Fast Five Quiz: Test Your Knowledge of Acromegaly

Romesh Khardori, MD, PhD

Disclosures

February 15, 2017

Acromegaly can be an insidious disease. Symptoms, which may precede diagnosis by several years, can be divided into the following groups:

  • Symptoms due to local mass effects of an intracranial tumor

  • Symptoms due to excess of GH/IGF-I

Symptoms due to local mass effects of tumor depend on the size of the intracranial tumor. Headaches and visual field defects are the most common symptoms. Different visual field defects manifest depending on which part of the optic nerve pathway is compressed. The most common manifestation is a bitemporal hemianopsia caused by pressure on the optic chiasm.

Tumor damage to the pituitary stalk may cause hyperprolactinemia due to loss of inhibitory regulation of prolactin secretion by the hypothalamus. Damage to normal pituitary tissue can cause deficiencies of glucocorticoids, sex steroids, and thyroid hormone. Loss of end-organ hormones results from diminished anterior pituitary secretion of corticotropin.

Symptoms due to excess of GH/IGF-I include:

  • Soft tissue swelling and enlargement of extremities

  • Increase in ring and/or shoe size

  • Hyperhidrosis

  • Coarsening of facial features

  • Prognathism

  • Macroglossia

  • Arthritis

  • Increased incidence of obstructive sleep apnea

  • Increased incidence of glucose intolerance or frank diabetes mellitus, hypertension, and cardiovascular disease

  • Hyperphosphatemia, hypercalcuria, and hypertriglyceridemia possible

  • Increased incidence of congestive heart failure, which may be due to uncontrolled hypertension or to an intrinsic form of cardiomyopathy attributable to excess GH/IGF-I

  • Increased incidence of colonic polyps

For more on the presentation of acromegaly, read here.

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