CASE

A 44-year-old woman presents with excessive sweating and an increase in hat size over a 3-year period.
She comments that her face and hands just seem ‘bigger’ than before.

For the case scenario given, consider the following:

Q1: What do you think the likely diagnosis is?

The diagnosis of the disease is acromegaly. It is a rare condition where the body produces too much
growth hormone, causing body tissues and bones to grow more quickly. Over time, this leads to
abnormally large hands and feet, and a wide range of other symptoms. Acromegaly is usually diagnosed
in adults aged 30 to 50, but it can affect people of any age. When it develops before the end of puberty,
it's known as "gigantism". Acromegaly can cause a wide range of symptoms, which tend to develop very
slowly over time. *swollen hands and feet you may notice a change in your ring or shoe size *tiredness
and difficulty sleeping, and sometimes sleep apnoea *gradual changes in your facial features, such as
your brow, lower jaw and nose getting larger, or your teeth becoming more widely spaced *numbness and
weakness in your hands, caused by a compressed nerve (carpal tunnel syndrome)

Q2: What tests could you do to confirm this?

IGF-1 measurement. After you've fasted overnight, your doctor will take a blood sample to measure the
IGF-1 level in your blood. An elevated IGF-1 level suggests acromegaly.

Growth hormone suppression test. This is the best method for confirming an acromegaly diagnosis.
During this test, your GH blood level is measured both before and after you drink a preparation of sugar
(glucose). In people who don't have acromegaly, the glucose drink typically causes the GH level to fall.
But if you have acromegaly, your GH level will tend to stay high.

Imaging. Your doctor may recommend an imaging test, such as magnetic resonance imaging (MRI), to
help pinpoint the location and size of a tumor on your pituitary gland. If no pituitary tumors are seen, your
doctor may order other imaging tests to look for nonpituitary tumors.
Q3: What tests would help establish the cause?

Rarely, acromegaly is part of the multiple endocrine neoplasia type 1 (MEN-1) syndrome, carney
complex or the isolated familial acromegaly syndrome. Somatotropic adenomas has been described in
association with GH- releasing hormones secretion Gangliocytomas in the region of pituitary It is always
somatotrophic adenoma secreting too much GH
Q4: What is the initial management?

For the initial management or treatment may include removal of the tumor, radiation therapy, and
injection of growth hormone blocking drugs and also for the drug treatment of GH reduction is with
somatostatin analogues. Surgical therapy for acromegaly: Transsphenoidal surgery is the preferred first-
line treatment for patients with acromegaly that have intrasellar microadenomas, noninvasive
macroadenomas or patients in whom the tumor is causing comprehension symptoms

Q5: What are the long-term complications/sequelae?

Hypopituitarism, changes in visual filed, cardiac complications such as hypertension, risk for
cardiomyopathy, respiratory complications related to altered chest shape and movements. sleep apnea,
arthropathy, vertebral fractures and insulin resistance.