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Acromegaly - Cause - Diagnosis - Treatment - Dr. Adil Ramzan

Acromegaly is a condition which results due to excess of growth hormone.
Growth hormone is secreted by the anterior lobe of the pituitary gland under the influence of growth hormone releasing hormone which is secreted by the hypothalamus.

Causes of acromegaly. 

In 90% of cases, the cause of growth hormone excess or acromegaly is Pituitary adenoma while other 10% causes include; Ectopic secretion of growth hormone or growth hormone releasing hormone by some tumour.

Diagnosis of Acromegaly

It is diagnosed by the clinical features, which include; large spade-like hands, frontal bossing, large jaw and gigantism. IGF 1 and growth hormone level are raised and MRI of the brain usually show pituitary adenoma. 

Treatment of Acromegaly. 

Any of the following regimens can be tried. 
  1. Surgery is the first line: Transsphenoidal resection of pituitary adenoma is the first line treatment, and usually cure the disease. 
  2. Dopamine agonists, for example, bromocriptine was the first line therapy, but now superseded by the octreotide. Octreotide is effective in 50-70% of cases and may be used as an adjunct to surgery. 
  3. Pegvisomant is the newer drug which is growth hormone receptor antagonist and it is very effective and it decreases IGF1 levels in 90% of cases. But it has no effect on tumour size and surgery should be done to remove the pituitary adenoma. 
  4. External radiation is used when surgery or medical therapy fails. 


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