Acromegaly
A hormonal disorder caused by excess growth hormone from a pituitary adenoma, resulting in enlarged extremities and facial features. Somatostatin analogues (octreotide, lanreotide, pasireotide) are first-line medical therapy, suppressing GH secretion from the tumour.
Technical Context
Prevalence: approximately 60 per million. Caused by GH-secreting pituitary adenoma (>95% of cases). Diagnosis: elevated IGF-1 for age/sex + failure to suppress GH below 1 μg/L during 75g OGTT + pituitary MRI showing adenoma. Treatment algorithm: transsphenoidal surgery (first-line, cure rate 40-90% depending on tumour size), medical therapy for residual disease (somatostatin analogues — octreotide LAR or lanreotide autogel are first-line medical therapy, normalising IGF-1 in approximately 50-70%; pasireotide for patients resistant to first-generation SSAs; pegvisomant — GH receptor antagonist, not a peptide — for those resistant to SSAs), and radiotherapy (for refractory cases). Monitoring: serum IGF-1 (target: age/sex-normalised range) and random GH <1 μg/L indicate biochemical control. Somatostatin analogue tumour shrinkage: approximately 20-50% of patients achieve >20% tumour volume reduction, supporting their use as primary therapy in patients unsuitable for surgery.