Acromegaly

Acromegaly - neuroendocrine disease caused by a lesion of the hypothalamus and (or) pituitary and manifesting a pathological increase in the hands, feet, facial bones, the growth of soft tissues, increasing the internal organs, thickening of the skin, and metabolic disorders.

The emergence of acromegaly due to excessive release of blood somatotropin (growth hormone) in hormone-active tumor (pituitary adenoma) or increase the secretion of releasing factor growth hormone somatoliberina hypothalamus after traumatic brain injury, acute or chronic neuroinfections, trauma, etc. In some patients with acromegaly also note the increased blood levels of prolactin. The disease develops with equal frequency in men and women aged 20 to 50 years.

Clinical picture. Acromegaly is characterized by a combination of symptoms caused by excess growth hormone (sometimes, and prolactin) and the lack of other pituitary hormones, and symptoms of elevated intracranial pressure and compression of the optic nerves of the growing tumor. The disease develops gradually. A change in the appearance of patients. Features of their faces become rough, grow eyebrows, nose, jaw, enlarged interdental spaces, disturbed bite. The progressive increase in foot and hand, particularly in width, forcing patients to use the boots and gloves large size. Patients with acromegaly note curvature of the spine, increasing the size of the chest in the anteroposterior direction (barrel chest). Often develop arthritis, there gruboe body hair, the skin thickens and forms a fold characteristic of excessive sweating. The increase in the larynx, tongue (macroglossia) and vocal folds results in a change to vote: it becomes hoarse and low. Increasing the size and weight of internal organs (visceromegaly) is accompanied by a violation of their functions - developing heart failure, increased blood pressure, there are clinical signs of degeneration of the liver and emphysema. For an initial period of the disease characterized by hyperthyroidism and the appearance of nodes in the thyroid gland. Later, when large scale development of the pituitary tumor mark hypothyroidism and adrenal insufficiency, which manifests an increasing muscle weakness, edema. Half of the patients is disturbed glucose tolerance, show signs of diabetes. Almost all women under the influence of an excess of prolactin and gonadotropin-releasing hormone deficiency disrupted menstrual cycle, is often observed in lactating mammary glands, not associated with pregnancy and childbirth - galactorrhea. One-third of men decreased sexual potency. Sometimes reduced secretion of antidiuretic hormone that causes the symptoms of diabetes insipidus. With the growth of pituitary tumors and elevated intracranial pressure appear constant headache, vomiting, dizziness, blurred vision.

When a characteristic change of appearance, which gives reason to suspect in patients with acromegaly, it should be immediately sent to the doctor. Further examination is carried out in specialized clinics.

The diagnosis was based on the characteristic appearance of the patients. He confirmed a high concentration of growth hormone in the blood and the results of X-ray examination of skull and skeleton. About the size of pituitary adenoma (if it serves the cause of higher education growth hormone) and the nature of its increase is judged according to X-ray of the skull in the dynamics, computed tomography of the head, as well as on the basis of the fundus picture and determining the status of the visual fields.

The differential diagnosis is carried out with Paget's disease, accompanied by a specific strain of long bones and calvaria.

Treatment of diagnosed pituitary adenoma is surgical removal of tumors or cross radiosurgical destruction. When it is impossible operation or failure of radiation therapy long-term use Parlodel - a drug that can suppress the secretion of growth hormone. Symptomatic treatment is directed at reducing intracranial pressure, etc.

The prognosis for life expectancy at time diagnosis and proper treatment, favorable, there may be some improvement in appearance by reducing the amount of soft tissue, although all cosmetic defects are not corrected. For large, fast-growing inoperable tumors and severe disorders of function of cardiovascular disease prognosis is bad. Patients with acromegaly should always be supervised by an endocrinologist, an ophthalmologist and a neurosurgeon.