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Questions and Answers
What is the most common cause of acromegaly?
What is the most common cause of acromegaly?
At what average age is acromegaly typically diagnosed?
At what average age is acromegaly typically diagnosed?
Which of the following complications is least associated with acromegaly?
Which of the following complications is least associated with acromegaly?
What percentage of patients with acromegaly are associated with insulin resistance?
What percentage of patients with acromegaly are associated with insulin resistance?
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Which of the following is a common symptom of hypogonadism in men due to acromegaly?
Which of the following is a common symptom of hypogonadism in men due to acromegaly?
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What is the most significant risk associated with uncontrolled acromegaly?
What is the most significant risk associated with uncontrolled acromegaly?
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Which metabolic condition is commonly associated with acromegaly?
Which metabolic condition is commonly associated with acromegaly?
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Which statement regarding the annual incidence of acromegaly is true?
Which statement regarding the annual incidence of acromegaly is true?
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What is the primary cause of hypogonadism in women with acromegaly?
What is the primary cause of hypogonadism in women with acromegaly?
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Which of the following statements about complications of acromegaly is accurate?
Which of the following statements about complications of acromegaly is accurate?
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How does hyperphosphatemia typically occur in patients with acromegaly?
How does hyperphosphatemia typically occur in patients with acromegaly?
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In children with excess growth hormone, what condition occurs before the fusion of epiphyseal growth plates?
In children with excess growth hormone, what condition occurs before the fusion of epiphyseal growth plates?
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Which complication is primarily attributed to uncontrolled acromegaly?
Which complication is primarily attributed to uncontrolled acromegaly?
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What is a potential metabolic consequence of uncontrolled acromegaly?
What is a potential metabolic consequence of uncontrolled acromegaly?
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What is the effect of acromegaly on the left ventricular size?
What is the effect of acromegaly on the left ventricular size?
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Which statement regarding the incidence and diagnosis of acromegaly is true?
Which statement regarding the incidence and diagnosis of acromegaly is true?
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What is a major complication associated with uncontrolled acromegaly that affects cardiovascular health?
What is a major complication associated with uncontrolled acromegaly that affects cardiovascular health?
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How does acromegaly primarily affect renal function regarding phosphate levels?
How does acromegaly primarily affect renal function regarding phosphate levels?
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Which factor is considered a strong risk factor for developing hyperinsulinism in acromegaly patients?
Which factor is considered a strong risk factor for developing hyperinsulinism in acromegaly patients?
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What typical endocrine abnormality may occur in male patients due to hormone co-secretion in acromegaly?
What typical endocrine abnormality may occur in male patients due to hormone co-secretion in acromegaly?
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What is a potential gastrointestinal complication linked to acromegaly?
What is a potential gastrointestinal complication linked to acromegaly?
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What is the primary cause of pituitary adenomas leading to acromegaly?
What is the primary cause of pituitary adenomas leading to acromegaly?
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Which change in emerging organ structure is often noted in patients with acromegaly?
Which change in emerging organ structure is often noted in patients with acromegaly?
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What could be a consequence of hypersecretion of growth hormone after epiphyseal growth plate fusion in adults?
What could be a consequence of hypersecretion of growth hormone after epiphyseal growth plate fusion in adults?
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Which condition is characterized by hypersecretion of growth hormone after the fusion of epiphyseal growth plates?
Which condition is characterized by hypersecretion of growth hormone after the fusion of epiphyseal growth plates?
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What is the likely prevalence of hyperinsulinism in patients with uncontrolled acromegaly?
What is the likely prevalence of hyperinsulinism in patients with uncontrolled acromegaly?
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Which of the following complications is most seriously associated with cardiovascular disease in patients with acromegaly?
Which of the following complications is most seriously associated with cardiovascular disease in patients with acromegaly?
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In patients with acromegaly, what type of thyroid enlargement is frequently observed?
In patients with acromegaly, what type of thyroid enlargement is frequently observed?
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Which hormonal condition in women with acromegaly can result from the co-secretion of prolactin?
Which hormonal condition in women with acromegaly can result from the co-secretion of prolactin?
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What is a possible metabolic change seen in patients with acromegaly that can contribute to diabetes?
What is a possible metabolic change seen in patients with acromegaly that can contribute to diabetes?
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What is the primary reason for death in patients suffering from uncontrolled acromegaly?
What is the primary reason for death in patients suffering from uncontrolled acromegaly?
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Which physiological change is often noted in cardiovascular health due to acromegaly?
Which physiological change is often noted in cardiovascular health due to acromegaly?
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What is a significant reason for the insidious presentation of acromegaly before diagnosis?
What is a significant reason for the insidious presentation of acromegaly before diagnosis?
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Which complication is specifically associated with cardiovascular disease in acromegaly patients?
Which complication is specifically associated with cardiovascular disease in acromegaly patients?
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What endocrine condition is commonly co-secreting with growth hormone in patients with acromegaly?
What endocrine condition is commonly co-secreting with growth hormone in patients with acromegaly?
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Which of the following is an unusual metabolic change associated with uncontrolled acromegaly?
Which of the following is an unusual metabolic change associated with uncontrolled acromegaly?
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In the context of growth hormone excess in adults, what is the likely consequence after the fusion of epiphyseal growth plates?
In the context of growth hormone excess in adults, what is the likely consequence after the fusion of epiphyseal growth plates?
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What is the role of direct stimulation of renal tubular cells in response to hyperphosphatemia in acromegaly?
What is the role of direct stimulation of renal tubular cells in response to hyperphosphatemia in acromegaly?
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How does hyperinsulinism typically manifest in patients with uncontrolled acromegaly?
How does hyperinsulinism typically manifest in patients with uncontrolled acromegaly?
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Which of the following symptoms is least likely to be observed in men suffering from hypogonadism due to acromegaly?
Which of the following symptoms is least likely to be observed in men suffering from hypogonadism due to acromegaly?
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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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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.
