acromegaly treatment - Answer-CARDIOVASCULAR, METABOLIC, AND SYMPTOMS
OF TUMOR COMPRESSION = improve with treatment
SKELETAL ABNORMALITIES = irreversible
GOAL: Normalize GH and IGF-1 serum levels to age range, restoring normal pituitary
function, and relieving or preventing complications related to tumor expansion.
Treatment of choice Acromegaly: transsphenoidal surgery to remove GH-secreting
adenoma • Stereotactic radiation therapy if → rapid control of GH levels is not essential,
individual is not a good candidate for surgery, hyperfunction persists after subtotal
resection
Somatostatin analogs (octreotide, octreotide acetate, and lanreotide) --> normalize IGF-
1 levels and lower GH levels • Pegvisomant → supplement somatostatin analogs;
effective drug that induces tissue insensitivity to GH (blocks GH receptor)
Dopaminergic agonists (carbergoline) → if tumor is secreting prolactin
/.Aldosterone - Answer-Most potent of naturally occurring mineralocorticoids.
Acts to conserve sodium by increasing activity of sodium pump of epithelial cells.
In kidneys, primarily acts on epithelial cells of nephron collecting duct to increase
sodium reabsorption and increase potassium and hydrogen excretion
/.Amylin - Answer-peptide hormone secreted with insulin in response to nutrient stimuli.
Regulates blood glucose by delaying nutrient intake and suppressing glucagon
secretion after meals.
Has an antihyperglycemic effect through satiety
/.CalcitonIN - Answer-brings calcium back into the bones- decreasing serum calcium
levels
/.calcitonin is used to treat which conditions? - Answer-Osteoporosis, OA, Paget bone
disease, hypercalcemia, osteogenesis imperfecta, and metastatic cancer of the bone
/.Calcium - Answer-stored in your bones
/.causes of SIADH - Answer-common causes:
ectopic production of ADH by tumors (small cell carcinoma in the duodenum, stomach,
and pancreas)
Cancers of the bladder, prostate, and endometrium
lymphomas
,sarcomas
pulmonary disorders:
pna, asthma, CF, resp fail requiring mech ventilation
CNS disorders:
encephalitis, meningitis, intracranial hemorrhage, tumors, trauma including
neurosurgery
medications (especially in the elderly):
hypoglycemic, antidepressants, antipsychotics, narcotics, general anesthetics, chemo
agents, NSAIDs, synthetic ADH
/.clinical manifestations of acromegaly - Answer-connective tissue proliferation-
enlarged tongues, interstitial edema, enlarged overactive sebaceous/sweat glands,
body, odor, course skin/body hair
Bony proliferation- large joint arthropathy, periosteal vertebral growth, enlarged bones of
the hands, face, and feet, decreased ROM, kyphosis, lower jaw/forehead protrustion
Increased IGF-1 stimulation- cartiligenous growth- ribs elongate at bony-cartilage
junctions- barrel chest appearance
Increase proliferation of cartilage spine/joints- backaches and arthralgias
Continues bony/soft- tissue overgrowth- entrapement of nerves, peripheral damage,
weakness, muscular atrophy, footdrop, sensory changes in hands (carpal tunnel). Sleep
disordered breathing can exacerbate heart issues.
DM symptoms- polyuria and polydipsia
CNS symtpoms (growing tumor size)- headache, seizure activity, visual field
disturbances, and papilledema. Complete compression hypopituitarism- gonadotropin
secretion affected- amenorrhea or sexual disfunction in men.
acromegaly htn- asymptomatic until heart failure symptoms appear
hyperprolactinemia (30-40% occurrence)
/.clinical manifestations of DI - Answer-polyurina, nocturia, continuous thirst, polydipsia.
Untreated individuals with long-standing DI have large bladder capacity and
hydronephrosis
/.clinical manifestations of Grave's disease - Answer-Increased levels of TH affect all
systems- classic hyperthyroidism symptoms- thin hair, exopthalamus, enlarged-nodular
thyroid gland, tachycardia, wt loss, warm skin with heat intolerance.
, Two major distinguishing factors of grave's disease:
1. opthalmopathy
2. dermopathy
two categories of opthalmopathy are:
1. functional abnormalities-hyperactivity of the sympathetic division of the autonomic
system → lag of the globe on upward gaze and lag of the upper lid on downward gaze
2. infiltrative changes- orbital contents with enlargement of the ocular muscles → TSH
receptor autoantibodies reacting with receptors on orbital fibroblasts a. Increased
secretion of hyaluronic acid, adipogenesis, inflammation and edema of the orbital
contents → exophthalmos (protrusion of the eyeball), periorbital edema, extraocular
muscle weakness → strabismus and diplopia (double vision) i. irritation, pain,
lacrimation, photophobia, blurred vision, decreased visual acuity, papilledema, visual
field impairment, exposure keratosis, corneal ulceration
Very high levels of TSI → pretibial myxedema (Graces dermopathy) → subcutaneous
swelling on the anterior portions of the legs (indurated and erythematous skin
/.clinical manifestations of pituitary adenoma - Answer-HA, fatigue, neck pain, stiffness,
or seizures; visual changes and temporary blindness; and changes in neurologic
function.
/.clinical manifestations of prolactinoma - Answer-Clinical Manifestations:
Hypogonadotropic hypogonadism in both sexes
• Women → amenorrhea, infertility, nonpuerperal milk production (galactorrhea),
hirsutism
Undetection → estrogen deficiency → osteopenia or osteoporosis
• Men → erectile dysfunction, infertility, osteopenia Increasing tumor size → headache
and visual impairment
/.clinical manifestations of SIADH - Answer-hyponatremia causes hypervolemia and
weight gain. symptoms resolve witht the correction of hyponatremia.
Na decreases from 140 to 130 :
thirst, impaired taste, anorexia, dyspnea on exertion, fatigue, dulled sensorium. *wt gain
usually absent
Na decreases from 130-120:
vomiting, abd cramps, *wt gain from water retention
Na levels 110-115:
confusion, lethargy, muscle twitching, seizures, neurological damage
OF TUMOR COMPRESSION = improve with treatment
SKELETAL ABNORMALITIES = irreversible
GOAL: Normalize GH and IGF-1 serum levels to age range, restoring normal pituitary
function, and relieving or preventing complications related to tumor expansion.
Treatment of choice Acromegaly: transsphenoidal surgery to remove GH-secreting
adenoma • Stereotactic radiation therapy if → rapid control of GH levels is not essential,
individual is not a good candidate for surgery, hyperfunction persists after subtotal
resection
Somatostatin analogs (octreotide, octreotide acetate, and lanreotide) --> normalize IGF-
1 levels and lower GH levels • Pegvisomant → supplement somatostatin analogs;
effective drug that induces tissue insensitivity to GH (blocks GH receptor)
Dopaminergic agonists (carbergoline) → if tumor is secreting prolactin
/.Aldosterone - Answer-Most potent of naturally occurring mineralocorticoids.
Acts to conserve sodium by increasing activity of sodium pump of epithelial cells.
In kidneys, primarily acts on epithelial cells of nephron collecting duct to increase
sodium reabsorption and increase potassium and hydrogen excretion
/.Amylin - Answer-peptide hormone secreted with insulin in response to nutrient stimuli.
Regulates blood glucose by delaying nutrient intake and suppressing glucagon
secretion after meals.
Has an antihyperglycemic effect through satiety
/.CalcitonIN - Answer-brings calcium back into the bones- decreasing serum calcium
levels
/.calcitonin is used to treat which conditions? - Answer-Osteoporosis, OA, Paget bone
disease, hypercalcemia, osteogenesis imperfecta, and metastatic cancer of the bone
/.Calcium - Answer-stored in your bones
/.causes of SIADH - Answer-common causes:
ectopic production of ADH by tumors (small cell carcinoma in the duodenum, stomach,
and pancreas)
Cancers of the bladder, prostate, and endometrium
lymphomas
,sarcomas
pulmonary disorders:
pna, asthma, CF, resp fail requiring mech ventilation
CNS disorders:
encephalitis, meningitis, intracranial hemorrhage, tumors, trauma including
neurosurgery
medications (especially in the elderly):
hypoglycemic, antidepressants, antipsychotics, narcotics, general anesthetics, chemo
agents, NSAIDs, synthetic ADH
/.clinical manifestations of acromegaly - Answer-connective tissue proliferation-
enlarged tongues, interstitial edema, enlarged overactive sebaceous/sweat glands,
body, odor, course skin/body hair
Bony proliferation- large joint arthropathy, periosteal vertebral growth, enlarged bones of
the hands, face, and feet, decreased ROM, kyphosis, lower jaw/forehead protrustion
Increased IGF-1 stimulation- cartiligenous growth- ribs elongate at bony-cartilage
junctions- barrel chest appearance
Increase proliferation of cartilage spine/joints- backaches and arthralgias
Continues bony/soft- tissue overgrowth- entrapement of nerves, peripheral damage,
weakness, muscular atrophy, footdrop, sensory changes in hands (carpal tunnel). Sleep
disordered breathing can exacerbate heart issues.
DM symptoms- polyuria and polydipsia
CNS symtpoms (growing tumor size)- headache, seizure activity, visual field
disturbances, and papilledema. Complete compression hypopituitarism- gonadotropin
secretion affected- amenorrhea or sexual disfunction in men.
acromegaly htn- asymptomatic until heart failure symptoms appear
hyperprolactinemia (30-40% occurrence)
/.clinical manifestations of DI - Answer-polyurina, nocturia, continuous thirst, polydipsia.
Untreated individuals with long-standing DI have large bladder capacity and
hydronephrosis
/.clinical manifestations of Grave's disease - Answer-Increased levels of TH affect all
systems- classic hyperthyroidism symptoms- thin hair, exopthalamus, enlarged-nodular
thyroid gland, tachycardia, wt loss, warm skin with heat intolerance.
, Two major distinguishing factors of grave's disease:
1. opthalmopathy
2. dermopathy
two categories of opthalmopathy are:
1. functional abnormalities-hyperactivity of the sympathetic division of the autonomic
system → lag of the globe on upward gaze and lag of the upper lid on downward gaze
2. infiltrative changes- orbital contents with enlargement of the ocular muscles → TSH
receptor autoantibodies reacting with receptors on orbital fibroblasts a. Increased
secretion of hyaluronic acid, adipogenesis, inflammation and edema of the orbital
contents → exophthalmos (protrusion of the eyeball), periorbital edema, extraocular
muscle weakness → strabismus and diplopia (double vision) i. irritation, pain,
lacrimation, photophobia, blurred vision, decreased visual acuity, papilledema, visual
field impairment, exposure keratosis, corneal ulceration
Very high levels of TSI → pretibial myxedema (Graces dermopathy) → subcutaneous
swelling on the anterior portions of the legs (indurated and erythematous skin
/.clinical manifestations of pituitary adenoma - Answer-HA, fatigue, neck pain, stiffness,
or seizures; visual changes and temporary blindness; and changes in neurologic
function.
/.clinical manifestations of prolactinoma - Answer-Clinical Manifestations:
Hypogonadotropic hypogonadism in both sexes
• Women → amenorrhea, infertility, nonpuerperal milk production (galactorrhea),
hirsutism
Undetection → estrogen deficiency → osteopenia or osteoporosis
• Men → erectile dysfunction, infertility, osteopenia Increasing tumor size → headache
and visual impairment
/.clinical manifestations of SIADH - Answer-hyponatremia causes hypervolemia and
weight gain. symptoms resolve witht the correction of hyponatremia.
Na decreases from 140 to 130 :
thirst, impaired taste, anorexia, dyspnea on exertion, fatigue, dulled sensorium. *wt gain
usually absent
Na decreases from 130-120:
vomiting, abd cramps, *wt gain from water retention
Na levels 110-115:
confusion, lethargy, muscle twitching, seizures, neurological damage
