ACROMEGALY

ACROMEGALIA is a neuroendocrinal disease caused by damage to the hypothalamus and / or the pituitary gland and manifested by a pathological increase in the hands, feet, bones of the facial skeleton, proliferation of soft tissues, an increase in internal organs, thickening of the skin, and metabolic disorders.

The appearance of acromegaly is caused by excessive release of a growth hormone (growth hormone) into the blood with a hormone-active tumor (adenoma of the pituitary gland) or an increase in the secretion of the releasing factor of the somatoliburin growth hormone hypothalamus after a craniocerebral trauma, acute or chronic neuroinfection, trauma, etc. Part Patients with acromegaly also noted increased blood levels of prolactin. The disease develops equally often in women and men between the ages of 20 to 50 years.

Clinical picture . Acromegaly is characterized by a combination of symptoms caused by excess growth hormone (and sometimes prolactin) and a lack of other pituitary hormones, as well as symptoms of increased intracranial pressure and compression of the optic nerves by a growing tumor. The disease develops gradually. There is a change in the appearance of patients. The features of their face become rough, enlarged superciliary arches, nose, lower jaw, interdental spaces widen, bite is broken. Progressive increase in feet and brushes, especially in width, forces patients to use footwear and gloves of large sizes. In patients with acromegaly, the curvature of the spine is noted, an increase in the size of the chest in the anteroposterior direction (barrel chest). Often develop arthrosis, coarse hair appears, the skin thickens and forms folds, characterized by increased sweating. Increasing the larynx, tongue (macroglossia) and vocal folds leads to a change in the voice: it becomes husky and low. The increase in the size and mass of internal organs (splanchnomegaly) is accompanied by a violation of their function - heart failure develops , blood pressure rises, clinical signs of liver dystrophy and emphysema appear. The initial period of the disease is characterized by thyrotoxicosis and the appearance of nodes in the thyroid gland. Later, with large pituitary tumors, development of hypothyroidism and adrenal insufficiency are noted, which is manifested by increasing muscular weakness, swelling. In half of the patients impaired glucose tolerance, there are signs of diabetes. Almost all women under the influence of an excess of prolactin and a lack of gonadotropic hormones disrupted the menstrual cycle, often there is a secretion of milk from the mammary glands, not associated with pregnancy and childbirth - galactorrhea. A third of men have decreased sexual potency. Sometimes the secretion of the antidiuretic hormone decreases, which causes the appearance of signs of diabetes insipidus. As the pituitary gland grows and the intracranial pressure rises, there is a constant headache , vomiting , dizziness , and visual impairment.

When there are characteristic changes in appearance, which gives reason to suspect the patient of acromegaly, he should be immediately sent for consultation with a doctor. Further examination is carried out in a specialized hospital.

The diagnosis is made on the basis of the characteristic appearance of the patients. It is confirmed by a high concentration of growth hormone in the blood and the results of an X-ray study of the skull and skeleton. The size of the adenoma of the pituitary gland (if it causes increased formation of growth hormone) and the nature of its increase is judged by the radiography of the skull in dynamics, computed tomography of the head, and also on the basis of the picture of the fundus and the determination of the state of the visual fields.

Differential Diagnosis is carried out with Paget's disease, accompanied by a specific deformation of the long bones and the cranial vault.

Treatment for an identified pituitary adenoma is the surgical removal of the tumor or radiosurgical destruction. With the impossibility of surgery or inefficiency of radiotherapy, parlodel is used for a long time, a drug that can suppress the secretion of growth hormone. Symptomatic treatment is aimed at reducing intracranial pressure, etc.

The prognosis for life with a timely diagnosis and correct treatment is favorable, perhaps some improvement in appearance due to a decrease in the volume of soft tissues, although completely cosmetic defects are not corrected. With large, rapidly growing inoperable tumors and severe disorders of the cardiovascular system, the prognosis of the disease is poor. Patients with acromegaly should be constantly under the supervision of an endocrinologist, an ophthalmologist and a neurosurgeon.