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Growth Hormone Axis (Physiology (Hypothalamus releases growth-hormone…
Growth Hormone Axis
Physiology
Hypothalamus releases growth-hormone-releasing-hormone
Stimulated by sleep, stress, exercise, sex hormones
Stimulated by ghrelin
Stimulated by leptin
Inhibited by somatostatin
GHRH stimlates anterior pituitary
Pituitary releases growth hormone
Growth hormone acts on liver
Negative feedback
Liver releases IGF-1
Negative feedback
Acromegaly
Growth hormone excess
Presentation
Gigantism
Large jaw and hands
Hypertension
Migrainous headaches
Sleep apnoea
Diabetes mellitus
Bitemporal hemianopia
Investigations
IGF-1
Must be age/ sex matched
CT/ MRI
Glucose tolerance test
Suppression test
GH level should normally suppress
Elevated GH after = acromegaly
Management
Pituitary surgery
Radiotherapy
Medication if surgery unsuccessful
Dopamine agonist
Cabergoline
Somatostatin analogue
Octreotide
Negative feedback on pituitary
Lowers GH
Side-effects
Flatulence/ diarrhoea
Gastritis
Gallstones