from: hyperpituitary syndromes 󰒖

Acromegaly

(↑ GH; 10% of adenomas; Nat Rev Dis Primer 2019;5:1)

• Physiology:
  • stimulates secretion of insulin-like growth factor 1 (IGF-1)
• Clinical manifestations of Acromegaly 󰒗
• Diagnostic studies:
  • low utility in checking random GH levels because of pulsatile secretion
  • ↑ IGF-1 (somatomedin C); ± ↑ PRL; OGTT → GH not suppressed to <1 (<0.3 if newer assay) ng/mL; pituitary MRI to evaluate for tumor
• Treatment:
• Management of acromegaly
  • surgery of acromegaly
  • octreotide (long- and short-acting preparations),
  • dopamine agonists (if PRL cosecretion),
  • pegvisomant (GH receptor antagonist),
  • radiation
• Prognosis:
  • w/ and w/o Rx ↑ mortality, risk of
    • pituitary insufficiency,
    • colorectal cancer