USMLE/COMLEX - Step 2 - Acromegaly

USMLE/COMLEX - Step 2 - Acromegaly Acromegaly is a rare hormonal disorder that results from the excessive production of growth hormone in adults, typically caused by a benign tumor in the pituitary gland. Excessive GH production increases insulin-like growth factor-1 (IGF-1) levels in the body, which causes tissue overgrowth, metabolic disturbances, and cardiovascular and neurological complications. The metabolic changes result from the effects of GH and IGF-1 on glucose metabolism. Enlarged hands and feet Protruding jaw and brow Thickened skin Deepening of the voice Sleep apnea and snoring Enlarged hands and feet Protruding jaw and brow Thickened skin Coarse facial features Deepening of the voice Sleep apnea and snoring Excessive sweating and body odor Headaches, fatigue, and weakness Joint pain and stiffness Menstrual irregularities in women Erectile dysfunction in men Insulin-like growth factor-1 test Growth hormone suppression test Magnetic resonance imaging Visual field testing Bone density scan The treatment of acromegaly can involve various approaches, including: 1. Transsphenoidal surgery: The primary treatment for acromegaly is the surgical removal of the pituitary adenoma causing excess growth hormone production. Transsphenoidal surgery is the preferred approach, which involves removing the adenoma through the nose and sphenoid sinus. 2. Radiation therapy: Radiation therapy may be used as a primary treatment or in combination with surgery for residual or recurrent tumors. 3. Medical therapy: Medical therapy is used as primary therapy for patients who are not candidates for surgery or radiation or as an adjunctive treatment after surgery or radiation. Medications that are commonly used include somatostatin analogs (e.g., octreotide, lanreotide), dopamine agonists (e.g., cabergoline), and growth hormone receptor antagonists (e.g., pegvisomant).