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  1. Almost always due to pituitary adenoma secreting growth hormone
  2. If GH secretion occurs in childhood prior to skeletal epiphyseal closure it leads to gigantism
  3. If secretion begins after epiphyseal closure it leads to acromegaly.
  4. Clinical Feature
    1. There is excessive growth of hands, feet
    2. Jaw (prognathism)
    3. Voice deepening
    4. Joint erosions
    5. Carpal tunnel syndrome
    6. Proximal muscle weakness

Local effects of pituitary tumor-amenorrhea, headaches, visual field loss, weakness.


  1. DM as GH is counter-regulatory to insulin
  2. Vascular: ↑BP, LVH, cardiomyopathy.
  3. Malignancy: ↑development of colon cancer; 


  1. Increase heal pad thickness seen on X-ray lateral view of the heal

Extra Edge: Most common cause of increase heal pad thickness is heal injury (AIIMS Nov 2010). 

  1. Elevated IGF-I. Usually > 5 times normal.
  2. Serum GH not suppressed following oral glucose. OGTT test (75 gms of glucose given. After 1 hour if GH>1 ng/ml- suggestive of GH tumor.) It is the most definite test.
  3. Confirmation- MRI/CT neoplasm


  1. Trans-sphenoidal surgery: Usually the treatment of choice.
  2. Medical: 
    1. Somatostatin analogues eg octreotide & Lanreotide. (Ref. Hari. 18th ed., Pg - 2896)
    2. Dopamine agonist – Bromocriptine & cabergoline are also use. 
  3. Radiotherapy: If surgery inappropriate or as adjuvant; may take years to work.


Recent Advances:
  1. GH Receptor Antagonist, Pegvisomant, antagonizes endogenous GH action by blocking peripheral GH binding to its receptor.
  2. Consequently, serum IGF-I levels are suppressed, reducing the deleterious effects of excess endogenous GH. (PNQ) (Ref. Hari. 18th ed., Pg - 2896)

Extra Edge
(Ref. Hari. 18th ed., Pg - 2882)

  1. Carney syndrome is characterized by spotty skin pigmentation, myxomas, and endocrine tumors, including testicular, adrenal, and pituitary adenomas. Acromegaly occurs in about 20% of these patients.
  2. McCune-Albright syndrome consists of polyostotic fibrous dysplasia, pigmented skin patches, and a variety of endocrine disorders, including acromegaly, adrenal adenomas, and autonomous ovarian function.

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