SK 13

Acromegaly
Pretest Subbagian Endokrin Metabolik

Avino Mulana Fikri

PPDS Subbagian Endokrin Metabolik

A 42-year-old college lecturer was reviewed in the endocrine clinic following
trans-sphenoidal surgery for acromegaly, which was done about 8 months ago.
Post-surgically there was an improvement in his symptoms, although the IGF-1
levels remained high and his glucose tolerance test showed unsuppressed GH
levels suggestive of residual disease. He was started on somatostatin analogue
therapy, while awaiting repeat surgery.
All of the following statements regarding development/management of
colorectal polyps in patients with acromegaly are true except?

A. An increased risk of colorectal adenomas

B. An increased risk of colorectal cancer
C. Repeat colonoscopy offered in patients with no polyp/normal IGF-1 every 10 years
D. Repeat colonoscopy offered to patients with polyp and/or raised IGF-1 every 5 years
E. Routine initial colonoscopy screening should begin at age of 50 years
 Definition and Etiology

• Definition CAUSES OF ACROMEGALY

• Acromegaly is a rare disorder that
results from excess growth hormone
(GH) and insulin-like growth factor 1
(IGF-1) after the growth plates have
closed
• Over 95% of patients caused by a
somatotroph adenoma of the pituitary
gland
• About 98% of cases of acromegaly are
due to the overproduction of growth
hormone by a benign tumor of the
pituitary gland called an adenoma
• Other tumors. tumors of the pancreas,
lungs, and adrenal glands

3
Melmed S. Acromegaly. Vol. 1, The Pituitary: Fourth Edition. 2017. 423–466 p.
 Pathogenesis

Melmed S. Medical progress: acromegaly. N Engl J Med. 2006;355:2558–2573.

 Development of Neoplasms

• Reports of high prevalence of colonic polyps in acromegaly may reflect increased

physician awareness in screening for these tumors, as well as the use of diagnostic
colonoscopy
• The polyps are often multiple, dysplastic, and more commonly found in the right side
of the colon
• The routine initial colonoscopy screening is recommended from the age of 40 years
• In case there is no polyp and no active disease (based on clinical profile and normal
IGF-1 values), a repeat colonoscopy should be offered to the patients at every 10-year
interval
• In patients with benign polyp (and/or raised IGF-1, active disease) on initial
colonoscopy, it needs to be repeated every 5 years.

Melmed S. Acromegaly. Vol. 1, The Pituitary: Fourth Edition. 2017. 423–466 p.

A 42-year-old college lecturer was reviewed in the endocrine clinic following
trans-sphenoidal surgery for acromegaly, which was done about 8 months ago.
Post-surgically there was an improvement in his symptoms, although the IGF-1
levels remained high and his glucose tolerance test showed unsuppressed GH
levels suggestive of residual disease. He was started on somatostatin analogue
therapy, while awaiting repeat surgery.
All of the following statements regarding development/management of
colorectal polyps in patients with acromegaly are true except?

A. An increased risk of colorectal adenomas

B. An increased risk of colorectal cancer
C. Repeat colonoscopy offered in patients with no polyp/normal IGF-1 every 10 years
D. Repeat colonoscopy offered to patients with polyp and/or raised IGF-1 every 5 years
E. Routine initial colonoscopy screening should begin at age of 50 years
Terima Kasih