Internal Medicine Oasis

05/07/2025

Acromegaly: An Endocrine Society Clinical Practice Guideline
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https://academic.oup.com/jcem/article/99/11/3933/2836347

05/07/2025

The Endocrine Society guidelines
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https://www.endocrine.org/clinical-practice-guidelines

05/07/2025

Acromegaly: investigations
Growth hormone (GH) levels vary during the day and are therefore not diagnostic.
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Serum IGF-1 levels have now overtaken the oral glucose tolerance test (OGTT) with serial GH measurements as the first-line test.
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The OGTT test is recommended to confirm the diagnosis if
IGF-1 levels are raised.
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Serum IGF-1 may also be used to monitor disease
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Oral glucose tolerance test
1-in normal patients GH is suppressed to < 2 mu/L with hyperglycaemia
2-in acromegaly there is no suppression of GH
3-may also demonstrate impaired glucose tolerance which is associated with acromegaly
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A pituitary MRI may demonstrate a pituitary tumour.

05/07/2025

Serum IGF-1 levels are now the first-line test for acromegaly

05/07/2025

Type 1 diabetes in adults: diagnosis and management

This guideline covers care and treatment for adults (aged 18 and over) with type 1 diabetes. It includes advice on diagnosis, education and support, blood glucose management, cardiovascular risk, and identifying and managing long-term complications

05/07/2025

Diabetes (type 1 and type 2) in children and young people: diagnosis and management

This guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. The guideline recommends how to support children and young people and their families and carers to maintain tight control of blood glucose to reduce the long-term risks asso...

25/06/2025

Primary hyperaldosteronism: hypertension, hypokalaemia and metabolic alkalosis

25/06/2025

Primary hyperaldosteronism was previously thought to be most commonly caused by an adrenal adenoma, termed Conn's syndrome.
However, recent studies have shown that bilateral idiopathic adrenal hyperplasia is the most common cause.

25/06/2025

Medications that can cause false negative renin:aldosterone ratio results are the following:
= Angiotensin-converting enzyme inhibitors (e.g. ramipril or lisinopril).
= Angiotensin receptor blockers (e.g. losartan).
= Direct renin inhibitors (e.g aliskiren).
= Aldosterone antagonists (e.g. spironolactone or eplerenone).

25/06/2025

Pray for Gaza
Don't Forget Them

25/06/2025

pituitary adenoma:
Treatment may include a combination of
1- medical therapy:
= prolactinomas are generally treated first-line with dopamine agonists (e.g., cabergoline or bromocriptine).

= somatostatin analogues (e.g., octreotide, lanreotide) and GH receptor antagonists (e.g.,
pegvisomant) are used for GH-secreting adenomas

= for ACTH-secreting adenomas, medical therapy may include cortisol synthesis inhibitors (e.g., ketoconazole, metyrapone) and neuromodulators like pasireotide

2- transsphenoidal surgery
= the primary treatment for most pituitary adenomas is transsphenoidal surgery, especially for non-functioning and ACTH- or GH-secreting adenomas

= surgical intervention aims to remove the tumour mass, normalise hormone levels, and

= non-functioning adenomas are generally diagnosed due to their compressive symptoms (e.g. visual problems) or hormone deficiencies - surgery is therefore the first-line treatment

3- radiotherapy
= indicated for residual or recurrent tumours post-surgery

25/06/2025

Investigation requires: pituitary adenoma
- a pituitary blood profile (including GH, prolactin, ACTH, FSH, LSH and TFTs)
- formal visual field testing
- MRI brain with contrast