Endo: Acromegaly: Free MSRA Podcast

🧠FREE MSRA PODCAST –Acromegaly: Rare but Recognisable🎧 In this episode, we unravel the complexities of Acromegaly – a rare hormonal disorder that often goesundiagnosed for years. Understand the core mechanisms, signs, investigations,and management, all aligned with UK NICE guidelines. 🧠Key Learning Points📌Definition• Acromegaly =excess growth hormone (GH) secretion inadulthood (after growth plates fuse)• Caused in >95% of cases by a GH-secreting pituitary adenoma• Leads to increasedIGF-1, which drives tissue and organovergrowth 📌Mnemonic🖐"Acro =Extremities"→ Enlargement ofhands, feet, jaw🏀"Giant =Gigantism"→ If GH excessoccurs before growth plates fuse = gigantism (increased height) 📌Causes & RiskFactors• Pituitary adenoma (GH-secreting) = most common• Rare: ectopic GHRHfrom lung/pancreatic tumours• Geneticconditions: MEN1, FIPA, McCune-Albright, Carney complex• 🔬 AIP mutation seen in 15% of familial cases – more likely in young onset cases 📌Symptoms• Gradualenlargement of hands, feet, jaw• Facial coarsening, prognathism (prominent jaw),large nose• Hyperhidrosis, deepening voice, macroglossia →OSA• Joint pain, carpal tunnel syndrome• Metabolic: Type 2 diabetes, hypertension• Cardiac: Cardiomyopathy, arrhythmias• Visual fielddefects, headaches• Colon polyps,goitre, potential malignancy• 🌙 Poor sleep, low mood, body image concerns 📌Investigations🧪First line: IGF-1 (stable, reliable)• Normal IGF-1 →excludes acromegaly🧪Confirmatory: OGTT with GH measurement• In acromegaly: GH fails to suppress🧠MRI pituitary: Confirms tumour (macro/microadenoma)👁 Visual field testing if optic chiasm involvement🩺 Assess full pituitary function (TSH, cortisol,LH/FSH)🫀 ECG + Echo → cardiomyopathy🦠 Colonoscopy (↑ risk of polyps)🦴 Thyroid US for nodules/goitre📈 Liver function monitoring if on Pegvisomant 📌Management🎯Goals:Normalise GH and IGF-1Reduce tumour size/pressure effectsPrevent complications🔪1st line: Transsphenoidal pituitary surgery💊Medical therapy:• Somatostatin analogues (e.g. octreotide,lanreotide)• GH receptor antagonist: Pegvisomant• Dopamine agonists: cabergoline (esp. ifprolactin co-secreting)• Combinationtherapies often needed☢️Radiotherapy: For residual or invasive tumours👶 Pregnancy: Most medications stopped – closespecialist monitoring required 📌Complications🚨 If untreated, acromegaly increases mortality 2–3x• Cardiac disease (HTN, cardiomyopathy)• Diabetes mellitus• Colon adenomas and cancer• Thyroid nodules or cancer• OSA (obstructive sleep apnoea)• Arthropathy and joint destruction• Visual field loss• Hypopituitarism after surgery/radiotherapy• Psychosocial impact: Appearance, mood, QOL 📌Prognosis• GOOD with earlydiagnosis + treatment• POORER withdelayed recognition, large tumour, high GH levels, or existingcardiac/metabolic complications• Regular follow-up essential for hormonemonitoring, imaging, and screening 📎More MSRA Resourcesfor Acromegaly📝 Revision Notes:https://www.passthemsra.com/topic/acromegaly-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/acromegaly-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/acromegaly-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/acromegaly-rapid-quiz/🎓 Full Course – Endocrinology for the MSRA:https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA #MSRARevision#AcromegalyMSRA #MSRAFlashcards #EndocrinologyMSRA #GrowthHormone#PituitaryAdenoma #NICEGuidelines #MSRAExam #MedicalEducation#MSRAOnlineRevision #IGF1 #TranssphenoidalSurgery