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Acromegaly

What is acromegaly?

Acromegaly (from Greek words acron - limb, megalos - large) - a disease that is associated with increased production of growth hormone (somatotropin). It is characterized by disproportionate growth of the skeleton, soft tissues and internal organs. Acromegaly occurs in both sexes, there is usually after the growth of the organism, ie, mostly aged 20-40 years, develops gradually and lasts for many years.
This disease is known since ancient times. If acromegaly is changed appearance, facial features become larger, increasing the size of the feet and hands. Now we know why there are such changes.

Where and how growth hormone?

Growth hormone is produced in the pituitary gland. The pituitary gland is an endocrine gland, small size (less than 1 cm), which is located at the base of the brain, bone seizure under the name "Turkish saddle" and produces vital hormones. Growth hormone in children provides a process of linear growth and the formation of bones and muscles in adult controls metabolism, including carbohydrate metabolism, fat metabolism, fluid and electrolyte metabolism.

Control of pituitary function implements another part of the brain called the hypothalamus. The hypothalamus produces substances that stimulate or inhibit hormone in the pituitary gland.

In a healthy human growth hormone content during the day is not the same at different times of day, and is subject to certain fluctuations. During the day, alternating episodes of marked decrease and increase concentrations of growth hormone, with maximum values in the early morning hours. If acromegaly is marked not only elevated levels of growth hormone, but also disturbed the normal rhythm of its release into the blood.

The reasons that lead to acromegaly

Pituitary cells that produce growth hormone, a number of specific causes "escape" from the regulatory influence of the hypothalamus and begin to rapidly proliferate and actively produce growth hormone. Continued growth of these cells leads to the formation of benign tumors of the pituitary - "pituitary adenoma", which may in some cases up to several centimeters in size, that is to be more normal-sized pituitary gland. Unchanged pituitary cells at the same time can be squeezed or even collapse.

The majority of patients with acromegaly pituitary tumor produces only growth hormone, however, about a third of patients may experience and excessive production of other pituitary hormones.

The most common disease contribute to the injury of the skull, an unfavorable course of pregnancy, acute and chronic infections (influenza, measles, etc.), trauma, tumors of the central nervous system.

The manifestations of acromegaly

During acromegaly produce a series of stages.

The earliest stage - preacromegaly - rarely detected, because the display is not as pronounced.

Hypertrophic stage is characterized by an expanded clinic disease.

Tumor stage in the disease symptoms, signs of impact on adjacent organs and tissues (increased intracranial pressure, eye and nerve damage).

Kahekticheskaya stage of exhaustion is the outcome of the disease.

Patients complain of dizziness, headaches, fatigue, blurred vision, pain in joints and back. The appearance of the patient is original. There has been a significant increase in upper and lower extremities. Hands and feet get shovel-shaped form. Marked increase in the brow, cheeks, nose, lips and ears. The lower jaw is enlarged, protruding. Language is increased, barely fits in her mouth. Voice is rough. Headaches are primarily concerned with the nature of the tumor acromegaly. They are associated with increased intracranial pressure.

Quite often, in acromegaly are marked changes in the skin often in skin folds and areas of friction wear, high fat and moisture due to increased number and size of sweat and sebaceous glands, folding.

In the initial stages of the disease there is an increase in muscle strength, which was later followed by a decrease in muscle volume and muscle weakness. The functions of internal organs increased during the initial stages of the disease is almost unchanged. Later joined by signs of cardiac, pulmonary and hepatic failure. May increase blood pressure.

In 50-60% of patients there is a violation of tolerance to glucose.

Sometimes the reduced visual acuity, visual field narrows. In the fundus is marked succession of edema, stasis and atrophy of the optic nerve, which if untreated leads to irreversible blindness.

Almost all women's menstrual cycle is disrupted, often there is a selection of milk from the breast that is not associated with pregnancy and childbirth, galactorrhea. One third of male sexual potency is reduced.

Tumor growth predominantly in the direction of the hypothalamus causes in patients with sleepiness, thirst, polyuria (increased volume and quantity of urination), the sharp rises in temperature. Perhaps the emergence of epilepsy, ptosis drooping eyelids, double vision diplopia. Reduced hearing acuity.

Forecast

In the absence of adequate treatment for patients with life expectancy of 3-4 years with an unfavorable course and early onset (at a young age) and from 10 to 30 years of slow development and congenial. With timely treatment of the favorable prognosis for life may recover. Work capacity is limited.

What can a doctor do?

Treatment includes a package of measures aimed at reducing the concentration of growth hormone in serum:

- Removal of a pituitary tumor, which produces growth hormone, or prevention of further increasing its size;
- Reducing the level of growth hormone in the blood with drugs;
- The disappearance or a significant softening of the manifestations of the disease.

Reduction of growth hormone is not only important for good health and reduce the patient (disappearance) of clinical symptoms, but also to preserve life. It is now known that long-term elevated growth hormone in the blood leads to early death from cardiovascular, pulmonary, and cancer.

In any case, treatment of acromegaly is very important, because lack of treatment leads to early disability in patients active working age, and increases the risk of premature mortality.

What can you do?

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

Patients with acromegaly should always be supervised by an endocrinologist, an ophthalmologist and a neurosurgeon.