🧠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:
🔪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
