocrine condition is commonly co-secreting with growth hormone in patients with acromegaly?

    <p>Prolactin</p> Signup and view all the answers

    Which of the following is an unusual metabolic change associated with uncontrolled acromegaly?

    <p>Hypoadrenalism</p> Signup and view all the answers

    In the context of growth hormone excess in adults, what is the likely consequence after the fusion of epiphyseal growth plates?

    <p>Development of acromegaly</p> Signup and view all the answers

    What is the role of direct stimulation of renal tubular cells in response to hyperphosphatemia in acromegaly?

    <p>Increased phosphate reabsorption</p> Signup and view all the answers

    How does hyperinsulinism typically manifest in patients with uncontrolled acromegaly?

    <p>Insulin resistance leading to type 2 diabetes</p> Signup and view all the answers

    Which of the following symptoms is least likely to be observed in men suffering from hypogonadism due to acromegaly?

    <p>Vaginal atrophy</p> Signup and view all the answers

    Study Notes

    Acromegaly

    • Excess growth hormone (GH) secretion leading to bone and soft tissue growth
    • Rare condition (10/1 million people)
    • Diagnosed between 40-45 years old with a slow-progressing nature
    • Occurs in adults after epiphyseal growth plate fusion

    Gigantism

    • GH excess before epiphyseal growth plate fusion in children/adolescents
    • Leads to abnormally tall stature

    Acromegaly Etiology

    • Most commonly caused by pituitary adenomas, particularly somatotroph adenoma
    • Somatotroph adenomas account for approximately 1/3 of hormone-secreting pituitary adenomas
    • Other rare causes include ectopic GH production, hypothalamic lesions, and genetic syndromes

    Acromegaly Symptoms

    • Excessive growth: Hands, feet, jaw, tongue
    • Headaches: From tumor growth
    • Joint pain: Due to enlarged, thickened bones
    • Visual disturbances: Pressure from tumor on optic chiasm
    • Sweating and fatigue
    • Sleep apnea
    • Menstrual irregularities in women
    • Erectile dysfunction in men
    • Cardiovascular complications: Left ventricular hypertrophy, cardiomyopathy, hypertension
    • Metabolic alterations:
      • Insulin resistance, often leading to type 2 diabetes
      • Hypertriglyceridemia, hypercalciuria, hyperphosphatemia

    Acromegaly Complications

    • Visceral Organ Enlargement: Thyroid, heart
    • Cardiovascular Disease: Hypertension, cardiomyopathy, valvular disease, arrhythmias
      • Leading cause of death
    • Obstructive Sleep Apnea: Due to enlarged soft tissues, making breathing difficult
    • Colonic neoplasia: May be associated with increased risk of colon cancer
    • Other complications: Hypogonadism, hypothyroidism

    Acromegaly

    • Hypersecretion of growth hormone (GH) causes acromegaly
    • Annual Incidence: 10/1 million people - relatively rare
    • Average age of diagnosis is between 40 and 45 years
    • Acromegaly is often missed for years due to its gradual onset
    • Gigantism is GH excess that occurs before the fusion of the epiphyseal growth plates in children or adolescents.

    Acromegaly Etiology

    • Most common cause: pituitary adenoma
    • Somatotroph (GH-secreting) adenomas account for approximately 1/3rd of all hormone-secreting pituitary adenomas

    Acromegaly Complications

    • Metabolic
    • Uncontrolled acromegaly is associated with hyperinsulinism.
    • Insulin resistance occurs in about 50% of patients, which can lead to type 2 diabetes mellitus (T2DM)
    • Hypertriglyceridemia or hypercalciuria
    • Hyperphosphatemia (70%) due to direct stimulation of renal tubular phosphate reabsorption
    • Visceral Organ Enlargement
      • Thyroid enlargement may be diffuse or multinodular
    • Cardiovascular Disease
      • Hypertension (50% of patients)
      • Left ventricular hypertrophy and cardiomyopathy
      • Valvular disease and arrhythmia
      • Death from acromegaly is primarily due to cardiovascular disease
    • Obstructive Sleep Apnea
    • Conflicting evidence suggests that acromegaly may be linked to an increased risk of colonic neoplasia
    • Increased risk of adenomatous colonic polyps in patients with acromegaly
    • Increased prevalence of colonic polyps amongst patients with acromegaly

    Acromegaly

    • Acromegaly is characterized by excessive growth hormone (GH) secretion.
    • It is rare, with an annual incidence of 10 per 1 million people.
    • Typically diagnosed between the ages of 40 and 45.
    • Often goes unnoticed for years due to its subtle onset.

    Gigantism

    • Gigantism is caused by excess GH secretion during childhood or adolescence, before the epiphyseal growth plates fuse.

    Acromegaly Etiology

    • The most common cause is a pituitary adenoma, specifically a somatotroph (GH-secreting) adenoma.
    • These adenomas account for approximately one-third of all hormone-secreting pituitary adenomas.

    Acromegaly Signs and Symptoms

    • Clinical features:

      • Enlargement of hands and feet
      • Protrusion of jaw
      • Thickening of lips and tongue
      • Increased spacing between teeth
      • Soft tissue thickening (e.g., forehead, nose)
      • Deep voice
      • Headache
      • Vision problems (due to compression of the optic nerve)
      • Snoring (due to enlargement of soft palate)
      • Sweating
      • Fatigue

    • Biochemical features:

      • Elevated GH levels (typically > 10 ng/mL)
      • Decreased IGF-1 levels (due to resistance to GH's action)
      • Elevated prolactin levels (due to co-secretion or mass effect)

    Hypogonadism

    • Women: Menstrual dysfunction, galactorrhea (milk production), hot flashes, vaginal atrophy.
    • Men: Erectile dysfunction, decreased libido, reduced facial hair growth, decreased testicular volume.
    • Secondary hypothyroidism can also arise, while hypoadrenalism is uncommon.

    Acromegaly Complications

    • Metabolic:

      • Hyperinsulinism, leading to insulin resistance (approximately 50% of patients) and type 2 diabetes mellitus (T2DM).
      • Hypertriglyceridemia, hypercalciuria, and hyperphosphatemia (70%).
      • Hyperphosphatemia is often due to direct stimulation of phosphate reabsorption by the kidney.

    • Visceral Organ Enlargement:

      • Enlarged thyroid (can be diffuse or multinodular).

    • Cardiovascular Disease:

      • Hypertension (50% of patients), left ventricular hypertrophy, cardiomyopathy, valvular disease, and arrhythmias.
      • Cardiovascular disease is the primary cause of death in acromegaly.

    • Obstructive Sleep Apnea:

    • Colonic Neoplasia:

      • There is conflicting evidence regarding the link between acromegaly and increased risk of colon cancer.
      • Increased risk of adenomatous colonic polyps in patients with acromegaly.
      • Increased prevalence of colonic polyps.

    Acromegaly

    • Acromegaly is caused by the hypersecretion of growth hormone (GH)
    • The annual incidence of Acromegaly is 10 per million people
    • The average age of diagnosis is 40-45
    • Symptoms are often missed for years due to a gradual onset

    Gigantism

    • Gigantism is GH excess that occurs before the fusion of the epiphyseal growth plates in a child or adolescent

    Acromegaly Etiology

    • The most common cause is a pituitary adenoma
    • A Somatotroph (GH-secreting) adenoma accounts for approximately 1/3 of all hormone-secreting pituitary adenomas
    • Acromegaly can occur in a small proportion of patients with multiple endocrine neoplasia (MEN) type 1
    • Acromegaly can also occur in carcinoid syndrome

    Acromegaly Clinical Findings

    • Increased hand and foot size
    • Enlargement of the bones of the face
    • Deepening of the voice
    • Thickening of the skin
    • Impaired glucose tolerance and diabetes
    • Headaches
    • Visual disturbances
    • Joint pain
    • Hypertension
    • Cardiomegaly
    • Sleep apnea

    Acromegaly Complications

    • Metabolic
      • Uncontrolled acromegaly is associated with hyperinsulinism
      • Insulin resistance occurs in about 50% of patients
      • Acromegaly can lead to Type 2 Diabetes Mellitus
      • Hypertriglyceridemia
      • Hypercalciuria
      • Hyperphosphatemia (70%)
      • This increase in phosphate is due to direct stimulation of renal tubular phosphate reabsorption
    • Visceral Organ Enlargement
      • The thyroid may be enlarged and may be diffuse or multinodular
    • Cardiovascular Disease
      • Hypertension (50% of patients)
      • Left ventricular hypertrophy
      • Cardiomyopathy
      • Valvular disease
      • Arrhythmia
      • Cardiovascular disease is the primary cause of death in patients with acromegaly
    • Obstructive Sleep Apnea
    • Conflicting evidence suggests an increased risk of colonic neoplasia
      • There is an increased prevalence of adenomatous colonic polyps in patients with acromegaly

    Acromegaly

    • Hypersecretion of growth hormone (GH)
    • Annual incidence: 10 per 1 million people
    • Average age of diagnosis: 40-45 years old
    • Often goes undetected for years

    Gigantism

    • GH excess before epiphyseal growth plates fuse in children or adolescents

    Acromegaly Etiology

    • Most common cause: Pituitary adenoma
    • Somatotroph (GH-secreting) adenoma
    • Accounts for approximately 1/3rd of all hormone-secreting pituitary adenomas
    • Rare causes: Ectopic GH production, such as with lung cancer or carcinoid tumors; GH-secreting tumors in the pancreas, stomach or thalamus; GH-secreting hyperplasia of the pituitary gland

    Acromegaly Clinical Manifestations

    • Enlarged extremities, thickened skin and soft tissues, prominent jaw, frontal bossing, and enlarged hands and feet
    • Visual field defects due to compression of the optic chiasm
    • Headaches
    • Sleep apnea
    • Hypogonadism (secondary to co-secretion of prolactin or from mass effect):
      • Women: Menstrual dysfunction (both absent periods and abnormally frequent bleeding), with or without galactorrhea, hot flashes, vaginal atrophy
      • Men: Erectile dysfunction, loss of libido, decreased facial hair growth, decrease in testicular volume
    • Secondary hypothyroidism sometimes occurs; hypoadrenalism is unusual

    Acromegaly Complications

    • Metabolic
      • Hyperinsulinism
      • Insulin resistance about 50% of patients
      • Type 2 diabetes
      • Hypertriglyceridemia (high triglyceride levels in the blood)
      • Hypercalciuria (high levels of calcium in the urine)
      • Hyperphosphatemia (high levels of phosphate in the blood)
      • Due to direct stimulation of renal tubular phosphate reabsorption
    • Visceral Organ Enlargement
      • Thyroid enlargement: may be diffuse or multinodular
    • Cardiovascular Disease
      • Hypertension (50% of patients)
      • Left ventricular hypertrophy
      • Cardiomyopathy
      • Valvular disease
      • Arrhythmia
      • Death from acromegaly is primarily due to cardiovascular disease
    • Obstructive Sleep Apnea
    • Conflicting evidence suggests that acromegaly is associated with an increased risk of colonic neoplasia
    • Increased risk of adenomatous colonic polyps in patients with acromegaly
    • Increased prevalence of colon cancer

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    Acromegaly, Gigantism, & Short Stature PDF

    Description

    Explore the key concepts of acromegaly and gigantism, including their causes, symptoms, and diagnosis. Understand the role of growth hormone in these conditions and the impact it has on affected individuals. This quiz will challenge your knowledge on rare endocrine disorders.

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