A 44-year-old woman presents to the physician to establish care upon moving to a new area. She has no health concerns, and past medical history is unremarkable. Review of systems is notable for frequent headaches, heavy sweating, poor sleep, and reduced libido. Vital signs are temperature is 37.6°C (99.7°F), pulse is 83 beats/minute, blood pressure is 143/94 mmHg, respirations are 15/minute, and body mass index (BMI) is 28. On physical examination, she is a well-appearing though overweight woman with a noticeably deep voice. Her face displays coarse features, and there are spaces between her teeth. Her tongue is enlarged. Her hands and feet are enlarged, though not edematous, with thickening of the thumb and heel pads. Skin tags are found over her back and neck.
Which of the following treatments is most likely indicated for this patient after a thorough evaluation?
- A) Dopamine antagonist
- B) Insuline-like growth factor1 (IGF-1) receptor agonist
- C) Radioactive iodine
- D) Somatostatin analog
- E) Steroids
D) Somatostatin analog
This patient has signs and symptoms of acromegaly, which is caused by excess growth hormone (GH) and usually is secondary to a pituitary adenoma. Physical exam findings stem from tissue effects of GH excess. These include coarse facies, deep voice, large tongue, spaces between teeth, wide doughy hands and feet with thickening of the thumb and heel pads, and skin tags. Acromegaly is also associated with headaches, diaphoresis, poor sleep, reduced libido, and hypertension. Treatment often involves a somatostatin analog (octreotide) to inhibit GH secretion from the pituitary.
Dopamine agonists (e.g., cabergoline) may be used in the treatment of acromegaly, but dopamine antagonists are not indicated. An IGF-1 receptor agonist would exacerbate the disease since GH induces IGF-1 secretion from the liver. Radioactive iodine is used in the treatment of certain types of hyperthyroidism. Steroids are not used in the treatment of acromegaly.
Key Learning Point
Somatostatin analogs inhibit GH secretion from the pituitary gland.