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24 Cards in this Set

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Acromegaly is most often caused by
Acromegaly is most often caused by a GH-secreting adenoma.
If GH excess occurs before epiphyseal closure, a condition known as
If GH excess occurs before epiphyseal closure, a condition known as pituitary gigantism results; when it occurs in adulthood after epiphyseal closure, acromegaly ensues. C
clinical features of acromegaly include
clinical features of acromegaly include prognathism; enlargement of the nose, lips, and tongue; frontal bossing; malocclusion; increased spacing between the teeth; sleep apnea; enlargement of the hands and feet; arthritis of the hips and knees; carpal tunnel syndrome; oily skin; and skin tags.
Prolactin is coproduced with GH in approximately 40% of patients with acromegaly. Some of these patients also may have
Prolactin is coproduced with GH in approximately 40% of patients with acromegaly. Some of these patients also may have amenorrhea and/or galactorrhea. Ectopic production of GH-releasing hormone is a rare (<1%) cause of acromegaly.
There is a two- to threefold increase in mortality rate associated with GH excess because of its association with
There is a two- to threefold increase in mortality rate associated with GH excess because of its association with cardiovascular and cerebrovascular diseases.
occur in many patients with GH excess
Cardiac hypertrophy is common, and hypertension and diabetes mellitus occur in many patients with GH excess.
Because of an increased risk of premalignant polyps and colon cancer, what shall be done
Because of an increased risk of premalignant polyps and colon cancer, screening with colonoscopy is recommended for all persons with GH excess
is needed for making the diagnosis.
Random GH level measurements are not useful because of pulsatile secretion, and demonstration of nonsuppression during a glucose tolerance test is needed for making the diagnosis.
screening test for acromegaly.
IGF-1 levels provide an integrated index of GH production, correlate well with clinical activity, and serve as a better screening test for acromegaly.
evaluates the extent of tumor growth;
An MRI evaluates the extent of tumor growth; approximately 60% of patients have macroadenomas.
Medical therapies are used in patients who are
Medical therapies are used in patients who are not cured by surgery or in whom surgery is very unlikely to result in a cure.
cabergoline /somatostatin
Although cabergoline is successful in only approximately 10% to 20% of patients with GH excess, an initial trial may be warranted because it can be given orally and is relatively inexpensive compared with somatostatin analogues.
somatostatin analogues
somatostatin analogues octreotide and lanreotide can be given by injection every 4 weeks and reduce GH and IGF-1 levels to normal in approximately 60% of patients.
Adverse effects of somatostatin analogues
Adverse effects of somatostatin analogues include diarrhea and an increased risk of cholelithiasis; cholecystitis and the need for cholecystectomy occur rarely.
Pegvisomant i
Pegvisomant is a biosynthetic GH analogue that prevents binding of GH to its receptor. It has been shown to normalize IGF-1 levels in more than 90% of patients with GH excess, with corresponding clinical benefits, but has no effects on tumors. Pegvisomant is given by daily injection; long-term experience with its use is limited.
Adjunctive radiation therapy
Adjunctive radiation therapy may be required when elevated GH levels or mass effects persist after surgery and medical therapy.
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