acromegaly

ACROMEGALY

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.


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.


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.


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.


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.


Dopamine agonists- Cabergoline (Dostinex) and bromocriptine (Parlodel) offer another strategy to reduce growth hormone production and shrink tumors.


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.


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.


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=8yDiG

LqzKKA

http://www.youtube.com/watch?v=8yDiGLqzKKA

http://www.youtube.com/watch?v=8yDiGLqzKKA

GUESSING GAME

Arnold Schwarzenegger

Andre the Giant

YES!!!

Abraham Lincoln

YES!!!

Hulk Hogan

Bao Xishun

Antonio Silva

YES!!!

Yao Ming

Jocelyn Wildenstein

Richard Kiel

YES!!!

Primo Carnera

YES!!!

Barack Obama

Review Questions:

1. If Bobby, age 42, had a surgery to remove a benign tumor located at the base of the brain and the tumor was not completely removed, what course of action would you take to further treat the patient?

A. attempt a second surgery B. Assign radiation therapy C. Prescribe medication D. Both b and c

2. Brigitte, age 35, is being diagnosed with Acromegaly. She is assigned to take the IGF-1 blood level test. After she ingests the glucose, what will happen to her growth hormone level?

A. Stay high B. Increase C. Decrease D. Increase and then decrease

3. Stephany, age 15, has symptoms of enlarged hands and feet, chronic headaches, vision problems, broad facial features and irregular menstrual cycles. Which hormonal disorder will she be diagnosed with?

A. Dwarfism B. Gigantism C. Virilism D. Acromegaly

4. A patient diagnosed with acromegaly has developed precancerous growths in their…

A. Uterus B. Brain C. Colon D. Liver

5. A patient who has been diagnosed with acromegaly, will experience the following symptoms except…

A. Sleep apnea B. Arthritis C. Spinal Cord Compression D. Loss of hair

Works Cited: "Advances in the Treatment of ACROMEGALY." Innovation.org -. Web. 22

Mar. 2012. <http://www.innovation.org/index.cfm/InnovationToday/InnovationinRare Diseases/Rare_Diseases_-_Acromegaly>.

Board, A.D.A.M. Editorial. "Causes, Incidence, and Risk Factors." Acromegaly. U.S. National Library of Medicine, 11 Dec. 2011. Web. 20 Mar. 2012.<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001364/>.

Khandwala, MD, FRCPC, Hasnaim M. "Read What Your Physician Is Reading on Medscape." EMedicineHealth. Ed. Arthur B. Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Francisco Talavera, PharmD, PhD, and George T. Griffing, MD. 16 Nov. 2009. Web. 22 Mar. 2012. <http://www.emedicinehealth.com/acromegaly/article_em.htm>.

Miller, D'hania. "Endocrine System." Practicum in Health Science I. TX, Spring.19 Mar. 2012. Lecture.

Staff, Mayo Clinic. "Acromegaly." Mayo Clinic. Mayo Foundation for Medical Education and Research, 03 Aug. 2010. Web. 20 Mar. 2012. <http://www.mayoclinic.com/health/acromegaly/DS00478>.

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