Obligatory medical device diagnostics. Magnetic resonance imaging of the skull (cranial MRI, cranial MRI, or cMRI): thin-slice images of the sella turcica in coronal and sagittal slice direction in T2 and T1 weighting with and without contrast medium – in 99% of cases, a pituitary tumor (tumor of the pituitary gland) is detectable Perimetry (visual … Acromegaly: Diagnostic Tests
1st order. Surgical resection (selective adenomectomy) is the first-line therapy; usually, surgery is performed via the transnasal or transsphenoidal approach (i.e., removal of the tumor via an approach through the nose). Despite the surgery, complete recovery subsequently occurs in only about 50% of patients. Possible complications of surgery for pituitary adenoma: Diabetes insipidus – hormone … Acromegaly: Surgical Therapy
Occasionally, radiation therapy may be required as a secondary therapy after initial surgery. However, it is very rarely used today.Radiation therapy is always performed in combination with drug therapy. The following forms of radiatio (radiation therapy) can be distinguished in acromegaly: Conventional X-ray irradiation Stereotactic radiosurgery (high-precision irradiation).
In childhood, excess STH before the closure of the epiphyseal joints (growth plates) leads to proportioned gigantism (pituitary gigantism; marked tall stature; patients often reach a height of >2 m). In adults, i.e., after completion of physiological growth, excessive STH production manifests exclusively in the head, acras (protruding parts of the body such as hands … Acromegaly: Symptoms, Complaints, Signs
Pathogenesis (disease development) Acromegaly is caused by overproduction of growth hormone (GH). The cause of this overproduction is usually a tumor. It is a somatotrophic pituitary adenoma (benign neoplasm) in 99% of cases. A distinction is made between microadenomas and macroadenomas (> 1 cm). In 2017, the World Health Organization updated the histologic grading of … Acromegaly: Causes
General measures Aim for normal weight! Determine BMI (body mass index) or body composition using electrical impedance analysis. BMI ≥ 25 → participation in a medically supervised weight loss program. Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → … Acromegaly: Therapy
The following are the most important diseases or complications that may be contributed to by acromegaly: Eyes and eye appendages (H00-H59). Visual disturbances, unspecified Glaucoma – disease of the eye with increased intraocular pressure. Endocrine, nutritional and metabolic diseases (E00-E90). Diabetes mellitus (diabetes). Increase in lipoprotein(a) Hyperlipidemia/dyslipidemia Hypertriglyceridemia (excessive triglyceride levels in the blood). Tall … Acromegaly: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height [weight gain]; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye) [enlargement of acra – body ends such as nose, chin, ears, hands (wedding ring no longer fits), … Acromegaly: Examination
1st order laboratory parameters – obligatory laboratory tests. Stage I Serum IGF-I (insulin-like growth factor-I; somatomedin) [serum IGF-I: ↑] Stage II Growth hormone suppression test after oral glucose loading (gold standard); blood samples for determination of growth hormone and glucose are taken at time points 0, 30, 60, 90, and 120 min – administration of … Acromegaly: Test and Diagnosis
Therapeutic target Inhibition of the release or action of growth hormone. Therapy recommendations Surgical resection (selective adenomectomy/removal of the tumor via an approach through the nose) is the first-line therapy. Secondary therapy: treatment with dopamine agonists, somatostatin analogues (efficient lowering of GH levels), GH antagonists, or radiatio (radiotherapy) in combination with drug therapy. Therapy monitoring: … Acromegaly: Drug Therapy
Medical history (history of illness) represents an important component in the diagnosis of acromegaly. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). What symptoms have you noticed? Have you noticed that shoes, gloves, hats, etc. no longer fit? Have you noticed a change in the face (possibly by looking at older photos)? … Acromegaly: Medical History
Cardiovascular (I00-I99). Essential arterial hypertension (high blood pressure). Musculoskeletal system and connective tissue (M00-M99). Chronic polyarthritis
