Growth hormone-secreting pituitary tumors

Published on 02/03/2015 by admin

Filed under Endocrinology, Diabetes and Metabolism

Last modified 02/03/2015

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CHAPTER 21

Growth hormone-secreting pituitary tumors

1. What is the normal function of growth hormone in children and adults?

2. How are levels of GH normally regulated?

3. Does GH directly affect peripheral tissues?

4. What are the clinical features of excessive production of GH in children?

5. Describe the clinical features of excessive production of GH in adults.

In adults, excessive GH causes acromegaly. Acromegaly is rare, with an incidence of approximately 5 cases per million people per year, and often progresses gradually and insidiously. The pathologic and metabolic effects of acromegaly are summarized in Table 21-1.

TABLE 21-1.

CLINICAL EFFECTS OF ACROMEGALY

CLINICAL EFFECT CAUSE
Coarse features Periosteal formation of new bone
Enlarged hands and feet Soft tissue hypertrophy
Excess sweating Hypertrophy of sweat glands
Deepened voice Hypertrophy of larynx
Skin tags Hypertrophy of skin
Upper airway obstruction and sleep apnea Hypertrophy of tongue and upper airway
Osteoarthritis Hypertrophy of joint cartilage and osseous overgrowth
Carpal tunnel syndrome Hypertrophy of joint cartilage and osseous overgrowth
Hypertension, congestive heart failure Cardiac hypertrophy
Hypogonadism Multifactorial
Diabetes mellitus, glucose intolerance Insulin antagonism, other factors
Colonic polyps Colonic hypertrophy

6. What is the single best clue in examining a patient suspected of having acromegaly?

7. From what do patients with acromegaly die?

8. The husband of a patient with acromegaly complains that he cannot sleep because his wife snores. Is this relevant?

9. If I suspect that a patient may have acromegaly, what test should I order?

10. The patient’s IGF-1 value is not elevated, but I still think that she may have acromegaly. What other test should I order?

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