Acromegaly: causes, first signs and general symptoms (photo), treatment. Acromegaly: causes, symptoms and treatment Manifestations of acromegaly

22.09.2022

is a pathological process or otherwise a disease characterized by a disproportionate growth of bones, cartilage, and other tissues of the body. The disease occurs in adults and is caused by increased production of growth hormone - somatotropin. It occurs in both men and women.

Gigantism- this is the same pathological process in which the concentration of growth hormone in the blood is increased, but appears much earlier in childhood. It occurs mainly in adolescence, when all endocrine systems are activated and there is an increased development of the body and differentiation of the sexes.
The difference between gigantism and acromegaly is that with gigantism, organs, tissues, and especially bones of the skeleton grow proportionally quickly. This is due to the fact that during adolescence, there is still cartilage in the bones, due to which the bone grows evenly in length and breadth. It is customary to talk about gigantism when a person's height exceeds 2 - 2.05 meters.

At a more adult age, after about 25 years, the bones are already fully formed almost everywhere. If, starting from this period of life, there is an increase in the secretion of somatotropin, then those organs where cartilage tissue predominates will undergo development: lips, ears, nose, and also internal organs.

Anatomy and physiology of the central endocrine organs

In order to better understand the essence of the disease and the causes of its occurrence, you must first get acquainted with the anatomy and physiological characteristics of the endocrine system, under the influence of which the body grows and regulates its vital organs and systems.

Briefly, the endocrine system consists of the central organs that regulate the functioning of the peripheral organs of the endocrine system. Above all this is the central nervous system, without the influence of which, organs and organ systems, as a whole organism, are not able to work smoothly and perform the necessary functions.
The endocrine system is so called from the fact that hormones are synthesized and released directly into the blood.

Hormones- these are biologically active substances, under the influence of which the metabolism, maintenance of normal blood pressure, bone mineralization, sexual development, and much more.
The central organs of the endocrine system are the hypothalamus and the pituitary gland. They make up a small part of the brain. The pituitary gland is located in the bony recess of the skull called the Turkish saddle, and the hypothalamus is above it. There is a close relationship between the hypothalamus and the pituitary gland. In the hypothalamus, specific releasing factors are released - biologically active substances that stimulate (liberins) or depress (statins) the work of the pituitary gland. The pituitary gland, in turn, also synthesizes hormonally active substances, under the influence of which are peripheral organs and systems.

Causes of gigantism and acromegaly

The main reason leading to the development of this pathology is an excessively large amount of the pituitary hormone somatotropin in the blood. Somatotropin is responsible for the growth of bones, cartilage and connective tissue in the body. Under the influence of somatotropin, internal organs become larger, metabolism increases.
The causes leading to gigantism fall into two categories:

The first is directly related to the pathology of the pituitary gland, which produces growth hormone in large quantities. This may be a tumor of the pituitary gland, or its growth and increase in volume under the stimulating effect of the hypothalamus, and, accordingly, the functional activity also increases.
The second category of causes is associated with diseases that are not directly related to the pituitary gland, but due to their proximity, they compress the pituitary gland tissue and thereby disrupt its functions. Thus, there is an increase in the synthesis of growth hormone. These include tumors located nearby in the brain, or metastases (spread) of tumors from various internal organs. More often it happens with cancer of the lungs, pancreas, mammary glands, ovaries.

Among other things, there are situations that contribute to the development of this disease. If a person often suffers from infectious diseases, catches a cold several times a year, or if there have been head injuries in the past, then the likelihood of getting acromegaly is much higher.
Very often there are cases in which the production of not only growth hormone but also other hormones, which are also synthesized in the pituitary gland or in the hypothalamus, is disrupted. Then other signs of disturbances in the work of certain endocrine glands are added to the corresponding symptoms of acromegaly.

Symptoms of acromegaly disease

Symptoms of gigantism can be divided depending on the severity of pathological manifestations from different organs and systems. There are the following dominant forms of the disease:

With a predominant violation of the functions of internal organs, and excessive development of bone and cartilage tissue
With a predominance of compression syndrome. When a pituitary tumor compresses the surrounding soft tissues of the brain. The brain is located in a closed bone space - the cranium, so any slightest increase in pressure here will manifest itself in pain, endocrine disorders. And there will also be neurological disorders and mental disorders.

These forms combine common symptoms associated with increased growth and deformation of the skeletal system.

Violations of the normal development of internal organs, manifests itself in their exorbitant increase in size. Observed:

Cardiomegaly (enlargement of the heart). Often associated with high blood pressure. Patients complain of headaches mainly in the back of the head, pain around the eyes, a feeling of palpitations in the left half of the chest.
An increase in the size of the abdominal organs: stomach, liver, spleen, intestines. There are signs of digestive disorders, such as: pain in the abdomen, constipation, bloating, heartburn, frequent belching, and others.
The skin is thickened, there are many folds on the face. The sebaceous glands work hard, so the patient often develops acne in the face.
Characterized by an increase in the tongue, which interferes with chewing food and a clear pronunciation of words.
The voice gradually changes due to the growth of the vocal cords and a decrease in the lumen of the larynx in this place.

Increase and deformation of the skeletal system are manifested:

Lengthening of the limbs of the arms and legs. Excessive growth of the legs, with a combination of a fragile bone frame and increased load, cause the appearance of a curvature in the area of the knee joints. The legs become X-shaped. Increase in size and thicken the hands, feet.
Obvious changes in the structure of the bones of the face and skull.
Strengthening the growth of the joints of the lower jaw is manifested by the characteristic appearance of the patient. The lower jaw is strongly pushed forward and down.
The brow ridges are enlarged. The bones of the skull are deformed.
The bones and cartilages of the nose, increasing in size, are deformed.
The increased growth of the upper and lower jaws causes the appearance of obvious gaps between the teeth (diastema).

Compressive syndrome is characterized by:

Pain that is permanent and localized in the region of the superciliary arches and around the eyes.
Visual disturbances. It often manifests itself in the form of a narrowing of the visual fields. The patient sees everything as through a telescope. This symptom is caused by compression of the optic nerves at the point where they intersect with each other.
Weakness, increased fatigue.
Symptoms of increased intracranial pressure are rare and manifest as widespread headaches, nausea, and vomiting.

The growth of a tumor of the pituitary gland or hypothalamus disrupts the function of secreting other hormones. First of all, such as thyroid hormones, sex hormones.
Increased synthesis of thyroid hormones occurs due to the stimulating effect of the thyroid-stimulating hormone of the pituitary gland, which has the ability to increase the function and promotes the growth of the thyroid gland itself. Appear:

Increased sweating
The number of heartbeats increases
The patient becomes nervous and irritable

These symptoms are due to the fact that thyroid hormones increase metabolism and make all organs and systems work with increased load.
Over time, the function of the thyroid glands weakens.

Hormonal disorders of the functions of the genital organs are manifested:

In women - menstrual dysfunction. Menstruation becomes rare, and even may disappear altogether. In some cases, milky discharge from the mammary glands is observed.
In men, it manifests itself in the form of a decrease in potency and sexual desire.

Diagnosis of acromegaly and gigantism

Diagnosing this disease is not difficult, just look at the appearance of the patient, as you can immediately understand the possible cause of the disease. The data of the medical history will indicate at what age the first signs of the disease began. If we are talking about the period of puberty, approximately from 14 to 16 years, then we can confidently diagnose gigantism.

In later periods, the appearance of a violation of the release of growth hormone synthesis leads to partial changes in the skeleton and is manifested mainly by coarsening of facial features, increased hair growth, and the appearance of endocrine disorders. In such cases, the diagnosis is acromegaly.

To clarify the diagnosis in both cases, it is necessary to find out the quantitative content of growth hormone in the blood. Norms vary by age and gender.

Biochemical analyzes
They show an increase in the amount of total protein in the body is normal (65-80 grams), an increase in the concentration of glucose in the blood is normal (3.5-5.5 mmol / l). These changes are nonspecific and may also increase in other diseases.
Diagnostic samples

A glucose test shows whether there are disorders of the pituitary gland or not. Normally, after drinking a glass of water with sugar, there is a decrease in the amount of growth hormone in the blood. With gigantism of a tumor nature (origin), the level of growth hormone is constantly elevated, regardless of the hormonal background in the body and other influences, external and internal factors.
Determining the level of somatomedins reflects the activity of somatotropic hormone.

The higher the level of somatotropin, the higher will be the level of somatomedins.
Somatomedins- These are substances synthesized in the liver, in the kidneys under the influence of somatotropin. Together with somatotropic hormone, they are involved in the processes of growth and development of the body.

Laboratory tests to check the concentration of hormones in the blood, carried out using radioimmunological or enzyme immunoassay methods. If there are additional symptoms associated with disruption of the peripheral endocrine glands (thyroid gland, adrenal glands, ovaries in women, or testicles in men), the amount of the corresponding hormones in the blood is measured.

In case of dysfunction of the thyroid gland, the concentration of thyroxine (T4), triiodothyronine (T3), as well as the level of pituitary thyrotropic hormone (TSH), under the influence of which the thyroid gland itself is
With a delay in sexual development, impotence, menstrual irregularities, studies are carried out on the content of sex hormones: testosterone in men, estrogen and progesterone in women.

Instrumental diagnostic methods

Radiological methods, such as plain x-rays and computed tomography of the skull, can help in making a correct diagnosis.
On x-ray the expansion of the Turkish saddle is clearly visible - a bone formation where the pituitary gland is located.
On CT scans a tumor of various sizes and shapes is visualized. Especially clearly visible are the characteristic changes in the pituitary gland or hypothalamus, when using contrast (dye) substances.

In doubtful cases, studies are carried out using nuclear magnetic resonance (NMR).

Ophthalmic examination
In cases of visual impairment, the appearance of pain in the orbits, it is necessary to seek help from an ophthalmologist. With the help of special devices, the ophthalmologist will determine the condition of the fundus (edema, hemorrhage), and also measure the width of the visual fields, which in some cases may narrow.

Treatment of gigantism and acromegaly

Treatment of acromegaly and gigantism is based primarily on removing the cause that caused the disease, reducing the concentration of somatotropic hormone in the blood.

In the presence of complications from other organs and systems, symptomatic agents are used.
The treatment is carried out both with drugs and radiotherapy.
Drug treatment is based on the inhibition of the production of somatotropic hormone by the pituitary gland. The main drugs are:

Somatostatin (octreotide)- a synthetic analogue of a natural hormone that inhibits growth. The main value is the inhibition of the synthesis of somatotropic hormone. There is also a good hemostatic effect in intragastric and intra-intestinal bleeding.

Doses and regimen are prescribed by the doctor, depending on the severity of symptoms and the level of somatotropin in the blood.

Bromocriptine (parlodel)- the drug simulates special receptors in the brain responsible for the production of the biologically active substance dopamine. Dopamine, in turn, inhibits the synthesis of growth hormone.

The drug is taken in small doses under the control of laboratory indicators of the level of hormones in the blood, as well as under the supervision of an endocrinologist.

X-ray therapy- a method of treatment based on the use of highly active X-ray waves, which are able to suppress tumor growth and reduce the production of growth hormone.
Heading doses of radioactive radiation are prescribed by a doctor depending on the size and degree of activity of the tumor process.

Surgery used in cases where the size of the tumor exceeds the allowable limits, there is also a significant compression of the surrounding tissues of the brain and the appearance of symptoms of increased intracranial pressure. The surgical method is resorted to when conservative treatment does not give positive results.

Prevention of acromegaly

Preventive measures are reduced to the timely detection of symptoms of premature enhanced growth of the body.
Seek help from an endocrinologist at the first sign of illness.
Nutrition for children and adults should be complete and contain all the necessary healthy ingredients.
Timely treat concomitant infectious and inflammatory diseases of the central nervous system.
Prevention of injuries in the head area.
With the detected pathology of the pituitary gland, timely treatment will not allow the pathological development of the disease.
During treatment, it is necessary to constantly monitor the level of growth hormone in the blood, to be monitored by a specialist in endocrinology, as well as by an ophthalmologist at least once every six months.

Excess of what hormone can cause acromegaly?

somatotropic hormone ( a growth hormone) is produced in the pituitary gland. Normally, this hormone in children is responsible for growth, as well as the development of bones and muscles. And in adults, it controls metabolism ( metabolism) - carbohydrate, fat and water-salt.

On the body of an adult, this hormone acts as follows:

stimulates protein synthesis, and also stops its destruction;
increases the rate of fat burning;
reduces body fat;
increases muscle mass relative to fat;
raises blood glucose levels.

The production of this hormone is stimulated by:

hormone somatoliberin ( produced in the hypothalamus);
the hormone ghrelin produced in the gastric mucosa and hypothalamus);
physical activity;
low blood glucose ( hypoglycemia);
increased production of androgens during puberty.

The work of the pituitary gland, which produces this hormone, is controlled by the hypothalamus. However, in the case when the work of the hypothalamus is disturbed ( for example, with increased secretion of the hormone somatoliberin) or when the cells of the anterior pituitary for certain reasons begin to multiply intensively, a person has an increased production of somatotropic hormone.

Excessive proliferation of pituitary gland cells subsequently leads to the development of a benign tumor ( adenomas), in which acromegaly develops. It should be noted that with pituitary adenoma, acromegaly can only be caused by increased production of somatotropic hormone.

The development of pituitary adenoma can contribute to:

brain injury;
acute or chronic infectious diseases ( e.g. malaria, meningitis, tuberculosis);
pathological course of pregnancy and childbirth;
long-term use of hormonal contraceptives.

With an excess of somatotropic hormone in a person, the following symptoms may be observed:

an increase in the size of the head;
an increase in the size of the ears, lips, tongue, nose and lower jaw;
an increase in the size of the arms and legs ( especially stop);
decreased sensitivity of the upper and lower extremities;
increased weakness and fatigue;
dull headaches;
decrease in the field of view;
skin change ( there is coarsening of the skin, increased sweating, papillomas and warts appear);
pronounced growth of hair on the body and face.

In children, excess growth hormone causes gigantism. This disease is characterized by a proportional increase in bone and muscle mass, as well as internal organs. Most often, gigantism is observed in boys aged nine to ten years, as well as during puberty.

For the diagnosis of diseases associated with impaired secretion of somatotropic hormone, a blood test is widely used. This analysis allows you to determine the lack or excess of growth hormone in the human body.

The following tests are used to study the level of somatotropic hormone:

Suppression test. Determines the excess hormone in the blood. Twelve hours before the study, food intake should be excluded. In the office on the day of the study, before taking the test, the patient will need to ingest the prescribed amount of glucose solution. After that, at certain intervals, the patient will take a blood sample for the subsequent determination of the level of somatotropic hormone. The accepted glucose in this case will indicate how much the work of the pituitary gland and the production of growth hormone by it are suppressed. If, after consuming the solution, the level of the hormone remains high, then this means that the pituitary gland is producing an increased production of this hormone.
Stimulation test. Determines the lack of growth hormone in the blood. Twelve hours before the study, food intake should be excluded. On the day of the study, blood is taken from the patient, then a special drug is administered intravenously to stimulate the production of somatotropic hormone ( e.g. insulin, clonidine, arginine). Subsequent blood sampling takes place at certain intervals, the level of the hormone in the blood is determined and the extent to which the administered drug provokes its production in the pituitary gland is revealed.

Is a pituitary adenoma the cause of acromegaly?

The pituitary gland is a small endocrine gland located under the human brain. This gland produces many hormones that regulate the activity of all other glands ( e.g. thyroid, gonads, adrenals).

A pituitary adenoma is a benign tumor characterized by the growth of cells of the anterior lobe of the gland.

Currently, there is the following classification of pituitary adenoma:

hormonally active;
hormonally inactive does not produce a hormone);
malignant ( extremely rare).

There are the following types of hormonally active pituitary adenoma:

somatotropinoma (increased production of the somatotropin hormone);
corticotropinoma (increased production of adrenocorticotropic hormone);
prolactinoma (increased production of lactotropic hormone);
thyrotropinoma (increased production of thyroid-stimulating hormone);
gonadotropinoma (increased production of follicle-stimulating hormone).

It is the increased production of the hormone somatotropin ( growth hormone) leads to the development of acromegaly. A person with this disease begins to grow and increase markedly. This condition most often occurs in the third to fifth decade of life. If the disease develops in children, then they have increased growth, which is called gigantism.

The concept of acromegaly comes from Greek words and means the following:

« acron"- limb;
« megalos" - increase.

The patient has an increase in the nose, lips, jaw, hands and feet, that is, protruding parts of the body ( limbs).

There are the following signs of a pituitary adenoma:

decreased vision;
lack of menstruation;
severe sweating;
headache;
weakness;
increased fatigue.

Signs of acromegaly in pituitary adenoma are:

enlargement of the nose;
the appearance of cheekbones;
increase in superciliary arches;
change in bite;
divergence of teeth;
an increase in the size of the arms and legs;
pain in the limbs.

The patient over time notes a change in facial features, an increase in shoe size ( by increasing the foot), difficulty putting on a ring or gloves ( by increasing the size of the brushes).

Depending on the size of the adenoma, there are:

picoadenoma (the size of the tumor does not exceed three millimeters);
microadenoma (the size of the tumor reaches ten millimeters);
macroadenomas (the size of the tumor is more than ten millimeters);
giant adenomas (tumor size from forty to fifty millimeters or more).

Treatment of pituitary adenoma is selected individually depending on the following factors:

type of tumor;
adenoma size;
the severity of the course of the disease;
the general health of the patient;
patient's age.

As a rule, the main stage of treatment of this tumor is a surgical intervention, with the help of which it is removed. The operation is performed endoscopically through the nasal passages of the patient.

Also, in the treatment of this disease, radiation and drug therapy is widely used ( hormonal preparations) therapy.

What is the pathogenesis of acromegaly?

Acromegaly is a disease caused by an increase in the level of the hormone somatotropin in the body ( a growth hormone).

An increase in the production of this hormone can contribute to:

disruption of the pituitary gland;
disruption of the hypothalamus.

Disruption of the pituitary gland
About 99% of cases of acromegaly are associated with pituitary adenoma. An adenoma is a benign tumor that develops due to the fact that the cells of the anterior pituitary gland, for certain reasons, begin to divide intensively. Excessive cell division leads to the fact that the level of somatotropin hormone in the body increases significantly, which eventually leads to the development of acromegaly in a person.

Acromegaly is a sluggish disease and is characterized by a gradual increase in symptoms. Initially, the patient has coarsening of facial features, enlargement of the nose, ears and lips. Then the skull, lower jaw, as well as hands and feet begin to increase in size. The person himself may not notice the changes occurring in appearance and consult a doctor only a few years after the onset of the disease.

There are the following reasons that can provoke the formation of a pituitary adenoma:

brain injury;
infectious diseases ( e.g. meningitis, encephalitis, brucellosis);
long-term use of oral hormonal contraception;
pathological course of pregnancy.

The size of a pituitary tumor can vary from a few millimeters to several centimeters. With a later period of flow, the increased size of the pituitary gland begins to compress the surrounding areas of the brain, including large vessels and nerves. In this regard, a person begins to develop eye ( e.g. decreased visual acuity, reduced visual field), neurological ( e.g. elevation, headache) and other symptoms.

Disruption of the hypothalamus
The hypothalamus together with the pituitary gland form the hypothalamic-pituitary complex, in which the hypothalamus controls the production of pituitary hormones.

Hormones secreted by the hypothalamus are divided into the following groups:

releasing hormones. This group includes seven hormones that activate the production of hormones of the anterior pituitary gland. This includes hormones such as prolactoliberin ( stimulates the secretion of prolactin), thyroliberin ( stimulates the secretion of thyroid-stimulating hormone), somatoliberin ( stimulates the secretion of growth hormone) and others.
Statins. These hormones, on the contrary, inhibit the production of hormones from the anterior pituitary gland. These include somatostatin ( suppresses the secretion of growth hormone), prolactostatin ( suppresses the secretion of prolactin) and melanostatin ( inhibits the secretion of melanotropin).
Hormones of the posterior pituitary gland. The hypothalamus produces hormones such as oxytocin and vasopressin, which are then released to the pituitary gland.

It should be noted that various lesions of the hypothalamus can lead to disruption of its work and increased production of hormones. So, for example, increased secretion of the hormone somatoliberin or insufficient production of somatostatin, in turn, provoke increased production of somatotropic hormone, which subsequently leads to the development of acromegaly in humans.

If the hypothalamus is malfunctioning, a person may experience the following symptoms:

obesity;
sleep disturbance ( increased drowsiness);
change in thermoregulation ( an increase in body temperature above normal, less often its decrease);
increased appetite;
hypodynamia ( reduced motor activity);
diabetes insipidus;
psychoemotional disorders;
increased hair growth on the body and face.

What are the stages of acromegaly?

There are the following stages of acromegaly:

preacromegaly;
hypertrophic;
tumor;
cachexia.

Stage of acromegaly	Description
*Preacromegaly stage*	It is characterized by poor initial symptoms. The disease at this stage can be detected only on the basis of the results of studies, a blood test to detect the level of somatotropin and a computed tomography of the brain.
*hypertrophic stage*	*At this stage, the severity of signs of acromegaly is observed:* an increase in the size of the nose, ears, lips, tongue and lower jaw; malocclusion and divergence of teeth; increase in superciliary arches; increase in head size; increase in the size of the hands and feet; coarsening of the voice; thickening and roughness of the skin; increased sweating; an increase in the size of muscles and internal organs ( e.g. heart, liver).
*Tumor stage*	In this period of the disease, signs of compression of the parts of the brain located around the pituitary gland come to the fore ( e.g. vessels, nerves). *At the tumor stage, the patient may experience the following symptoms:* weakness; decrease in working capacity; high blood pressure; sleep disturbance; violation of the menstrual cycle; hearing loss; headache; dizziness; decreased vision; double vision; joint pain and back pain.
*stage of cachexia*	There is an exhaustion of the body as a result of acromegaly. There are dystrophic changes in the affected internal organs with the development of their insufficiency. Also at this stage, hemorrhage into the pituitary adenoma can occur, followed by death.

There are the following degrees of severity of acromegaly:

mild severity;
medium severity;
severe degree.

Severity	Description
*Light degree*	The patient does not need hospitalization. The ability to self-service and perform work of medium severity is preserved.
*Average degree*	The patient is active most of the day. The ability to self-service is preserved, however, a person can no longer perform work of moderate severity with a given degree of illness.
*Severe degree*	The patient lacks self-service skills, as well as the ability to perform various physical work. The patient with this degree is shown hospitalization and bed rest.

According to the activity of the process, acromegaly can be:

active;
inactive.

In the course of the disease process, acromegaly can be:

benign;
malignant.

How to treat acromegaly with folk remedies?

Acromegaly is a sluggish disease that develops due to excessive production of somatotropic hormone ( growth hormone). Hormonal disorders that occur in the human body with this disease cannot be eliminated with the help of folk remedies. And the lack of timely treatment can lead to early disability of the patient and a decrease in life expectancy.

That is why it is not recommended to treat acromegaly with alternative methods, and if symptoms of the disease appear, you should seek help from a specialist as soon as possible. The attending physician will prescribe the necessary studies, identify the cause of the disease, and prescribe the appropriate treatment. Treatment for this condition may include medication ( e.g. somatostatin analogues, dopamine receptor agonists), surgical intervention ( with pituitary adenoma), as well as radiation therapy.

With acromegaly, a person may experience the following symptoms:

gradual increase in limbs of the body ( e.g. nose, chin, ears, feet and hands);
an increase in the size of internal organs;
visual impairment;
violation of the menstrual cycle in women;
infertility;
weakness;
increased fatigue;
voice change ( getting rougher);
skeletal change ( for example, widening of the intercostal spaces, curvature of the spinal column);
increased sweating;
respiratory failure.

Acromegaly is a serious disease in which it is strictly not recommended to self-medicate using alternative methods, as they do not bring proper results, and the course of the disease, in turn, can only worsen.

What facial changes are observed in acromegaly?

Acromegaly is a long-term sluggish disease in which a person initially has a coarsening of facial features, and then their noticeable increase in size.

With acromegaly, the patient has an increase in:

nose
ears;
superciliary arches;
cheekbones;
language;
chin.

Due to the pronounced protrusion of the lower jaw forward, a change in bite occurs in a person. The teeth move apart, forming free spaces between them, and the tongue grows to such a size that it does not fit in the oral cavity. Due to the thickening of the vocal cords, a person's voice becomes rough, more hoarse. Speech, in turn, becomes less clear.

The skin on the face coarsens, becomes more edematous and dense. Due to the increase in the size of the sweat and sebaceous glands in humans, there is an increased secretion of sweat and sebum. These changes subsequently lead to the formation of rough and deep folds on the face, drooping of the eyelids and thickening of the lips ( especially the lower lip). In addition, warts and papillomas may appear on human skin.

Also, due to the changed hormonal background, the patient increases hair growth both on the body and on the face. So in women with acromegaly, increased growth of mustaches and beards can be observed.

With acromegaly, the patient may also experience the following symptoms:

headache, usually in the temporal and frontal regions;
increased intracranial pressure;
decreased visual acuity;
decrease in the field of view;
hearing loss;
an increase in the size of the limbs and internal organs;
weakness;
decrease in working capacity;
violation of the menstrual cycle;
infertility.

When conducting an X-ray examination, the patient has an increase in size:

skulls;
Turkish saddle ( recess in which the pituitary gland lies);
lower jaw;
paranasal sinuses;
cheekbones;
superciliary arches;
occipital protuberance.

Also, a person can identify changes in appearance on his own by making a comparative analysis of two photographs - the first in the present time and the second, for example, five years ago.

What drugs are prescribed for acromegaly?

Drug treatment for acromegaly can be prescribed in the following cases:

early stage of the disease;
refusal of the patient to undergo surgical treatment;
the presence of contraindications for surgical intervention or radiation therapy;
low efficiency of radiation therapy.

In acromegaly, the following groups of drugs are widely used:

somatostatin analogues;
dopamine receptor agonists.

Somatostatin analogs
Drugs from this pharmacological group act similarly to the somatostatin hormone secreted by the hypothalamus, that is, they suppress the production of somatotropic hormone, reducing its level in the blood plasma, and also reducing the manifestations of acromegaly.

Somatostatin analogues can be used when treatment of the disease with dopaminomimetics is ineffective.

Sandostatin;
Somatulin.

Name of the drug	Active substance	Dose and route of administration
*Sandostatin*	Octreotide	The drug is administered subcutaneously at a dose of 0.05 - 0.1 mg ( 50 - 100 mcg) at intervals of eight or twelve hours. If necessary, the dose can be increased to 0.2 - 0.3 mg ( the maximum daily dose is one and a half milligrams). The doctor should prescribe the required amount of the drug individually, depending on the level of somatotropic hormone in the blood. If after three months of treatment the concentration of the hormone does not decrease, then the use of the drug is recommended to stop.
*Somatulin*	Lanreotide	Initially, the drug is administered to the patient on a trial basis, after which the level of somatotropic hormone in the blood is determined. If the introduced remedy did not bring results, its further use is considered inappropriate. Dosage and duration of treatment is determined individually by the attending physician. However, as a rule, thirty milligrams of the drug is administered intramuscularly once every two weeks ( may prescribe an injection once every ten days).

Redness, itching, burning and pain may occur at the injection site.

Taking these drugs can cause the following side effects:

loss of appetite;
nausea and vomiting;
stool disorder diarrhea, fatty stools);
disruption of the liver;
increased levels of bilirubin;
allergic reactions;
hyperglycemia or hypoglycemia.

Dopamine receptor agonists
Hormonal drugs from this pharmacological group stimulate dopamine receptors and reduce the production of the anterior pituitary gland of the hormone prolactin. Also, these drugs reduce the production of growth hormone, so they are widely used in the treatment of acromegaly, especially in conjunction with radiation therapy or surgery.

With acromegaly, the following drugs can be prescribed:

Parlodel;
Abergin;
Norprolac.

Name of the drug	Active substance	Dose and route of administration
*Parlodel*	Bromocriptine	Initially, 1.25 mg is prescribed two to three times a day. In the case of normal tolerability of the drug and the effectiveness of treatment, the dosage is gradually increased. The next four days, ten milligrams are recommended, after which the dose is increased to twenty to twenty-five milligrams four times a day. If there are indications, the dose of the drug can be increased to thirty to forty grams.
*Abergin*	Bromocriptine	The initial amount of the drug includes oral administration of 1.25 mg two to three times a day. Subsequently, under the control of the level of growth hormone in the blood, the daily dose may increase to eight ( two tablets) – twenty ( five tablets) milligram.
*Norprolac*	Quinagolide	The drug is administered orally in an amount of 0.15 - 0.3 mg twice a day during meals.

When taking these medicines, a person may experience the following side effects:

thirst;
nausea or vomiting;
stool disorder constipation);
dizziness and headache;
severe weakness;
increased drowsiness;
allergic reactions;
feeling of coldness in the extremities;
increased psychomotor activity;
disturbance of consciousness.

In the treatment of acromegaly is also used:

Surgery. To remove a pituitary adenoma, surgery is effectively used, in which the tumor is removed using endoscopic instruments. The results of studies show that if the size of the adenoma was up to one centimeter, then 90% of patients reached remission after surgery. If the tumor is larger than one centimeter, then it can be removed in two stages.
Radiation therapy. This method consists in the fact that the affected area of the pituitary gland is exposed to irradiation with gamma rays or a proton beam. Radiation therapy can be used simultaneously with surgical treatment or alone. Treatment usually includes four courses of radiation under regular monitoring of research results.

Does acromegaly affect pregnancy?

Acromegaly is a serious disease in which there is an excess production of somatotropic hormone. This disease usually develops between the ages of 30 and 50.

The clinical picture of acromegaly includes an increase in the size of the limbs ( e.g. hands, feet, nose, chin) and internal organs, neurological ( e.g. weakness, fatigue, headaches) and ophthalmic ( e.g. decreased visual acuity) symptoms.

Also in women, this disease causes the following changes:

menstrual irregularity (up to the absence of menstruation - amenorrhea);
galactorrhea (a pathological condition in which there is a release of milk from the mammary glands);
infertility.

Also, acromegaly can provoke the development of diseases such as polycystic ovaries and uterine fibroids.

After the onset of pregnancy, during its normal course, the pituitary gland undergoes a number of changes. For example, under the action of sex steroids of the placenta, hyperplasia of prolactin-secreting cells occurs ( lactotrophs) and increased prolactin levels. Also, a woman has an increase in the concentration of growth hormone. At the same time, the body suppresses the production of follicle-stimulating and luteinizing hormones. The size of the pituitary gland by the end of pregnancy can increase two to three times. All these changes are physiological, and the body of a pregnant woman easily adapts to them, which guarantees the child protection and normal development.

However, it should be noted that if the body of a pregnant woman weakens and fails, then a woman in this period can be diagnosed with an exacerbation of a previously treated disease or the development of a new one ( e.g. pituitary adenoma).

In a woman, infertility with acromegaly may be associated with a hormonal disorder in the work of the hypothalamus-pituitary-ovaries complex. However, with adequately selected treatment of the disease, the ability to conceive in women after therapy, as a rule, returns.

If acromegaly began to develop during pregnancy, or conception occurred during the period of the disease, then an increased level of somatotropic hormone can affect the health of the mother to a greater extent than the fetus, since this hormone is not able to pass through the placental barrier.

Treatment of acromegaly during pregnancy is set individually and depends on the following factors:

the severity of the disease;
general condition of the pregnant woman;
pituitary adenoma size.

In some cases, treatment of the disease may be delayed until the postpartum period.

In 30% of men, acromegaly causes erectile dysfunction, that is, it leads to the development of impotence.

What is partial gigantism?

Partial or partial gigantism is an increase in a certain part of the body, for example, toes, hands, or half of the body. This disease is congenital. Most often, a child is born with an already enlarged area of \u200b\u200bthe body, less often pathological growth can be observed later.

Currently, the following causes are distinguished that can lead to the development of partial gigantism:

Mechanical. Due to the incorrect position of the fetus in the uterine cavity, compression of certain parts of the body, for example, by the umbilical cord, can occur. This may lead to the development of stagnation and subsequently an increase in the size of the compressed area.
Embryonic. During fetal development, there may be a violation of the formation of body structures ( for example, incorrect laying of the bone or vascular systems), which can eventually lead to increased growth of certain parts of the body.
Nervous-trophic. It is characterized by neurotrophic changes ( e.g. damage to sympathetic fibers), in which an increase in body area can be observed.

With partial gigantism, the following changes are observed:

increase in the size of the affected area of the body in length and width;
excessive growth of soft tissues;
external cosmetic changes in a certain part of the body.

In most cases, children have partial gigantism of the toes, that is, macrodactyly.

Macrodactyly can be of two types:

true, in which there is an increased growth of soft tissues and bones of the fingers ( metatarsal bones and phalanges);
false, which is characterized by congenital disorders of the vascular network, as a result of which the child has an increase in toes.

It is possible to diagnose true macrodactyly with the help of an X-ray examination, which will show pronounced changes in the bones. False, in turn, can be detected using external changes in the skin. So, for example, with this type of disease, there is a pronounced vasodilation, as well as hemangiomas ( vascular spots) on foot.

Most often there is an increase in the size of the second and third fingers, which subsequently leads to an increase in the size of the entire foot. During growth, the affected fingers begin to take a forced position, bend or move apart excessively.

In the diagnosis of this disease, a visual examination of the patient is widely used, as well as an x-ray examination, in which one can see an increase in the bones of the studied area of the body in length and width.

In the treatment of this disease, as a rule, surgical intervention is used, in which it can be performed:

removal of soft tissues;
deletion ( resection) section of the epiphyseal plate;
partial or complete disarticulation of the fingers.

What are the signs of gigantism in children?

Gigantism is a disease that develops in childhood due to excessive production of somatotropic hormone ( a growth hormone).

There are the following main reasons that can affect the increase in the level of growth hormone:

pituitary adenoma;
head injury;
infectious diseases affecting the nervous system e.g. meningitis, encephalitis).

The development of this disease is observed to a greater extent in boys during the period when the processes of bone formation have not yet been completed, as a rule, at the age of nine to fifteen ( or during puberty from twelve to eighteen years). In this case, the growth of the child is accelerated and, when measured, an excess of the physiological norm is observed. So, for example, by the end of sexual development, the height of girls reaches 190 cm, while boys have two meters and more. It should also be noted that the parents of children suffering from gigantism are usually of normal height.

With gigantism, the following changes are observed:

high growth;
limb lengthening;
disproportionately small head size;
violation of sexual activity;
changes in the psycho-emotional sphere;
reduced work capacity;
development of infertility is possible.

With this disease, the child may experience the following symptoms:

increased fatigue;
weakness;
decreased vision;
headache ( due to increased intracranial pressure);
dizziness;
numbness of the limbs;
arthralgia ( joint pain);
pain during physical activity;
menstrual disorders ( until the disappearance of menstruation).

With gigantism, a child may develop complications such as:

dysfunction of the thyroid gland hypothyroidism or hyperthyroidism);
increased blood pressure;
heart failure;
liver damage;
respiratory failure.

There are the following types of gigantism:

true, in which there is a proportional increase in the size of all parts of the body and the absence of violations of mental and physiological functions;
partial, characterized by an increase in individual parts of the body ( e.g. toes, hands or half of the body);
acromegalic, accompanied by a pronounced increase in limbs ( e.g. upper and lower limbs as well as nose, chin);
splanchnomegaly, characterized by an increase in the size and mass of internal organs;
eunuchoid in which there is a lack or underdevelopment of secondary sexual characteristics due to disruption of the sex glands;
cerebral, accompanied by violations of the intellect due to brain damage.

Gigantism can be identified using:

visual examination of the patient;
laboratory research ( blood test to determine the level of somatotropic hormone);
instrumental diagnostics ( e.g. computed tomography, x-ray, magnetic resonance imaging).

Treatment of the disease is prescribed individually, depending on the type of gigantism and the patient's manifestations. As a rule, somatostatin analogues are prescribed for gigantism ( e.g. Octreotide, Lanreotide), as well as preparations of sex hormones. In the presence of a pituitary adenoma, surgical treatment or radiation therapy may be prescribed.

Acromegaly is a pathological process in which the functionality of the anterior pituitary gland is impaired. Acromegaly disease manifests itself after the end of growth, accompanied by an expansion of the facial parts of the skull, feet and hands.

The provocateur of acromegaly is an increase in the concentration of somatotropic hormone. The development of the disease in adolescence is called gigantism.

Root causes and stages of acromegaly

The pituitary gland produces somatotropic hormone (GH), which is responsible for the formation of the musculoskeletal skeleton in childhood, and in adults controls the water-salt metabolism.

In patients with acromegaly, there is a violation of the production of this hormone and an increase in its concentration in the blood. A pituitary adenoma in acromegaly occurs when the cells of the pituitary gland grow.

Experts believe that the most common cause of acromegaly is pituitary adenoma, which can form in the presence of tumors of the hypothalamus, head injuries, and chronic sinusitis. The hereditary factor plays an important role in the development of acromegaly.

Acromegaly is characterized by a long-term course, its manifestations depend on the stage of development:

Preacromegaly is characterized by a slight increase in the level of growth hormone, as a result of which there are practically no signs of the manifestation of pathology;

Hypertrophic stage - clearly expressed symptoms of the disease are observed;

The tumor stage is characterized by an increase in intracranial pressure and disturbances in the functioning of the visual and nervous systems;

Cachexia - there is an exhaustion of the patient.

Due to the long development in the first stage of acromegaly, no external signs are observed.

Clinical manifestations

Symptoms of acromegaly in children and adults include:

Soreness in the spinal column and joints due to their destabilization and the development of arthropathy;

Excessive male pattern hair in women;

Expansion of the gaps between the teeth, an increase in various parts of the face, thickening of the skin;

The appearance of villous-warty growths;

Enlargement of the thyroid gland;

Decreased ability to work, fatigue;

The development of cardiovascular pathologies that can lead to death;

The development of diabetes;

Violation of pigmentation of the skin;

Violation of the respiratory system.

With acromegaly of the pituitary gland, healthy cells are squeezed, provoking:

Decreased potency and libido in men;

Infertility, violation of menstruation in women;

Frequent migraines that are not amenable to medical treatment.

Diagnosis

Diagnosis of acromegaly and gigantism is possible on the basis of data: MRI of the brain, symptoms, radiography of the foot, biochemical parameters.

Among laboratory studies, the determination of the concentration of growth hormone and insulin-like growth factor-1 is distinguished. Normally, the level of growth hormone is not more than 0.4 μg / l, and IGF-1 corresponds to the normative indicators according to the gender and age of the subject. With deviations, the presence of the disease cannot be ruled out.

X-rays of the foot are taken to assess the thickness of its soft tissues. Reference values for men are up to 21 mm, for women - up to 20 mm.

If the diagnosis has already been established, the pathogenesis of acromegaly is studied and deviations in the work of the pituitary and hypothalamus are determined.

Computed tomography of the pelvic organs, chest, retroperitoneum, mediastinal organs is performed in the absence of pituitary pathologies and the presence of biochemical and clinical manifestations of acromegaly disease.

Therapeutic measures for acromegaly

The main goal of carrying out therapeutic measures for such a pathology is the normalization of the production of somatotropin, that is, bringing it into a state of remission.

For this, the following methods are used:

Surgical therapy is used in two types: transcranial and transsphenoidal. The choice is made by the neurosurgeon. Surgical intervention is performed to remove a microadenoma or partial resection of a macroadenoma.

Radiation exposure is carried out in the absence of effect after surgical therapy; for this, gamma knives, a proton beam, and a linear accelerator can be used.

In drug therapy, the following groups of drugs are used: growth hormone antagonists, somatostatin analogues, dopaminergic agents.

The combined method of treatment is used according to the doctor's recommendations.

The choice of therapeutic measures should be carried out in conjunction with a specialist who has studied the pathogenesis of acromegaly, the symptoms and the results of biochemical studies of the patient.

According to statistics, surgery is considered the most effective, about 30% of those operated on fully recover, and the rest have a period of stable remission.

Timely treatment of diseases affecting the nasopharynx;

Avoid head injury.

If you have any doubtful signs, consult an endocrinologist. It is not necessary to self-diagnose and even more so treat.

Symptoms

Clinical manifestations of acromegaly are due to increased production of somatotropin, a specific growth hormone that is synthesized by the pituitary gland, or diseases that cause the development of tumor formations (pituitary adenomas, brain tumors, metastases from distant organs).

The causes of the development of the disease lie in the hyperproduction of somatotropic hormone, which is of a primary pituitary nature, or has a hypothalamic origin.

It is generally accepted that the pathological process that develops at an early age, the advantage in adolescence, is called gigantism. A characteristic feature of gigantism in children is the rapid and proportional growth of organs, tissues, bones of the skeleton, and hormonal changes. A similar process that develops after the cessation of body growth is called acromegaly in adulthood. The characteristic symptoms of acromegaly are a disproportionate increase in organs, tissues and bones of the body, as well as the development of concomitant diseases.

Signs of gigantism in children

Early signs of acromegaly (gigantism) in children can be detected some time after the onset of its development. Outwardly, they manifest themselves in the increased growth of the limbs, which unnaturally thicken and become loose. At the same time, one can notice that the zygomatic bones, superciliary arches increase, the nose, forehead, tongue and lips hypertrophy occurs, as a result of which facial features change, becoming coarser.

Internal disorders are characterized by swelling in the structures of the throat and sinuses, which causes a change in the timbre of the voice, making it lower. Some patients complain of snoring. In the photo, acromegaly in children and adolescents is manifested by high growth, unnaturally enlarged parts of the body, elongated limbs due to uncontrolled expansion of the bones. The development of the disease is also accompanied by hormonal changes, the symptoms of which are:

increased sweating;

hypersecretion of the sebaceous glands;

increased blood sugar levels;

increased calcium in the urine;

the likelihood of developing gallstone disease;

swelling of the thyroid gland and disruption of its functioning.

Often at an early age, a characteristic proliferation of connective tissues is observed, which causes the appearance of tumor formations and changes in internal organs: heart, liver, lungs, intestines. Quite often you can see in the photo of newborns with acromegaly of the neck, a characteristic feature of which is the lengthening of the sternocleidomastoid muscle.

Symptoms of acromegaly in adults

Hyperproduction of somatotropic hormone causes pathological disorders in the body of an adult, which lead to a change in his appearance, which can be clearly seen in his photo or in person. As a rule, this manifests itself in the disproportionate growth of individual parts of the body, including the upper and lower extremities, hands, feet, and skull. As well as in children, in adult patients, the forehead, nose, shape of the lips, superciliary arches, zygomatic bones, lower jaw change, as a result of which the interdental spaces increase. Most patients have macroglossia, an abnormal enlargement of the tongue.

The symptoms of acromegaly, the causes of which in adults in most cases are pituitary adenoma, include skeletal deformity, in particular, curvature of the spinal column, an increase in the chest, followed by expansion of the intercostal spaces, pathological changes in the joints. Hypertrophy of cartilage and connective tissues leads to limited joint mobility, resulting in arthralgia.

Often patients complain of frequent headaches, fatigue, muscle weakness, decreased performance. This is due to an increase in muscle size with subsequent dystrophy of muscle fibers. At the same time, myocardial hypertrophy may appear, turning into myocardial dystrophy, causing the development of heart failure.

Patients in whom the symptoms of acromegaly progress are often photographed with characteristic changes in appearance that make them look similar to each other. However, internal organs and systems are also subject to changes. So in women, the menstrual cycle is disturbed, infertility develops, galactorrhea - the release of milk from the nipples against the background of the absence of pregnancy. Many patients, regardless of gender and age, are diagnosed with sleep apnea syndrome, in which severe snoring develops.

In the absence of treatment, as a rule, the prognosis remains disappointing. The progression of pathological disorders leads to complete disability, and also increases the risk of premature death, which occurs as a result of heart disease. The life expectancy of patients with acromegaly disease is significantly reduced and does not reach 60 years.

Diagnostics

Diagnosing acromegaly is quite simple, especially in the later stages, since its external manifestations are specific. However, there is a certain category of diseases, the symptoms of which are in many ways similar to those of acromegaly. To conduct differential diagnosis and confirm (or exclude) the presence of acromegaly, an endocrinologist's consultation is prescribed, as well as visual, laboratory and instrumental methods for diagnosing acromegaly.

Visual examination of the patient

Before prescribing the necessary diagnostic procedures and proper treatment, the doctor collects an anamnesis, determines the hereditary predisposition to the development of this disease, and also conducts an objective examination - palpation, percussion, auscultation. Based on the results of the initial examination, the necessary diagnostic procedures are prescribed.

Laboratory diagnostic methods

To diagnose acromegaly, traditional laboratory methods are used: blood and urine tests. However, the most informative and therefore frequently used of them are the determination of hormones in the blood in acromegaly: STH - somatotropic growth hormone, and insulin-like growth factor - IGF-1.

Determining the level of growth hormone

Confirmation of the development of gigantism or acromegaly is an increased content in the blood of somatotropin, a growth hormone that is produced by the anterior pituitary gland. A distinctive feature of the production of growth hormone is cyclicality, therefore, to conduct a test to determine its level, multiple blood sampling is practiced:

in the first case, a three-time sampling is performed with an interval of 20 minutes, after which the serum is mixed and the average level of growth hormone is determined;

in the second case, five blood samples are taken with an interval of 2.5 hours, but the level is determined after each blood sample is received. The final score is obtained by averaging all values.

Confirmation of the diagnosis of acromegaly is possible when the hormone level exceeds the value of 10 ng / ml. The disease can be excluded if the mean value does not exceed 2.5 ng/ml.

Determining the level of IGF-1

Another informative screening test is the determination of the level of the IGF-1 hormone. It has high sensitivity and specificity, since it does not depend on daily fluctuations, like somatotropin. If the level of IGF-1 in the blood is higher than normal, the doctor may diagnose acromegaly. However, this test should be carried out in conjunction with other studies, since the value of IGF-1 may change under the influence of several factors:

be reduced in case of liver dysfunction, hypothyroidism, excess estrogen, starvation;

be elevated as a result of hormone replacement therapy, as well as with an increase in the level of insulin in the blood.

Glucose tolerance test

With doubtful results, a test for determining growth hormone using glucose is performed to clarify the diagnosis. For its implementation, the basal level of somatotropin is measured, after which the patient is offered to take a glucose solution. In the absence of acromegaly, a glucose test shows a decrease in GH secretion, and with the development of the disease, on the contrary, its increase.

Instrumental diagnostic methods

To clarify the diagnosis of acromegaly and identify the nature of its origin, the doctor often resorts to instrumental diagnostic methods.

CT or MRI

The main and highly informative diagnostic method is CT or MRI, which allows you to identify pituitary adenoma, as well as the degree of its prevalence in regional organs and tissues. The procedure is performed using a contrast agent that accumulates in altered tissues, which simplifies the examination procedure and allows you to determine the characteristic changes in the pituitary or hypothalamus.

In the process of carrying out diagnostic measures, many patients are interested in how often an MRI should be done with acromegaly. This procedure is usually carried out at the stage of hypertrophy of individual parts of the body, advanced clinical manifestations, and later, at the tumor stage, when the patient complains of increased fatigue, headaches, muscle and joint pain, as well as other concomitant manifestations.

Skull x-ray

This procedure is carried out in order to identify the characteristic radiographic manifestations of acromegaly, as well as signs of the development of pituitary adenoma:

an increase in the size of the Turkish saddle;

development of osteoporosis;

increased pneumotization of the sinuses;

wall doubleness.

In the process of radiography in the early stages of the disease, these signs may be absent, therefore, other, often auxiliary, diagnostic methods are prescribed:

radiography of the feet, which allows you to determine the thickness of the soft tissues in this area;

examination by an ophthalmologist for swelling, stasis, and atrophy of the optic nerves, which often leads to blindness.

If necessary, the patient is prescribed an examination to identify complications: diabetes mellitus, intestinal polyposis, nodular goiter, adrenal hyperplasia, etc.

Treatment

Acromegaly refers to diseases whose treatment cannot be postponed until later. Excess production of growth hormone can lead to early disability and reduce the chances of a long life. If you have the first symptoms, you should consult a doctor. Only a doctor after all examinations can diagnose the disease and prescribe the correct treatment.

Goals and Methods

The main goals of the treatment of acromegaly are:

decreased secretion of somatotropin (growth hormone);

decreased production of insulin-like growth factor IGF-1;

reduction of pituitary adenoma;

tumor removal.

Treatment is carried out in the following ways:

drug therapy;

surgical intervention;

radiation therapy.

After clinical studies, the doctor chooses the most appropriate method, taking into account the course of the disease and the individual characteristics of the patient. Often, acromegaly, the treatment of which requires a careful approach, is carried out in a complex manner, combining different techniques.

Surgical intervention

The most effective treatment for acromegaly is surgery to remove a pituitary adenoma. Doctors recommend surgery for both microadenoma and macroadenoma. If the rapid growth of the tumor is noted, surgery is the only chance for recovery.

Surgery is performed in one of two ways:

Minimally invasive method. The tumor is removed promptly without incisions in the head and craniotomy. All surgical actions are carried out through the nasal opening using endoscopic equipment.

transcranial method. This method of the operation is used only if the tumor has reached a large size and removal of the adenoma through the nose is impossible. Both the operation and the rehabilitation period are difficult, since a craniotomy is performed.

Sometimes acromegaly returns after surgery. The smaller the tumor, the more likely it is that the period of remission will be long. To reduce the risks, it is necessary to undergo a medical examination in a timely manner.

Medical therapy

Doctors prescribe drugs for the complex treatment of the disease. In the form of monotherapy, drugs are prescribed extremely rarely, since they help reduce the production of growth hormone, but they cannot completely cure the disease.

Most often, drugs are prescribed in such cases:

if surgery has not yielded results;

if the patient refuses surgery;

if there are contraindications for the operation.

Taking medication helps to reduce the tumor in size, so sometimes drug therapy is prescribed before surgery.

For the treatment of acromegaly, drugs of the following groups are used:

somatostatin analogues (octreodite, lantreodite);

growth hormone receptor blockers (pegvisomant).

Medications are taken only as prescribed by a doctor. Self-medication, as well as folk remedies, can aggravate the course of the disease.

Radiation therapy

Radiation therapy in the treatment of acromegaly is rarely used, since it has a frequent complication - the development of hypopituitarism. Complications may occur several years after therapy. In addition, the result in most cases when using this method does not occur immediately.

The following methods of radiation therapy are currently used:

remote;

gamma knife;

proton therapy.

The use of radiation therapy is necessarily accompanied by the intake of drugs.

Medications

The term of the disease "acromegaly" means that this is a disease that occurs in a person whose production of growth hormone is impaired, namely, manifestations of increased reproductive function of somatotropic hormone after a period of maturation. As a result, the proportional growth of the entire skeleton, internal organs and soft tissues of the body is disturbed (this is due to nitrogen retention in the body). Acromegaly is especially pronounced on the limbs of the body, face and entire head.

This disease occurs in both women and men after the completion of the growth period. The prevalence of the disease is from 45-70 people per one million population. This ailment affects the children's body extremely rarely. In rare cases, in growing children, this excess growth hormone leads to a condition called "gigantism". Such a change is definitely characteristic due to an excessive increase in body weight and growth of bone tissue.

Since acromegaly is not very common, and the disease goes away gradually, it is not easy to identify this disease in the early stages.

All this is caused not only due to a violation of growth hormone, but also a change in other functions of the glands:

Endocrine.

pancreas.

Dysfunction of the adrenal cortex.

As a result of acromegaly, metabolism is disturbed, which in most cases leads to diabetes mellitus and carries a great danger to human life. But do not be upset, there are certain medical manipulations that can significantly alleviate the symptoms and reduce the further development of acromegaly.

Symptoms of acromegaly is a slow and subtle manifestation of the clinical development of the disease. This disease occurs due to a violation of the hormonal background by a change in appearance, as well as a deterioration in well-being. There are patients who determined this diagnosis only after 10 years. The main complaints of patients are enlargement of the auricles, nose, limbs of the arms and legs.

In developing an effective fight against the disease, there are two main consequences: malignant neoplasms and pathology of the cardiovascular system. There are four main methods of getting rid of this disease:

surgical method. Qualified doctors completely remove tumors. This method allows you to quickly get results. There are some complications after surgery.

Radiation therapy or irradiation. Most often, this method is used in the case when surgical intervention did not help. Irradiation also has underinvestigative shortcomings: the optic nerve is affected, a secondary brain tumor.

Medical way. Acromegaly is treated with the following three types of drugs:

CCT analogues (long-acting (samatulin and sandostatin LAR) and short-acting - sandostatin octroedit).

STG antagonists.

Dopamine agonists (ergoline and non-ergoline drugs).

Combined. Thanks to this method, the most positive result of treatment is achieved.

Medications

But as experience shows, doctors still adhere to drug treatment. This method has a less negative effect on the human body.

There is a sufficient list of medicines to combat the consequences of acromegaly:

Genfastat is a homeopathic remedy.

Octrid is a mucolytic agent.

Parlodel - Mibp-bacteriophage.

Sandotatin - Beta - A blocker.

Samatulin is an antiseptic.

In most of these drugs, the active ingredient is octreodite. All dosages and treatment regimens are prescribed only by the attending physician.

Folk remedies

Treatment of acromegaly with folk remedies is an excellent preventive measure, which, in order to achieve the maximum effect, must be agreed with a specialist. In this case, it is the endocrinologist.

What to remember when using folk remedies in the treatment of acromegaly

Decoctions and teas prepared from plants and herbs such as:

root part of licorice and ginseng;
linden flowers.

Acromegaly, folk remedies for the treatment of which are used only after consultation with the doctor, is quite amenable to relief. It must be remembered that herbal infusions and teas should not be stored for a long period of time. They should be used within 24 hours of infusion and straining.

This is explained by the fact that if they stand for a long time, they will lose all healing, restorative characteristics and, even worse, can cause significant harm. When treating acromegaly with folk recipes, this is unacceptable, because any negative impact will affect the body and the activity of the thyroid gland, which plays one of the main roles in this case.

A mandatory step, which also needs to be agreed with a specialist, is diet therapy. It allows you to strengthen the body, speed up metabolism and increase the degree of body resistance.

Most requested recipes

If you have acromegaly, folk recipes will help stop some of the symptoms of the disease. One of the most popular recipes is a mixture consisting of pumpkin seeds, primrose herb, grated ginger root, sesame seeds and 1 tsp. honey. The presented mixture must be used in 1 tsp. four times during the day. If after 14-16 days there are no positive changes in the treatment process, it is necessary, after consultation with the endocrinologist, to correct the composition or refuse to use this remedy.

Recovery for acromegaly with folk recipes involves the use of plant collections. The presented medicinal composition includes such ingredients as:

adonis herbs;

calendula;

cottonweed;

A mixture of plants (at least 10 gr.) is brewed in 200 ml. boiling water. It is required to use the presented remedy in 40-50 ml. before meals and do this at least 4 times within 24 hours.

It should be noted that the use of folk remedies and recipes in the treatment of acromegaly is definitely useful. This is due to the positive effect on the work of the endocrine gland. However, the main emphasis in the treatment of acromegaly should be placed not only on prescriptions, but also on the use of medications, surgical methods of recovery. With the correct combination of the presented methods, the result will be 100%.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

(hypo- or hyperfunction). May develop. When a tumor of the pituitary gland compresses the optic chiasm, visual disturbances occur (narrowing, decreased visual acuity). On: increase in size, Turkish saddle, lower; thickening of the bones of the feet and hands. At the beginning of the disease, a comparison of the type of patient with photographs of past years, x-ray, ophthalmological examinations, and the determination of somatotropic hormone in the blood can help in the diagnosis.

With a benign course of acromegaly in relation to life and favorable.

Treatment. To suppress excessive secretion of somatotropic hormone, x-ray or tlegammatherapy is performed on the pituitary region. In addition, the method of radiation hypophysectomy is used (implantation in radioactive yttrium-90 or radioactive). In case of violation of the function of the gonads, a substitution is carried out: women are prescribed with preparations of the corpus luteum, men - androgens. In cases of persistent headache, 5 ml of a 25% solution of magnesium sulfate is administered intramuscularly, intravenously - 10 ml of a 10% solution of sodium chloride. A sharp narrowing of the visual fields and absence after radiation therapy serve as an indication for surgical intervention (removal of a pituitary tumor). Patients with acromegaly should be under dispensary observation.

Acromegaly (acromegalia; from the Greek akron - limb and megas, megalos - large) is a disease characterized by the growth of bones and soft tissues of the face, enlargement of the limbs and splanchnomegaly.

Etiology unknown. The most characteristic manifestations of acromegaly develop under the influence of excess growth hormone entering the body, which is due to the hyperfunction of eosinophilic cell formations of the anterior pituitary gland due to adenoma or their hyperplasia. A number of symptoms are caused by secondary disorders of other endocrine glands that are functionally related to the pituitary gland, as well as changes in the diencephalic region adjacent to the pituitary gland.

Acromegaly is relatively rare; usually begins at the age of 20-30 years. Children and adolescents rarely get sick.

pathological anatomy. An anterior pituitary tumor underlying acromegaly is usually a benign adenoma of eosinophilic cells, rarely malignant. It can sprout chiasm, brain, sphenoid bone. Sometimes the tumor develops in the sphenoid bone or along the cranio-pharyngeal canal. In some cases, along with a pituitary adenoma, adenomas of the parathyroid, thyroid, pancreas, and adrenal cortex are described. With acromegaly, splanchnomegaly, pancreatic sclerosis, hyperplasia of the thyroid, goiter, and parathyroid glands are observed.

Sometimes hyperplasia of the lymph nodes develops. Changes in the osteoarticular system in patients with uncovered epiphyseal growth zones are expressed in the development of proportional gigantism.

With the development of acromegaly in adults, there is a resumption of growth of bones and cartilage of varying degrees in different parts of the skeleton.

The natural features of its structure are emphasized in the skull (A. V. Rusakov): with an elongated shape, the skull takes on a dolichocephalic shape, with a wide one - brachycephalic, etc. An increase in the size of the prominent parts of the face, hands, feet is due to the growth of not only bones, but also soft tissues.

Changing the shape of the lower jaw, pushing the teeth apart, progeny are due to the growth and restructuring of the mandibular bone. In the spine, the anterior and lateral surfaces of the vertebral bodies thicken so that their width exceeds their height. In the cervical-thoracic spine, kyphosis is noted, in the lumbar - compensatory lordosis. In the later stages of acromegaly occurs. The ribs lengthen, their anterior sections expand, the so-called acromegalic rosary is formed. Tubular bones, especially of the hands and feet, become wider, deforming arthrosis develops.

Muscles in the early stages of the disease hypertrophy, then atrophy. The skin thickens, sweat and sebaceous glands hypertrophy.

Rice. 1. Face, hand and foot of a patient with acromegaly (right hand and foot of a healthy person).

Clinical picture(symptoms, signs and course). The disease develops slowly, and for a long time neither the sick nor others may not notice it. The first most often appear complaints of a headache of a paroxysmal or persistent nature, usually in the fronto-parietal or temporal regions. Headache caused by increased intracranial pressure may be accompanied by dizziness, nausea, vomiting, epileptoid seizures. The growth of bones and soft tissues occurs gradually and causes a slow change in the appearance of the patient. The greatest changes occur in the bones of the skull, hands and feet (Fig. 1). Due to the disproportionate growth of the bones, the shape of the skull, especially its facial part, is sharply disturbed: the superciliary arches and zygomatic bones protrude, the occipital protuberance and the circumference of the skull increase. The lower jaw protrudes forward in relation to the upper jaw (prognathia), which is especially characteristic of acromegaly; the gaps between the teeth increase, the bite changes. Due to the growth of cartilage and soft tissues, the nose becomes thick; ears enlarge. The lips, especially the lower, thicken. The skin on the neck and skull thickens, forms deep folds. The fingers thicken, the hands and feet more often increase only in width (“wide type”), but if acromegaly develops with uncovered epiphyseal growth zones, the hands and feet may also increase in length (“long type”). The chest increases in volume due to the thickening of the ribs and the expansion of the intercostal spaces, its lower edges acquire an unfolded position. The clavicles and sternum thicken. Exostoses are formed on the bones, especially in the places of muscle attachment. Hair thickens, becomes coarse and thicker; profuse hair growth is often observed. In women with acromegaly, profuse virilous hypertrichosis with the appearance of a beard and mustache may develop, due to secondary dysfunction of the adrenal cortex (see Virilism).

As a rule, the size of the internal organs increases (splanchnomegaly). An increase in language (macroglossia) leads to a change in speech, it becomes slurred. There are disorders of other endocrine glands, most often sexual (impotence, infertility, menstrual dysfunction). Often there is hyperplasia of the thyroid gland with a tendency to form nodes, sometimes a violation of its function (myxedema, thyrotoxicosis).

Often with acromegaly, diabetes mellitus develops, in some cases with insulin resistance, less often diabetes insipidus; the latter can occur both as a result of the loss of the antidiuretic function of the posterior pituitary gland, and on the basis of a violation of the regulation of water-salt metabolism due to tumor pressure on the interstitial brain.

Due to increased intracranial pressure, a significant number of patients develop visual disturbances (hemianopsia, decreased visual acuity), more often caused by pressure of the tumor growing from the fossa sella turcica on the optic nerves, less often by congestion in them. Changes in the autonomic nervous system are usually expressed by symptoms of increased excitability: "hot flashes", hyperhidrosis, a tendency to tachycardia, instability of blood pressure, etc.

There are no specific psychoses for acromegaly. Often, patients with acromegaly have apathy, lethargy, slowness, drowsiness, and sometimes a decrease in intelligence.

The most common complications in acromegaly are: reduced vision to complete blindness due to atrophy of the optic nerves, cerebrovascular accident, cerebral hemorrhage.

Acromegaly, which develops in childhood and adolescence, differs in some clinical signs from adult acromegaly: since the disease occurs before the completion of sexual development and the closure of the epiphyseal growth zones, it is combined with gigantism or subgigantism.

Diagnosis acromegaly is not difficult. X-ray of the Turkish saddle specifies the localization of the adenomatous process in the pituitary gland, which caused the development of the disease (see below). It is necessary to systematically monitor the state of the functions of the eye and the fundus. Hemianopsia is often preceded by achromatopsia (change in color vision), so it is necessary to study the visual field for colors.

Increasing changes in the fundus and eye functions allow you to correctly determine the method of treatment.

Forecast depends on the nature of the process in the pituitary gland. The cause of death may be intercurrent infections, resistance to which in patients with acromegaly is reduced.

Treatment. The most radical methods are surgery to remove a pituitary tumor (see Pituitary gland, surgical treatment of tumors) and radiotherapy (see below). Hormonal treatment is indicated for secondary dysfunctions of other endocrine glands. Sex hormone preparations are often used: for men - testosterone propionate (intramuscularly at 25-50 mg every other day, for a course of 20-30 injections) or methyltestosterone (sublingually at 5-10 mg 3 times a day), for women - estrogenic drugs and progesterone for the same principle and in the same dosages as in the treatment of amenorrhea (see). For other complications, appropriate treatment is carried out with thyroidin, methylthiouracil, mercazolil, microdoses of iodine, insulin (see Hypothyroidism, Sugar diabetes, Diffuse toxic goiter).

X-ray diagnostics. Acromegaly is characterized by thickening of the bones of the cranial vault, protrusion of the superciliary arches and the occiput, and an increase in the facial bones, especially the lower jaw (Fig. 2). The pneumatization of the air-bearing bones of the skull is pronounced.

With a tumor of the pituitary gland, the sella turcica is enlarged in size, the bottom of the pituitary fossa is lowered into the lumen of the sinus of the main bone, the back is elongated. The entrance to the Turkish saddle may not be expanded if the enlarged pituitary gland has not gone up beyond the diaphragm of the saddle. In this case, chiasmatic phenomena are absent. Thinning from the bottom of one or both anterior sphenoid processes or the usuration of the apex of the temporal bone pyramid indicates that the tumor is large and makes it possible to judge the direction of its growth. When carotid angiography in patients with acromegaly, there may be a displacement of the siphon of the internal carotid artery to the side, anteriorly or posteriorly.

The bones of the skeleton in acromegaly are enlarged in size. Severe kyphoscoliosis of the spine.

With the development of the disease, after the end of the period of ossification, the bones of the limbs are thickened, especially in the epiphyses, where osteophytes occur. If acromegaly occurs before the end of the period of ossification of the tubular bones, the limbs are elongated, the patient's height exceeds the norm.

X-ray therapy in acromegaly, it is used as an independent method or in combination with surgical treatment. The central location of the tumor in the skull makes it preferable to use pendulum and rotary devices. In the presence of x-ray machines with a fixed tube, the maximum number of fields and the narrowest possible tube (4X4 cm) are advantageous. Three or five fields are used: two temporal and two along the midline - lower frontal and upper frontal. The fifth field from the back of the head is also rarely used. At 200-190 kv and 10-20 mA and filters 1 Cu + 1 Al, a single dose of 100-200 r per session on the skin surface daily. The total dose for one course is brought to 4000-4500-6000 r.

Repeated courses are carried out (with control over the condition of the skin, hair, blood, fundus, eye functions, endocrine system and metabolism) at the following intervals: the second course - two months after the first, the third - three months after the second, the fourth - four months after the third course.

Positive results of treatment - restoration of menstruation or streamlining of the menstrual cycle, sexual function, improvement of fields and visual acuity, improvement of metabolic parameters. Negative results indicate continued growth of the neoplasm.

Acromegaly (synonymous with Marie's disease) is a syndrome with hyperplastic changes in the eosinophilic cellular elements of the anterior pituitary gland, causing increased secretion of growth hormone. Described in 1886 by P. Marie, who associated the disease with damage to the pituitary gland. It affects people of both sexes equally, often begins between 20 and 30 years old, rarely develops in children and adolescents.

The etiology has not been elucidated. In some cases, the disease may be associated with trauma to the skull or infection. Pregnancy, removal of the ovaries and menopause can provoke the syndrome.

Pathogenesis. All the most characteristic manifestations of acromegaly are caused by hyperfunction of eosinophilic cell formations of the anterior pituitary gland and develop under the influence of excess growth hormone entering the body. The close anatomical and functional connection of the pituitary gland with the diencephalon and the functional subordination of the latter to the cerebral cortex oblige to attach importance to disorders of the central nervous system in the pathogenesis of acromegaly.

The diverse pathological phenomena that develop with acromegaly can be divided into 2 groups according to their origin. The first group of disorders caused by a disorder of the diverse endocrine functions of the cerebral appendage, as well as a secondary change in the functions of other endocrine glands, includes diabetes and diabetes insipidus, galactorrhea, thyrotoxicosis, myxedema, viril syndrome and disorders of the ovarian-menstrual cycle in women, morphological and functional changes in sexual spheres in men. The second group includes disorders due to the pressure of the growing adenoma on the nerve formations adjacent to the pituitary gland.

For acromegaly, a narrowing of the visual fields from the temporal sides is typical (bitemporal hemianopsia). In some cases, from the pressure of the pituitary tumor on the adjacent parts of the diencephalon, dysfunctions of the autonomic nervous system of central origin may occur.

On the basis of endocrine and central nervous disorders, various secondary changes occur - the early development of atherosclerosis, hypertension, diseases of the digestive system, kidneys, etc.

Course and symptoms. The disease develops slowly and can go unnoticed by both the patient and others for a long time. Usually the patient goes to the doctor about changes in the face and limbs several years after the onset of the disease.

Early signs include sexual dysfunction, complaints of headaches of a paroxysmal or persistent nature. Localization of pain is different, more often in the fronto-parietal or temporal areas; Pain is accompanied by dizziness, nausea and vomiting. Often at the beginning of the disease there is an increase in muscle strength.

Late symptoms include visual disturbances, increased thirst, edema, and muscle weakness.

Gradually develop manifestations of the disease associated with the growth of the skeleton and soft tissues. They slowly change the appearance of the patient. Due to the disproportionate growth of bones, the shape of the skull, and especially the facial skeleton, changes dramatically. The superciliary arches increase due to the expansion of the air cavities of the frontal sinus, the zygomatic bones protrude, the occipital protuberance grows, and the circumference of the skull increases.

Especially characteristic is the increase in the lower jaw, the anterior angle of which protrudes forward in relation to the upper jaw (prognathism), the teeth move apart and the gaps between them increase (diastema). The bite changes. The auricles, nasal bones, cartilage and soft tissues grow, the nose becomes thick, rarely increases in length. The skin of the face and neck (back) thickens and forms deep folds. Facial features are enlarged. Acne often appears. Lips thickened. Eyelids swell. Hands and feet change dramatically. The fingers thicken both due to an increase in the phalangeal bones and due to the growth of soft tissues. An increase in limbs can be not only in width (“wide type”), but also in cases where acromegaly begins to develop in individuals with incomplete growth and uncovered epiphyseal zones, and in length (“long type”). Heel bone spurs grow. The chest increases due to the thickening of the ribs and the expansion of the intercostal spaces. The lower edges of the chest acquire a deployed position. The sternum and collarbones thicken. Exostoses form on the bones.

There is a tendency to develop multiple fibromas and lipomas in the subcutaneous tissue, as well as warts and skin papillomas. Hair thickens, coarsens and becomes thicker on the head and eyebrows. Abundant hair growth often develops on the trunk and limbs. Women may develop profuse virillic hypertrichosis with beard and mustache growth. The development of hypertrichosis in acromegaly is explained by the increased formation of androgenic steroids in the adrenal cortex.

An increase in the tongue causes slurred speech of the patient, the timbre of the voice decreases due to the growth of the tongue and vocal cords.

In most cases, men's potency decreases or disappears, and women develop amenorrhea, infertility, and atrophic changes in the internal genital organs. Galactorrhea may occur. The absence of violations of the sexual sphere in some cases of the disease is explained by the preservation of the functional usefulness of basophilic cellular elements in the anterior pituitary gland, which own the secretion of gonadotropic hormones.

Secondary disorders of the functions of the gonads and the adrenal cortex can lead to disturbances in the metabolism of steroid hormones, which may be accompanied by abnormalities in the content of 17-ketosteroids in the urine.

Often there is hyperplasia of the thyroid gland with a tendency to form nodes. In the initial stages of the disease, the phenomena of thyrotoxicosis may be noted, in the later stages - hypofunction of the thyroid gland due to loss of the thyrotropic function of the pituitary gland. Secondary insufficiency of the islet apparatus of the pancreas may develop. This is manifested in the development of diabetes mellitus, which can appear both as a result of a violation of the hormonal functions of the anterior pituitary gland, and as a result of a violation of the function of the central nervous regulation of carbohydrate metabolism from tumor pressure on the bottom of the third ventricle.

From the side of the central nervous system, there are phenomena of increased intracranial pressure: headache with nausea and vomiting, dizziness, and sometimes epileptoid seizures. A significant proportion of patients have visual disturbances, which may be the result of pressure from the tumor growing from the cavity of the Turkish saddle, on the optic chiasm, as well as congestive nipple. The disease is characterized by bitemporal hemianopia, usually beginning in the upper outer quadrant. Unilateral hemianopia may also develop. With endosellar growth of a pituitary tumor, visual disturbances characteristic of the disease do not develop. It is necessary to systematically monitor the condition of the fundus with the measurement of visual fields. Due to the fact that hemianopsia is sometimes preceded by a change in color vision, perimetry should also be performed on colors.

With the disease, radicular pains in the back, lumbosacral region, and neuralgia are often noted due to the pressure of the deformed vertebrae on the nerve roots and trunks. Changes in the functions of the autonomic nervous system are expressed in hot flashes, hyperhidrosis, a tendency to tachycardia, arterial blood pressure instability, sleep disorders, etc. Disorders are manifested in apathy, lethargy, sluggishness, drowsiness, memory loss.

Acromegaly can develop very slowly. In some cases, tumor growth may stop on its own and the development of the disease stops. Such forms are called "benign" acromegaly in contrast to "malignant" with rapid tumor growth and clinical manifestations, in particular vision loss.

With erased forms, the disease signs of acromegaly are mild and do not tend to progress. These forms approach the manifestation of certain acromegaloid features in the structure of the body of constitutional and hereditary origin. There are families where several members of the family have "acromegaloid features."

With the so-called "partial acromegaly", some separate parts of the body (limbs, fingers, tongue, nose) grow due to the increased reactivity of the tissues of these organs to growth hormone that enters the body in a normal amount. In these cases, there is no adenoma of the anterior lobe of the cerebral appendage.

If the disease occurs before the completion of puberty and the closure of the epiphyseal growth zones, it is associated with gigantism or subgigantism. At the same time, changes in the hands and feet develop not according to the “wide”, but according to the “long” type. Often, acromegaly in childhood is combined with eunuchoidism.

Complications. The most common complications are vision loss and diabetes mellitus. With hemorrhage or vascular thrombosis in the pituitary adenoma, followed by necrosis, brain symptoms are noted, and hypopituitarism may develop in the future.

Diagnosis is based on typical skeletal and soft tissue changes. X-ray of the Turkish saddle specifies the localization of the adenomatous process in the pituitary gland. The increase in the size of the Turkish saddle is determined by the nature of tumor growth. The bones of the cranial vault and their external protrusions are thickened. Enhanced pneumatization of the facial, temporal and main bones. Thickening of the bones is noted. Repeated fundus examinations with perimetry for different colors are needed.

Clinical and laboratory examinations make it possible to clarify the participation in the clinical picture of each individual case, secondary endocrine and metabolic disorders
In the differential diagnosis between acromegaly and Paget's disease, it is taken into account that in the latter, only individual bones of the skeleton are disfigured, which have a specific, roughly trabecular structure on the radiograph, which is not observed in acromegaly.

The prognosis depends on the nature of the process in the pituitary gland, it is unfavorable for malignant adenoma. In other cases, the disease progresses very slowly: a patient with acromegaly can live to old age and remain able to work for many years. Timely treatment can delay the development of the process, which improves the prognosis.

Treatment. Radical treatments for acromegaly are surgical removal of the pituitary tumor and deep X-ray therapy. The main method of surgical treatment of pituitary adenomas is transfrontal. In this case, local anesthesia is used with the addition of barbiturate anesthesia into a vein.

With deep X-ray therapy of eosinophilic adenomas and pituitary hyperplasia, the total dose is 12000-15000 r, a single daily dose is from 100 to 200 r, a course dose is 3000-4000 r with an interval of 1.5 to 6 months. Treatment is usually performed from two temporal and one frontal fields.

The Swedish method includes irradiation from 4-5 fields at 500 r per session. The total dose is 3000 r.

With secondary dysfunctions of other endocrine glands (genital, thyroid, pancreas), appropriate hormonal therapy is indicated.

Pathological anatomy. The disease is based on eosinophilic adenoma or diffuse hyperplasia of the anterior lobe of the cerebral appendage, less often there is a malignant adenoma with metastases. Sometimes the tumor is located in the sphenoid bone along the cranio-pharyngeal canal.

The pressure of the tumor can lead to atrophy of the optic and other cranial nerves, brain matter, and bone. In various systems of the body, hyperplasia of the connective tissue and parenchyma develops, often splanchnomegaly, the epiphysis, thymus and thyroid glands, and adrenal glands increase. The testicles atrophy, cysts form in the ovaries. Hyperplasia of the interstitial tissue develops in the pancreas, sometimes the islets of Langerhans. A pituitary tumor can be combined with a tumor of the parathyroid glands and pancreatic islets, with pheochromocytoma. Bones are intensively rebuilt and grow. At a young age, with incomplete growth of the skeleton, a simple increase in growth is noted. In adults, interstitial and endochondral bone growth resumes. Simultaneously with the new formation of bone tissue from the side of the periosteum, the inner zone of the compact layer is resorbed, which is why there is no noticeable increase in the mass of the bone substance.

Changes in the shape of the skull are not permanent and vary from patient to patient. The increase in the superciliary arches, characteristic of acromegaly, is changeable. In the entire skeletal system, growth is especially noticeable in the area of natural thickening of the bones, in particular, the collarbones thicken. The growth of the ribs occurs due to hyperplasia of the cartilaginous tissue, accompanied by the resumption of enchondral growth of the ribs. There is kyphoscoliosis of the thoracic spine, which eventually deforms spondylosis. The volume of the chest increases. Hyperplastic processes also occur in articular cartilage. With a long existence of the disease, the phenomena of deforming arthrosis develop.

Which lead to excessive production of pituitary growth hormone.

Acromegaly is a rare disease in medical practice. It manifests itself in the form of enlargement of some parts of the face and limbs (ears, lips, tongue, lower jaw, fingers, feet).

Pathology begins to develop after the end of the natural growth of a person. It can take 5-7 years from the onset of the disease to the clear presence of clear symptoms. In other words, the first signs of an abnormal state of the body appear closer to 30 years of age.

Reasons for the development of acromegaly

Acromegaly is a neuroendocrine disease that occurs due to hormonal imbalance and hyperfunctioning of the pituitary gland. The brain appendage in the form of a rounded formation (pituitary gland) produces growth hormone (somatotropic hormone), which ensures the correct and proportional development of tissues, muscles and bone apparatus, is responsible for water-salt, lipid and carbohydrate metabolism. The level of growth hormone in the bloodstream of a healthy body changes throughout the day. So, in the morning, the concentration of biologically active substances reaches the upper limit of the norm.

In patients who suffer from acromegaly, there is an excess of somatotropic hormone and its daily disproportionate fluctuation is fixed. The imbalance process is as follows. For some reason, the pituitary cells cease to “obey” the hypothalamus, which controls the rate of their growth and reproduction. As a result, their accelerated development occurs, which leads to the active and productive production of a “signal chemical”, which is responsible for maintaining normal homeostasis.

The proliferation of tissue leads to the formation of a pituitary adenoma. This is a benign tumor, which, although it does not cause metastases, can reach a significant size.

The main causes of the development of the disease:

benign or malignant neoplasms of the hypothalamus (tumors, cysts, hematomas);
traumatic brain injury, contusion and concussion;
some ENT pathologies (frequent sinusitis, sinusitis);
hereditary factor.

Sometimes acromegaly can be combined with other diseases, such as Rosenthal-Klopfer syndrome (gigantism and the presence of an additional thickened crease at the back of the head) and Sotos syndrome (an increase in internal organs and accelerated body growth).

Symptoms of acromegaly

The severity of symptoms depends on the stage of the disease. Thus, at the beginning of the development of the pathology, the patient does not feel any disorders, and his appearance practically does not change. With the progression of the disease, certain signs appear that indicate the development of acromegaly.

The main symptoms that occur when the function of the pituitary gland is impaired:

chronic increase in intracranial pressure, which causes a systematic headache;
lethargy, insomnia, frequent dizziness;
progressive deterioration in visual acuity;
pain in the joints and spine;
muscle weakness up to atrophy (last degree);
there is an increase in the palms and feet;
face modification: ears, cheekbones, eyebrows, lower lip, nose are enlarged. The lower jaw is pushed forward, the tongue becomes so large that it is difficult for it to fit in the oral cavity;
an increase in sweat glands, so the surface of the skin in patients is always moist and oily. There are diaper rash in large folds;
profuse growth of body hair;
decrease in voice timbre;
in women, there is an irregular monthly cycle (sometimes - amenorrhea), and in men - weakening of sexual function;
at the last stage of the disease, there is a violation of cardiac activity, renal and hepatic dysfunction.

Diagnosis and treatment of the disease

For the diagnosis of pathology, the following modern methods are used:

brain x-ray;
computer and magnetic resonance imaging of the brain;
taking venous blood to determine hormonal concentration;
consultation of an ophthalmologist and ENT doctor;
a study of the general analysis of blood and urine;
electrocardiogram, ultrasound diagnostics of internal organs.

The elimination of the disease is aimed primarily at lowering the level of the hormone, which causes abnormal tissue growth. In modern medical practice, there are the following methods of treatment:

Medical. The patient is prescribed hormonal therapy, which inhibits the abundant growth of pituitary tissue.
Operative treatment. Based on the removal of the adenoma by the transsphenoidal and endonasal transsphenoidal methods. To implement the first method, an incision is made in the gums, through which pathological tissues are destroyed. The second method is the introduction into the cranial cavity through the nasal passages.
Irradiation with a gamma spectrum or a proton beam. As a rule, this is an additional treatment that is prescribed after surgery in order to destroy the remaining pathological cells.

In addition, the treatment of parallel diseases that contributed to the development of hormonal imbalance must be present.

Complications and prevention

The prognosis of acromegaly with timely access to a specialist (in the early stages) is usually favorable. Successful and correct treatment helps to reduce growth hormone, which in turn eliminates adverse symptoms.

If the obvious signs are ignored, the disease leads to an irreversible process, which leads to death or serious disability.

After surgical removal of the tumor, relapses are often observed, that is, hormonal imbalance can worsen throughout life.

Preventive measures consist in the timely sanitation of the infectious process of the nasopharynx, the implementation of safety rules in order to prevent trauma to the brain.

You will learn more about acromegaly from the video.

Acromegaly is a pathological syndrome that progresses due to hyperproduction of somatotropin by the pituitary gland after ossification of the epiphyseal cartilage. The disease is characterized by pathological growth of bones, organs and tissues. Often with this disease, limbs, ears, nose, etc. increase. Due to the rapid growth of these elements, metabolism is disturbed and the risk of developing diabetes increases.

Acromegaly is more commonly diagnosed in people between the ages of 30 and 50. The fair sex is more susceptible to it. In rare cases, acromegaly is diagnosed in children. Pathology is more difficult for them, since the process of formation of bone structures has not yet been fully completed, and because of this, gigantism can progress. The patient has rapid growth, later the limbs increase, soft tissues and vital organs grow.

Etiology

Common causes of acromegaly:

pituitary microadenoma;
hyperplasia of acidophilic cells that produce growth hormone;
ectopic pituitary.

Hypersecretion of the hormone can be triggered by:

hypothalamic or ectopic production of somatoliberin;
ectopic production of somatotropin (often observed in the presence of a malignant tumor in the lungs).

Acromegaly can also be provoked by such reasons:

skull trauma;
tumors of a malignant and benign nature, localized in the central nervous system;
epidemic encephalitis;
various infectious diseases with acute or chronic course. This group includes, and so on;
tumors of a malignant nature, located in the left frontal lobe;
(congenital, acquired);
formed cysts in the brain.

Symptoms

Acromegaly develops rather slowly, so its first symptoms often go unnoticed. Also, this feature makes it very difficult to diagnose pathology early. The first signs that indicate the progression of the disease begin to appear a few years after the hormonal background has been disturbed due to various adverse causes. Most often, from the moment the first symptoms appear to the confirmation of the diagnosis, it can take from 5 to 10 years.

The clinic of acromegaly is quite diverse, but often the only complaint made by patients is a distortion of appearance. The patient's ears, nose, feet and hands are enlarged. As the pathology progresses, a thickening of the bones of the cranium is observed - the superciliary arches protrude, the jaw and occipital protuberance increase. As a result, the correct bite is disturbed, the tongue increases. The voice also changes. This is due to thickening of the ligaments and coarsening of the glottis.

In addition, the clinical picture is supplemented by the following symptoms:

muscle hypertrophy is observed only in the early stages of the progression of acromegaly. Muscular structures atrophy as the pathology progresses;
increase in blood pressure;
weight gain. It is worth noting that the mass increases moderately;
headache;
drowsiness;
violation of the normal functioning of the cardiovascular system. This can lead to the development of dangerous pathologies -, and so on;
the stomach, liver, and also the length of the intestine increase in size;
hypertrophy of the gonads is observed mainly in the fair sex;
neuritis;
a characteristic symptom of pathology is the loss of the ability to perceive any particular color;
peripheral vision drops out;

In severe cases, there is photophobia, decreased visual function. If the tumor grows too much and puts pressure on the brain tissue,.

Diagnostics

When the first symptoms appear that indicate acromegaly, you should immediately contact a qualified doctor for diagnosis and accurate diagnosis.

Acromegaly is diagnosed by an endocrinologist. The patient is prescribed instrumental and laboratory methods of examination.

Laboratory diagnostics:

blood sugar test;
a blood test to determine the concentration of phosphates;
blood serum to determine the concentration of cosatine phosphokinase;
joint puncture to take joint fluid (allows you to determine signs of inflammation);

Instrumental diagnostics:

electromyography;
x-ray. For an accurate diagnosis of the disease, this method examines the skull, joints, spine. The resulting images will clearly show changes in bone structures;

Treatment

Only after the diagnosis and confirmation of the diagnosis, the doctor will be able to prescribe a treatment plan for acromegaly. The main goals of therapy are to eliminate the cause of the progression of the pathology, as well as to reduce the concentration of somatotropin in the bloodstream.

Treatment of acromegaly is carried out with the help of drugs, as well as radiation therapy. Synthetic medications are prescribed to reduce the production of growth hormone by the pituitary gland. The most effective are the following:

somatostatin;
bromocriptine.

Sometimes doctors are forced to resort to surgical methods for the treatment of acromegaly. This usually happens if the formed tumor reaches too large a size and compresses the surrounding brain tissue. Also, these techniques are used if it was not possible to achieve positive dynamics from the use of conservative methods.

Anatomy and physiology of the central endocrine organs

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Symptoms of acromegaly disease

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How to treat acromegaly with folk remedies?

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What drugs are prescribed for acromegaly?

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What are the signs of gigantism in children?

Root causes and stages of acromegaly

Clinical manifestations

Diagnosis

Therapeutic measures for acromegaly

Symptoms

Signs of gigantism in children

Symptoms of acromegaly in adults

Diagnostics

Visual examination of the patient

Laboratory diagnostic methods

Determining the level of growth hormone

Determining the level of IGF-1

Glucose tolerance test

Instrumental diagnostic methods

CT or MRI

Skull x-ray

Treatment

Goals and Methods

Surgical intervention

Medical therapy

Radiation therapy

Medications

Medications

Folk remedies

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Symptoms of acromegaly

Diagnosis and treatment of the disease

Complications and prevention

Etiology

Symptoms

Diagnostics

Treatment

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