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  1. Anterior Pituitary Hormnes
    • Tropic hormones
    •    -TSH
    •    -ACTH
    •    -FSH
    •    -LH
    • Growth Hormone
    • Prolactin
  2. Posterior Pituitary Hormones
    • ADH
    • Oxytocin
  3. Reasons for symptoms that occur from tumors:
    • Mass effect (pressure) on local structures:
    •    Optic chiasm
    •    Cranial nerves
    •    Hypopituitarism
    •    Hormonal excess syndromes
    •    Hormonally nonfunctional
    • Most tumors are benign. Almost always very small. Most have no known cause. Small number may run in families- multiple endocrine neoplasia
  4. Abnormalities of Excessive Growth Hormone
    • Growth Hormone (GH) from anterior pituitary gland:
    •    -Promotes protein synthesis
    •    -Mobilizes glucose and free fatty acids
    •    -Triggers the liver to release insulin-like growth factor(IGF-1)
    •    -Short half life in circulation

    • Continuous excessive levels of GH produces:
    • -Giantism in children and adolescents whose epiphyseal plates have not closed
    • -Acromegaly in adults
  5. Cause of Acromegaly
    GH-secreting pituitary adenoma
  6. Physical Changes of Acromegaly
    • Physical features due to inability of GH to cause further growth in bones where epiphyseal closure has occurred
    • Enlargement of:
    •    Hands and feet
    •    Soft tissues of face and head
    •    Mandible (jaw juts forward)
    •    Tongue
    • Hypertrophy of vocal cords
    • Widening of spacing between teeth
    • Clubbing of fingertips
    • Thickening of skin
    • Increased sweating
  7. Acromegaly
    -Rare disease, but more common than once thought. Both genders affected equally

    -Usually diagnosed in adults between 40-50 years old

    -Clinical manifestations begin between age 20 to 30

    -Slowly progressive, totally unpredictable
  8. Clinical manifestations of Acromegaly
    • Arthritis
    • Speech difficulties
    • Sleep apnea
    • Upper airway obstruction
    • Peripheral neuropathy
    • Muscle weakness
    • Menstrual disturbances
    • Colon polyps
    • Colon cancer
    • Visual disturbances and headaches
    • Atherosclerosis
    • Insulin resistance/hyperglycemia/
    • Diabetes Mellitus
    • Cardiomegaly
    • Left ventricular hypertrophy
    • Hypertension
  9. Questions to ask if Acromegaly is suspected
    Have you noticed a change in your shoe size?

    Have you noticed that you cannot sing high notes any longer?

    Have you had any trouble swallowing?

    Have you noticed that it is more difficult to puncture the skin when you have blood drawn?

    Have you fallen lately?

    Tell me how your vision has been.  Have you noticed a change?

    Have you been experiencing headaches?

    Have you been experiencing increased thirst or increased urination?

    Have you had any chest discomfort?
  10. Physical Exam for Acromegaly
    • -Check BP
    • -Note facial features, skin thickness, tongue size, clubbing of fingers
    • -Assess visual fields
    • -Assess for displacement of PMI
    • -Assess joint movement for crepitus
    • -Assess sensation of lower extremities
    • -Note BG, HgA1C on labs
    • -Note CXR report for cardiomegaly
    • -Ask family to bring in pictures from past
  11. Dx Acromegaly
    History and Physical exam

    Plasma IGF-1 levels

    Oral glucose tolerance test (for GH suppression)- very specific


    CT scan with contrast

    Complete opthalmologic exam
  12. Drug Therapy
    Somatostatin analogs (Growth Hormone)

    • ­Sandostatin (Octreotide)- most commonly used
    •    -Reduces GH levels to within normal range
    •    -Given subcutaneously three times a week

    • ­Sandostatin LAR and Lanreotide SR
    •    -Long-acting analogs
    •    -Given IM every 2-4 weeks

    • ­Side effects:
    • N&V, diarrhea, stomach pain, dizziness, headache, pain at injection site, gallstones, elevated blood glucose
    • ­Pegvisomant (Somavert)
    •    -GH antagonist
    •    -Alternative to somatostatin analogs
    •    -Daily subcutaneous injection

    ­Side effects: Few, but some may develop liver damage

    • Hormone replacements after surgery may be needed
  13. Surgical Procedures to Correct Acromegaly
    • Surgical treatment
    •    -Transsphenoidal hypophysectomy
    •    (Incision beneath upper lip or via nose)
    •    -Hormone replacement therapy
    •    (May cause menopause & infertility)
    •    -Open cranium procedure

    • Radiation Therapy
    •    -Reduce tumor size
    •    -High risk for surgery
    •    -Failed remission after surgery
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