Download
1 / 56
E N D
Acromegaly • Acromegaly is a rare hormonal disorder that develops when your pituitary gland produces too much growth hormone. This is almost always a result of a benign (noncancerous) tumor. This, however, is different from gigantism, which is basically the same disease, but it occurs when a person is still young and growing.
Acromegaly • Acromegaly is uncommon and the physical alterations occur over long periods of time. Many of these symptoms may remain unnoticed for up to a period of 10 years. These changes may be noticed when seeing before and after pictures of a person with this disorder.
Symptoms • Enlarged hands and feet • Fatigue and muscle weakness • Larger and broader facial features • Underbite • Excessive sweating and body odor • Thick, oily skin • Enlarged liver • Enlarged heart • Enlarged kidneys • Enlarged spleen and other organs
Symptoms • Enlarged tongue • Pain and limited mobility in joints • Barrel Chest • Sleep Apnea • Impaired vision • Headaches • Husky Voice • Reduced sex drive • Erectile dysfunction in men • Back pain • Menstrual cycle irregularities in women
Causes • Acromegaly occurs when your body produces too much growth hormone. The source of the excess hormone is almost always your pituitary gland, a small bean-shaped structure at the base of your brain behind your nose. Growth hormone is one of several hormones your pituitary gland produces.
Causes • Pituitary tumors- Most cases of acromegaly are caused by a benign tumor of the pituitary gland. In addition to producing excess growth hormone, these tumors can press on nearby tissues as they grow. This pressure can cause some of the symptoms of acromegaly, such as headaches and impaired vision.
Causes • Nonpituitary tumors- In a few people, acromegaly is caused by benign or cancerous tumors in other parts of the body, such as the lungs, pancreas or adrenal glands. Some of these tumors actually secrete growth hormone. In other cases, they produce a hormone called growth hormone-releasing hormone (GH-RH), which stimulates the pituitary gland to make more growth hormone.
Complications • High blood pressure (hypertension) • Heart disease, particularly enlargement of the heart muscle (cardiomyopathy) • Arthritis • Diabetes • Precancerous growths (polyps) in your colon • Sleep apnea, a condition in which breathing repeatedly stops and starts during sleep
Complications • Carpal tunnel syndrome — tingling or pain in your fingers caused by excess wrist tissue pressing on nerves • Reduced production of other pituitary hormones (hypopituitarism) • Benign tumors in the uterus (uterine fibroids) • Spinal cord compression • Vision loss
Test and Diagnosis • Measuring IGF-1- Because growth hormone stimulates your liver to produce IGF-1 — another growth hormone — IGF-1 blood levels are nearly always elevated when you have acromegaly.
Test and Diagnosis • Measuring growth hormone before and after you drink glucose. In this test, your blood levels of growth hormone are measured both before and at several points after you drink a preparation of sugar (glucose). Normally, taking in glucose causes growth hormone levels to fall. But if your body is producing too much growth hormone, levels stay high
Test and Diagnosis • Imaging - Magnetic resonance imaging (MRI) of your brain to pinpoint the size and location of your tumor. Brain imaging may sometimes be performed with Computerized tomography (CT). If brain imaging fails to detect a pituitary tumor, your doctor may recommend additional blood work and further imaging studies of your chest or abdomen.
Treatments and Medications • Transsphenoidal surgery- In this procedure, named for the sphenoid sinus — air pocket behind the nose — your surgeon extracts the tumor through a small incision through the back wall of the nose. • Removing the tumor surgically can quickly and effectively return growth hormone levels to normal and relieve pressure on the tissues around your pituitary gland
Treatments and Medications • But even the most experienced surgeon may not be able to completely remove tumors that have grown large or extended into nearby blood vessels or other structures. Incomplete tumor removal may result in growth hormone levels that stay high after surgery, requiring further treatment with medication or radiation.
Treatments and Medications • If the pituitary tumor is inaccessible to surgery, or the patient is at high risk of surgical complications. They may also need medications if their growth hormone levels stay high following surgery. The need for medications may continue for the rest of your life.
Treatments and Medications • Medications used to lower the production of growth hormone or block its action on target tissues include: • Somatostatin analogues (SSAs). • Growth hormone receptor antagonists (GHRAs). • Dopamine agonists.
Treatments and Medications • Somatostatin analogues (SSAs). The drugs octreotide (Sandostatin, Sandostatin LAR) and lanreotide (Somatuline Depot) are synthetic versions of the brain hormone somatostatin — growth hormone release-inhibiting hormone. They can decrease growth hormone levels by blocking the pituitary gland's excess production.
Treatments and Medications • Growth hormone receptor antagonists (GHRAs). The medication pegvisomant (Somavert) blocks the effect of growth hormone on body tissues. This medication can normalize IGF-I levels and relieve symptoms in most people with acromegaly, but doesn't lower growth hormone levels or reduce the tumor size.
Treatments and Medications • Dopamine agonists- Cabergoline (Dostinex) and bromocriptine (Parlodel) offer another strategy to reduce growth hormone production and shrink tumors.
Treatments and Medications • Radiation therapy can quickly stop lingering tumor cells from growing and slowly reduce growth hormone levels. It may take years for this treatment to noticeably improve acromegaly symptoms, and patient’s may continue to need medication while waiting for growth hormone levels to fall.
Treatments and Medications • Conventional radiation therapy- This type of radiation is usually given every weekday over four to six weeks. It may take five to ten years or more for your growth hormone levels to return to normal.
Treatments and Medications • Stereotactic radiosurgery- Radiation can also be given stereotactically, with intense, focused beams aimed at a tumor from various directions. This form of treatment damages the tumor, while still doing little damage to the surrounding areas.
Video • http://www.youtube.com/watch?v=8yDiGLqzKKA
