Acromegaly is a type of syndrome which occurs due to hormonal disorder occurring in the pituitary gland leading to the abnormally high release of growth hormones during adulthood. When growth hormone is released in excess than normal levels there occur an increase in the size of bones including hands, feet, and face.
In cases of children, too much release of growth hormone leads to a condition known as gigantism. In these children, there is an abnormal increase in the length of bones and abnormal increase in height. As the acromegaly is uncommon disease and physical change occur slowly so it is not recognized immediately.
Acromegaly is a syndrome that occurs when anterior part of pituitary gland produces an excess of growth hormone after the epiphyseal plate closure at puberty. There are a number of conditions that lead to increasing the pituitary GH output and that conditions are a pituitary adenoma, a pituitary tumor that is somatotroph tumor.
PATHOPHYSIOLOGY OF ACROMEGALY – Growth hormone (GH) which is secreted from pituitary somatotrophs, its release is controlled by hypothalmic factors and that factors are as follows
GHRH is formed in the hypothalamus and through the hypothalamic pituitary portal system is released and act on anterior pituitary leads to synthesis and secretion of growth hormone. When GHRH is released at high levels it acts on pituitary gland which leads to increase in secretion of growth hormone and when this hormone acts on other systems of the body they increase in size. Tumors of the pituitary gland such as adenomas lead to excess formation of the growth hormone.Who Are More Affected Acromegaly
Acromegaly occurs in both sexes in equal frequency. Males and females are both equally affected. In males diagnosis of disease is made at the age of 40 years and in females at the age of 45 years.
The cause of overproduction of growth hormone in 90 percent of cases is due to following:
• Benign tumor of the pituitary gland called as adenoma. In other cases where acromegaly is not due to pituitary adenoma then the other type of tumors which can leads to increase in secretion of growth hormone are as follows:
• Tumors which occur in pancreas can lead to acromegaly.
• Tumor of the lungs can also be one of the causes to acromegaly.
• Tumors of adrenal gland also lead to be a cause of acromegaly. These tumors themselves release growth hormone or produce GHRH hormone that stimulate the increase in secretion of growth hormones from pituitary gland.
Different symptoms that appear due to high levels of growth hormone are as follows:
• There is soft tissue swelling occur in internal organs such as heart, kidneys and many more.
• In the heart there is a weakness of its muscularity and also same happen in kidneys.
• On vocal cords, it can lead to deepening of the voice, thickening of voice and slowness of speech.
• There is generalized expansion at the fontanelle of the skull.
• There is pronounced protrusion of the brow along with ocular distension.
• There is protrusion of lower jaw with macroglossia (enlargement of the tongue) and more gapping in teeth.
• Hyperthecosis, hyperpigmentation, hyperhidrosis.
• Carpel tunnel syndrome occurs.
• Enlarged hands and feet.
• Facial features are enlarged and coarsened.
• There is severe snoring due to obstruction of the upper highway.
• Impaired vision.
• There is the pain in joints and mobility is decreased.
• There is excessive sweating on a body with the offensive odor.
• There are small outgrowths of skin tissues.
• Muscular fatigue occurs with muscle weakness.
• The menstrual cycle becomes irregular in women.
• There are erectile dysfunctions in men.
• Enlargement of vital organs like liver.
• Increase in size of chest and chest appear as barrel size.
• Enlarged heart.
• Arthritis and carpal tunnel syndrome.
• Diabetes mellitus.
• Heart failure.
• Kidney failure.
• Colorectal cancer.
• A severe headache.
• There is compression of optic chiasm leading to loss of vision in the outer visual fields.
• Increased palmar sweating and sebum production over the face.
Diagnosis is confirmed by following tests:
• Hormone tests
• GH and IGF 1 hormones are tested and their levels are checked.Other tests are
• Growth hormone suppression test: In this test blood levels of growth hormone are checked before and after a drink of preparation of sugar.
• Imaging is done to test the cause of acromegaly
• Magnetic resonance imaging (MRI) of the pituitary gland, brain.
• CT scan of the brain.
With successful treatment, there is a good improvement in the symptoms and complications. There is the decrease in the size of soft tissue enlargements.
• Somatostatin analogues are given.
• Dopamine agonists.
• Growth hormone receptor antagonists.
• Surgery of the pituitary adenoma or other tumors.
• Radiation therapy is helpful.
• This medicine exercises a superior control over the growth and development of the sexual organs.
• Stimulates the muscular activity and overcomes the inertia of uterus.
• Indicated for high blood pressure, chronic nephritis.
• There is vertigo and difficult mental concentration.
• There is confusion and dullness deep in the frontal region.
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