Growth Hormone - Acromegaly

What causes acromegaly?

Excess growth hormone (GH) secretion after the epiphyseal plates have closed.

What is the growth plate?

A region of cartilage near the ends of long bones where bone growth occurs during childhood.

What is the most common cause of acromegaly?

Pituitary adenoma.

What are less common causes of acromegaly?

Hypothalamic dysfunction and ectopic GH or GH-releasing hormone-producing tumors.

What soft tissue and skeletal changes occur in acromegaly?

• Enlarged hands

• Feet

• Nose

• Tongue

• Lips

• Jaw

• Thickened skin

What respiratory issue is common in acromegaly?

Sleep apnea due to a large tongue.

What voice change occurs in acromegaly?

A deepened voice from enlarged vocal cords.

What neurologic manifestations occur in acromegaly?

• Headache

• Visual disturbances

• Peripheral neuropathy (e.g., carpal tunnel).

What metabolic complications are associated with acromegaly?

• Hyperglycemia

• Insulin resistance

• Possible diabetes

• Fatigue

• Weakness

What cardiovascular complications occur in acromegaly?

• Cardiomegaly

• Hypertension

• Increased risk of heart failure

What reproductive changes occur in acromegaly?

• Women: menstrual irregularities

• Men: decreased libido and impotence

What is the gold-standard screening test for acromegaly?

Elevated IGF-1 level, which reflects average GH secretion over several hours.

What imaging is used to identify a pituitary adenoma in acromegaly?

Pituitary MRI.

When is a CT scan used for acromegaly?

To search for ectopic GH-releasing sources when indicated.

What is the first-line treatment for acromegaly?

Transsphenoidal hypophysectomy (surgical removal).

What medications are used when surgery is incomplete or contraindicated?

• Somatostatin analogs

• GH-receptor antagonists

• Dopamine agonists

When is radiation therapy used in acromegaly?

For residual disease after surgery or medical therapy.

What should be monitored after transsphenoidal surgery for acromegaly?

Nasal and ear drainage for possible CSF leak; test for glucose and protein.

What signs should the nurse monitor for possible meningitis after surgery?

• Fever

• Neck rigidity

Why should the nurse monitor urine output post-transsphenoidal surgery?

To detect diabetes insipidus (polyuria and polydipsia).

What head positioning is recommended after transsphenoidal surgery?

Elevate head ≥30° to lower intracranial pressure.

What metabolic parameters should be monitored postoperatively?

• Blood glucose

• Blood pressure