Acrome

Det Chbonic hype:Sexrt ion of GH afte pubety (kusion of long bong Shaf-tsu th

epiphyies)
2 CSes
. Somalofboph pituitar odenoma -Usualy maCoadenoma
2- MENI Syndrame Sually assoiattd wth lactothoph adeloma
3.aely pavaleoplastic. Syndrome Cproladinoma)niked putuitovj tunor

Secrefing GHRH,8 CH

Ashont of GH: 1. onaboku effect on potin,oskognusi,chondrogehuir

2. hyperyiemia inSuln vesistance)
3. minends hyperralma venurehiom of Na Ak
4. Prolachn like action
5. anabolic eflect on medin of BVs (CU owth Factors)UcHTN
AGrOwth ofBone &oft hswes
s k l l (facial chanyes): 1. enlargedskull 2.PhoMinent Supraokbitaliidgas
3.Forward displacement of tigoma y.0vekgrouth af
Macc MaCroglossia
5. enlo yed nose LipT Tongue, aks
aCal parts in cwde Shul, Hands, mokllory bone
daastema 1.ramus gkots So
Feet 6. Teeth Jepovated orlost long
0sgle ben iamus s body of mandible 1 phognathum
Hands& eet Squak shaped doughysensaNon
1-enlavgement in lenyth Awidt & bulky (3pade Flcshy oppearane{i" se)|
ike hands) s

thick skin (piolfovahon of Jweatylands8 Sebowhea dt 11 Sebacious

2. Suweaty 1gensy ing
3. Foof eqwes larye Jhoes &fingers exbemdy thickened sot Fingersite Hx takigg
4. capol tunoel Syndbome Cdt
Soft his proliferohon in wrist Compnymedian lue)
3 Husele: enlorged bulky then myopathy (prolunoll dt fat infihafin
orans 1.toiter
in
2. Salivay gfand 3-heatoplanomeyaly
4. Cardiomeyaly1. Cakdiomyopahy (+HTN)Heat Failurt(most
importont COuJe of dath)
5. enlavge) Kidney b. Colonic polypatis CRe
Shin1thickened, SweoatySebovheoa
Nech
2- Acanthosi nigvicans (DE insulin Esstane Tnsuln has anaboki effect
on
Pigmnt cels Gbio) hype 0tichosis pigmentata
3-Hyper-tchosis & hjisuhism in famales hidrosis
. SKin tags 5.acne like Comedones
Vetebiae:
1.yphois 2-0A 3.vetckol bodies f AP damckh with new bone Fomoka
pressun
onench
Othe Costeophyt) mokily in thoratic regian
Dnewous Syskm: dt compretion fotm oddacent soft Asfua.s
1CTS 2.deaneir 3.perigheal neopatty dt gcompresion
DA
others:
ichondraenesis.hyperrorhy of coJiod cailages (uwith vibsgclavides wid:o)>1 Giuwnfo
nc of thoaX

Hype:-tvophy of nasal oual cavhlages-yenlarjemantof nose eas

2-0steognesis hen oskoporolis: 1periosfeun thikening early then bone eSophon vapy &lalr
2 Stagesof aurofmegaly lcodiny to osteopovosis (iong bones thick alate defounied.ib
3. Acranegalis aothvihs: aflec mainly lovge doints
spine
y-HoarSness of Voic
Metoboli effets 1DM 2. HTW
SPresru effects: in oll pitutoy turnor"
"

prtSfwe on other cells 23 hypothyiodism , 23

hypogonadism, 2" AdenocotLol faluee
ypopituatavisn) More lakeally, tmpovod lobe
newologicad Stiutures Convudsons
lattral
3,4,6 CN oph thalmoplegia (cavenous
-

Sius Compeaian)
-

ophc chiasma. (Spiasella extnSion) bitempoo humianopia Visual loJs

TCP vomihing, hadbcha, blued vision More 8upraselja extension
Pothalamus>Diabets
nsipida
CQS of inferh\uty in Qtomeod: 1. polauhn in miKed pithitary tunor
2-preSse on jonadotrophic celli hgpogonadin
3prolacfho lke achon of G1H
* CAuSeSof galactoeo 1,3
RespiefoH yiktn alechion: |SleePapmeo (uURT profeiationof fissu)
Signs pfachviky of aukome gal
1. Suweaty3jraty hads 5.tbone width
2. Iaf1
3. CaS Phosphate
ut musce buk
HIN 1.onaboli on medio of BUs VC HTN *X*
See Edacrinal HTN
2-Hpecal cemia. dt tnfeshiaal aksonpkonofca s hypapavathyioidim(MENT

DCompliation (=causes ol death

Degenea1. Hiw
4.Pituctay apopleky (Hje ujthin pituitarg adenoma)
VScdarL 2. Hf L5. hyp>ptutanim
disease
3.DM
Ox of ucromesal
Lab Mueshgatians
Homofn ad:
1.o4al gluCOse Juppiesion teSt: odministcr
1oo gm alucose mealue
basal gleePe GHQftes 1 hr
22ng/m is Cutoff poilt diagng
2-ICf.T (mave acuwate than Bolad GH 2-
3.Basal GiH (Normal-o.5
yml)
u. pholachin
5. FSHSLH,TSH, Testostetone hyp>pituatarism)
xother Lab inveshjarions
1. hyperycnia Ayasio
4hr natemua(1 Naealsonton)
2hupercalcemia (ferdisnt hype-talcemia despitR HENr
3. hyfer inswinemia

2Aodioloica Lakeal view

1X ay Skull (fellatucita):Qbalioninaof sello.tucta oion &Destuchormf
Double floo Sella floor
ant fost. inoid Proca
4.feakuies ofSkuli,enlargod, ?bone thickness, Sepavakd te
Veicbra Kyphosis & Osfcophyfes
Aow hesd=mushromshoped
honds: Spode.uke hands, Tuf hoq
-

Cathny)of fminal phalmaess harges

heet: T heel pol thick neas22 ma of metatat.
bals
MRT Sela turuta Dionostic lor pitufar tumoy X*
3 TTof Aurart
Sgicol treatmert: of pituitary tumod (# of choica in acramagoly)
RadiotheveP
Hedical hatment a dast find
1.Dopamine agonist Bhomoc pline (inhibit GaH hyfaseciefion in Some acromeyaliu pts)
2. ach
octoñde Atetale (Somatostatine. analojue) Sc 3hmes daily
3. 1 Lav
(lony afing once month,IH
Pegvisoment (GH eeptor antayonst)
* OCtreotide: SSay **
1. mechanism: Somatostatin analogue
2. Dose: actatt3 fmas daily, Laryoncefmonth , Sc
3. uses:Oacomegalj vAi eal bleding vipoma (tumor secrehinq VIP)
insulinoma Cuthin ndrome OTSH secrhing oden oma 180
4 SE: 1. N,U,0.constipation 3. heada the 5.Irritaion on injechion Sit
2. abdominal pain 4. d1tiness

10odsof Hinatronegalg:
1IOfT eaces noHnal lwel
2. G1H bwl<2 nlml
3. GTH Lwel afte gaose
Suppiedion fst <inglm