acromegaly - a disease of the pituitary gland, associated with their increased production of growth hormone - somatotropin, is characterized by increased growth of the skeleton and internal organs, coarsening of facial features and other body parts, metabolic disorders.The disease debut, when the normal physiological growth of the organism has been completed.In the early stages of pathological changes caused by it, subtly or not noticeable at all.For a long time progresses acromegaly - increases its symptoms and changes in appearance become apparent.On average, the first symptoms before the diagnosis takes 5-7 years. Content
suffer from acromegaly face adulthood: usually between 40-60 years
secretion of growth hormone - growth hormone - is carried out by the pituitary gland.It is regulated by the hypothalamus, which is optionally produces neurosecretion somatostatin (inhibits the production of growth hormone) and somatoliberin (activates it).
The human growth hormone provides a linear increase in the skeleton of the child (ie. E. The growth of its length) and is responsible for the correct formation of the musculoskeletal system.
In adults, growth hormone persons involved in metabolism - has a strong anabolic effect, stimulates protein synthesis, reduces fat deposits under the skin and increase its combustion, increases the ratio of muscle to fat mass.In addition, this hormone regulates carbohydrate metabolism, being one of kontrinsulyarnyh hormones, t. E. Increasing the level of glucose in the blood.
available data and that the effects of growth hormone are also immunostimulatory and increased absorption of bone calcium.
In 95% of cases the cause of acromegaly is a pituitary tumor - adenoma, or somatotropinoma providing increased secretion of growth hormone.In addition, the disease can occur when:
Typically, acromegaly develops after CNS injury, infectious and noninfectious inflammatory diseases it.
proved that often suffer from acromegaly, those persons whose relatives have also have this pathology.
Morphological changes in acromegaly characterized hypertrophy (increase in volume and weight) tissue of the internal organs, the growth of connective tissue in them - these changes increase the risk of benign and malignant tumors in the body of the patient.
subjective symptoms of this disease are:
An objective study of a person suffering from acromegaly, a doctor will be found the following changes:
In 9 of 10 patients with acromegaly in a developed stage, it marked symptoms of sleep apnea.The essence of the state lies in the fact that, due to hypertrophy of the soft tissues of the upper respiratory tract and disorders of the respiratory center in man during sleep the case of brief stops breathing.The patient himself, as a rule, about them and does not know and pay attention to this symptom relatives and friends of the patient.They say the night snoring, which is interrupted by pauses, during which often completely absent respiratory movements of the chest of the patient.These pauses last for a few seconds, after which the patient wakes up suddenly.Awakenings per night is so much that the patient does not get enough sleep, feeling overwhelmed, he worsens mood, he becomes irritable.Furthermore, there is a risk of death of the patient, if one of the stops breathing delayed.
In the early stages of acromegaly does not cause discomfort to the patient - not very attentive, patients did not even notice the increase in a particular part of the body in size.As the disease progresses, symptoms become more pronounced, eventually develop symptoms of cardiac, hepatic and pulmonary insufficiency.In these patients, the risk of developing atherosclerosis, hypertension is much higher than in persons not suffering from acromegaly.
If pituitary adenoma develops in the child, when the growth zone of its skeleton still open they begin to grow - the disease appears gigantism.
doctor suspect this pathology has on the basis of patient complaints, anamnesis of disease (progressing for several years, the nature of symptoms) and the results of the physical examination of the patient (visual inspection Note the increase in the size of the body, palpation detects abnormal size of the internal organs).In order to confirm the diagnosis of the patient will be assigned additional diagnostic methods:
determine the level of growth hormone, it is important to remember that the peak of its secretion in a healthy person falls on the night, and in the case of acromegaly, this peak is absent.
confirms the diagnosis of acromegaly results of instrumental methods - X-ray of the skull: the picture will render an increase of the Turkish saddle.To see directly pituitary adenoma, patients underwent computed or magnetic resonance tomography.
In the case of complaints of the patient on a visual impairment, consult an ophthalmologist prescribed it.At the last survey finds characteristic of acromegaly narrowing of the visual field.
If the patient complained of peculiar pathology specific internal organ, additional methods of research it is assigned individually.
differential diagnosis in cases of suspected acromegaly should be hypothyroid, and Paget's disease.
goal of treatment is to normalize the blood level of growth hormone (decrease it below 5 ng / ml) and IGF-1.
For the treatment can be utilized medical, surgical, radiation techniques, and combinations thereof.The choice of method depends on the size and growth of the tumor of the pituitary gland, the state of the body, the level of growth hormone, the patient's age and the presence of comorbidity.
In uncomplicated, non-progressive pituitary adenomas recommended drug therapy.Use cabergoline (Dostinex) at a dose of 0.5 mg twice a week, and bromocriptine (Parlodel) in 2.5-10 g per day.In recent years, well established drug Octreotide - a synthetic analogue of the long-acting somatostatin, which suppresses the production of pituitary growth hormone by reducing the size of the adenoma.
If adenoma reached a considerable size, or rapidly progressing disease, drug therapy alone is not enough - in this case the patient operative treatment.The direct indication for surgery is the rapid loss of vision.The tumor is removed through the cuneiform.In 85% of patients after tumor removal has been a significant reduction in growth hormone up to the normalization and stable remission of the disease.When a particularly large size of the tumor in a single operation, probably not limited - as a result it can be cured only one-third of patients, the rest require re-operation or continued therapy with other methods.
In the case of contraindications to surgery, the impossibility of carrying out his or categorical refusal patient from surgery radiation therapy.It is carried out by irradiating the area of the pituitary gland or proton beam radiation to the tumor implantation of gold.The effectiveness of this method is about 60-80%.
In the case of early diagnosis of the disease and adequate treatment of his remission reaches the vast majority of patients.When large-sized adenomas recurrence of the disease is quite large even after surgery.If the treatment of acromegaly is not carried out at all, the quality of life is rapidly reduced, and the risk of premature death increases: 90% of patients die under the age of 60 years.
Primary prevention of acromegaly is to prevent injuries of the head, timely readjustment of acute and chronic foci of infection of upper respiratory tract.To prevent the development of complications of the disease has made its debut as early as possible to begin treatment - to bring the level of growth hormone in the blood back to normal.