Acromegaly is a condition of the body in which certain parts of the body are pathologically enlarged. The disease is associated with excessive production of growth hormone (somatotropic hormone). This process occurs as a result of tumor lesions of the anterior pituitary gland.
One of the serious complications of acromegaly can become diabetes, further aggravating the course of the disease.
As a rule, the disease manifests itself in people of adult age and is characterized by a significant enlargement of certain facial features. In addition, symptoms will be noted:
- an increase in feet and hands;
- regular pain in the head;
- pain in the joints;
- sexual and reproductive dysfunction.
High levels of growth hormone - is the cause of too early mortality of patients from various associated diseases.
Acromegaly begins its development immediately after stopping the growth of the body. Symptoms of the disease increases gradually and after a long period of time there is a noticeable change in the patient's appearance. If we talk about the time frame, the disease is diagnosed only 7 years after it began.
Acromegaly affects men and women equally. The average age of patients is 40-60 years.
This disease is quite rare and is observed in about 40 people for every million population.
The causes of the disease
As noted, the production of somatotropic hormone is due to the work of the human pituitary gland. In childhood, the hormone is responsible for the formation of bones and muscle skeleton, as well as linear growth. In adults, he controls the body's metabolism:
Growth hormone production is regulated by the hypothalamus, which produces specific neurosecretes:
If we talk about the norm, the concentration of somatotropin in a person’s blood over 24 hours varies considerably. Maximum level of hormone reaches in the predawn hours.
Patients with acromegaly will suffer not only an increase in growth hormone in the blood, but also problems with an adequate rhythm of its production. Pituitary cells (its anterior lobe) are not able to obey the influence of the hypothalamus and their rapid growth occurs.
The active proliferation of pituitary cells is the cause of a benign neoplasm - pituitary adenoma, which produces somatotropin extremely quickly. The size of the glandular tumor may exceed the volume of the gland itself. In addition, normal pituitary cells are compressed and destroyed.
In about half of cases with a pituitary tumor, only somatotropin is produced. In 30 percent of patients, additional production of prolactin was noted, and the remaining patients will suffer from secretion:
- follicle-stimulating hormones.
In 99 percent of cases, pituitary adenoma will be the cause of acromegaly. Causes of adenoma:
- tumors in the hypothalamus;
- traumatic brain injury;
- sinusitis (inflammation of the sinuses) in the chronicle.
Heredity plays a significant role in the development of the disease due to the fact that it is relatives who most often suffer from acromegaly.
In children and adolescents, against the background of rapid growth, gigantism arises. It is characterized by an excessive and relatively uniform increase in bones, tissues, and all internal organs.
As soon as the child’s physiological growth is stopped and the skeleton becomes ossified, the body’s proportions like acromegaly will begin to deteriorate (disproportionate thickening of the bones, enlargement of the internal organs), as well as characteristic disruptions in the metabolic processes.
When the symptoms of the disease begin to be observed, hypertrophy of the parenchyma and stroma of some organs will be immediately detected:
- the liver;
It is the problems with the pancreas that are the causes of the development of diabetes in these patients. The growth of connective tissue becomes a prerequisite for sclerotic changes in the above organs, an increase in significant threats of the onset of tumor development. These can be benign or malignant endocrine neoplasms.
Stages of illness
The disease is characterized by a multi-year and sluggish course. Symptoms will be expressed depending on the degree of the disease:
- preacromegaly - the first symptoms are usually mild. At this stage, the disease is extremely difficult to identify. This becomes possible only on the basis of indicators of blood tests for somatotropic hormone and computed tomography of the brain;
- hypertrophic stage - the beginning of the bright severity of symptoms of acromegaly;
- stage of the tumor - the patient begins to feel symptoms of constriction in the neighboring parts of the brain (increase in intracranial pressure, as well as problems with nerves and eyes);
- cachexia - the outcome of the disease (exhaustion).
Symptoms of the disease
Symptoms of the disease acromegaly can be caused by an excessive concentration of the hormone somatotropin, or the influence of pituitary adenoma on the optic nerves and nearby brain structures.
An overabundance of growth hormone provokes characteristic changes in the appearance of patients and coarsening of facial features. This may be an increase in cheekbones, lower jaw, eyebrows, ears and nose. As the lower jaw grows, bite deformation is noted due to the discrepancy between the gaps between the teeth.
The disease can be marked by a significant increase in the language (macroglossia). Hypertrophy of the tongue causes changes in the voice. Significant problems with vocal cords and larynx may begin. This all happens almost imperceptibly for the sick person himself.
In addition to these symptoms, acromegaly is characterized by thickening of the phalanges of the fingers, a significant increase in the bones of the skull, feet, and hands.
As this process develops, it becomes necessary to purchase hats and gloves several sizes larger than previously required..
The disease causes skeletal deformities:
- spinal curvature;
- increase in the size of the chest;
- widening the gaps between the ribs.
As a result of hypertrophy of cartilage and connective tissue, limited movement of the joints is observed, as well as arthralgia. Manifestations of diabetes mellitus, for example, excessively frequent urination can be detected.
If there is no treatment, the disease causes excessive sweating and sebum secretion, which is due to the increased work of the corresponding glands. The skin in such patients thicken, thicken, and can still be collected in the folds on the head under the hair.
In the case of acromegaly, the muscles as well as the internal organs are enlarged. Patients begin to suffer from:
- increased fatigue;
- progressive reduction in performance.
Against this background, myocardial hypertrophy develops, alternating with myocardiodystrophy and rapidly increasing heart failure.
Approximately 1/3 of patients will have problems with blood pressure. 90 percent will develop the so-called sleep apnea syndrome. This pathological condition is directly related to hypertrophy of the soft tissues of the respiratory tract, as well as malfunctions in the normal functioning of the respiratory center.
Quite often, the disease disrupts normal sexual function. In the female half of patients with a significant excess of prolactin and lack of gonadotropin, menstrual failure and infertility will develop. Galactorrhea will be marked - a condition where milk is released from the mammary glands in the absence of pregnancy and lactation.
In about 30 percent of men, sexual function will be significantly reduced. In addition, these symptoms are the causes of diabetes insipidus. This disease occurs against the background of high secretion of antidiuretic hormone.
With the growth of tumors in the pituitary gland and squeezing of nerve endings, the following symptoms will occur:
- double vision;
- loss or partial loss of hearing;
- numbness of the upper and lower extremities;
- pain in the forehead and cheekbones;
- frequent gagging.
Acromegaly sufferers are at an increased risk of developing tumors in the thyroid gland, uterus, and digestive tract, especially if there is no treatment.
What could be the complications?
The course of the disease acromegaly is often accompanied by the development of serious complications from virtually all organs. Most often it can be such illnesses:
- heart failure;
- cardiac hypertrophy;
- myocardial dystrophy.
In almost 1/3 of cases, diabetes mellitus type 1 or even the second type of flow occurs. In addition to diabetes, pulmonary emphysema and liver dystrophy can begin. If there is no treatment, then when hyperproduction of growth factors arise tumors in various organs. Tumors can be either benign or malignant.
What is needed to detect acromegaly?
As already noted, in the early stages this disease can only be identified by chance. If acromegaly is present for more than 5 years, then at such late stages it may be suspected with an increase in some parts of the body, as well as based on the symptoms described above.
If you suspect acromegaly, you should consult a doctor endocrinologist. He recommends that the appropriate tests are taken to confirm or exclude the intended diagnosis.
The main laboratory criteria for detecting the disease are certain blood components:
- IGF I (insulin-like growth factor);
- somatotropic hormone (it is performed in the morning immediately after the glucose concentration test).
With acromegaly, the treatment will be aimed at achieving remission of the disease by eliminating the excessive production of somatotropin and bringing the IGF І concentration to normal.
Treatment of the disease in modern medicine, and in particular endocrinology, can be based on:
- combined methods.
To correct blood counts, it is necessary to take somatostatin analogues, which suppress the production of growth hormone. In addition, the disease requires treatment based on sex hormones, dopamine agonists.
The most effective method of therapy will be surgical. It provides for the disposal of the neoplasm at the base of the skull through the sphenoid bone.
If the adenoma is small, then in about 85 percent of cases, treatment will bring normalization and remission.
With significant tumor sizes, the positive dynamics after the first surgical intervention will be in about 30 percent of cases. Not excluded during surgery and death
What is the forecast?
If there is no treatment for acromegaly, then a patient’s disability will occur. Even at a sufficiently active and working age there is a high risk of sudden death of the patient. Rarely such people can live to 60 years. As a rule, death will be caused by problems with the heart and blood vessels.
The result of the operation of small-sized adenomas will be more successful. The recurrence rate in such cases will be much lower than when large tumors are removed.
How to avoid?
An excellent prevention of acromegaly will be a thorough debridement of the nidi-pharynx foci of infections and their treatment, as well as avoiding head injuries. Early detection of the disease and bringing growth hormone to a normal mark will provide an opportunity to prevent many complications and cause prolonged remission.