ACROMEGALY AND GIGANTISM

 


                                                  ACROMEGALY AND GIGANTISM

Head to foot examination

Face

Prominent brow,thick wrinkles in the forehead

Wide spaced teeth, macroglossia

Prominent nasolabial fold

Seborrhea,acne,hirsutism

Fundus:

Optic atrophy

Papilledema

Retinopathy-diabetic/hypertensive

Eye:

Angioid streaks,bitemporal hemianopia ,ophthalmoplegia

Neck: goiter,

Parathyroid,pituitary and pancreatic  tumor called wermer syndrome-

(Multiple endocrine neoplasia)

Voice: deep or highpitched if hypogonodal

Chest: gynecomatia, galactorrhea

Cardiomegaly,with S3 S4

Back:Kyphosis

Joints

Wide spread osteoarthritis

Abdomen:

Hepatosplenomegaly

Palpable kidney

Testicular atrophy

Lower limbs:Proximal muscle weakness,osteoarthritis of hip and knee,palpable peroneal nerve and  foot drop

Ankle:Hung up reflex

Large feet,thick heel,heel pad thickness increased

Hands;Spade like hands,spatulate fingers,positive tinel,s sign

Thenar wasting and weak opponens,

Sweaty palms

Arm;Hypertension,

 Palpable Ulnar nerve,supraclavicular nerve,

proximal muscle weakness and atrophy of shoulder girdle

Axilla:acanthosis nigricans,fibroma molluscum

CNS;Emotional lability

In gigantism In addition to all the above findings tall tature(7-8feet height) s seen

 In acromegaly Growth hormone excess occurs after the closure of epiphysis.

So bone cannot grow long but grows wide.

In gigantism growth hormone excess occurs before the closure of epiphysis.

ACROMEGALY –Indications of disease activity:

1.Severity of seborrhea,sweating.

2.number of fibromatous molluscae.

3.Degree of hypertension

4.serial measurement of visual field and visual acuity.

5.degree of glycosuria, ,hyperglycemia.

6.plasma level of somatomedin.

Mechanism of polydipsia in Acromegaly:

1.dehydration due to hyperhydrosis

2.osmotic diuresis (in 10%( secondary to glucose intolerance(in 50%)

3.diabetes insipidus.

Mechanism of galactorrhea in acromegaly:

1. concomittant adenomatous secretion of prolactin(in30%)2.Compression of posterior pituitary stalk by

adenoma causing reduced ingress oh prolactin inhibiting factor(PIF)

2. Reduced pituitary TSH leading to compensatory elevation of hypothalamic elevation of TRH and resultant stimulation of prolactin release.

Diagnosis:

1.      Typical body configuration, visual field defect and skeletal changes seen on radiological examination.

2.      Serial levels of basal plasma growth hormone is important in follow up.

Treatment

Surgery or irradiation of the tumor

Substitution therapy  of adrenal ,thyroid and gonodal hormones for resultant hypopituitorism

After surgery.

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