acromegaly is a rare hormonal disorder that develops when your pituitary gland produces too much...
TRANSCRIPT
ACROMEGALY
ACROMEGALY
Acromegaly is a rare hormonal disorder that develops when your pituitary gland produces too much growth hormone. This is almost always a result of a benign (noncancerous) tumor. This, however, is different from gigantism, which is basically the same disease, but it occurs when a person is still young and growing.
ACROMEGALY
Acromegaly is uncommon and the physical alterations occur over long periods of time. Many of these symptoms may remain unnoticed for up to a period of 10 years. These changes may be noticed when seeing before and after pictures of a person with this disorder.
SYMPTOMS
Enlarged hands and feet
Fatigue and muscle weakness
Larger and broader facial features
Underbite
Excessive sweating and body odor
Thick, oily skin Enlarged liver Enlarged heart Enlarged kidneys Enlarged spleen
and other organs
SYMPTOMS
Enlarged tongue Pain and limited
mobility in joints Barrel Chest Sleep Apnea Impaired vision Headaches Husky Voice
Reduced sex drive Erectile dysfunction
in men Back pain Menstrual cycle
irregularities in women
CAUSES
Acromegaly occurs when your body produces too much growth hormone. The source of the excess hormone is almost always your pituitary gland, a small bean-shaped structure at the base of your brain behind your nose. Growth hormone is one of several hormones your pituitary gland produces.
CAUSES
Pituitary tumors- Most cases of acromegaly are caused by a benign tumor of the pituitary gland. In addition to producing excess growth hormone, these tumors can press on nearby tissues as they grow. This pressure can cause some of the symptoms of acromegaly, such as headaches and impaired vision.
CAUSES
Nonpituitary tumors- In a few people, acromegaly is caused by benign or cancerous tumors in other parts of the body, such as the lungs, pancreas or adrenal glands. Some of these tumors actually secrete growth hormone. In other cases, they produce a hormone called growth hormone-releasing hormone (GH-RH), which stimulates the pituitary gland to make more growth hormone.
COMPLICATIONS High blood pressure
(hypertension) Heart disease, particularly
enlargement of the heart muscle (cardiomyopathy)
Arthritis Diabetes Precancerous growths (polyps) in
your colon Sleep apnea, a condition in which
breathing repeatedly stops and starts during sleep
COMPLICATIONS
Carpal tunnel syndrome — tingling or pain in your fingers caused by excess wrist tissue pressing on nerves
Reduced production of other pituitary hormones (hypopituitarism)
Benign tumors in the uterus (uterine fibroids)
Spinal cord compression Vision loss
TEST AND DIAGNOSIS
Measuring IGF-1- Because growth hormone stimulates your liver to produce IGF-1 — another growth hormone — IGF-1 blood levels are nearly always elevated when you have acromegaly.
TEST AND DIAGNOSIS
Measuring growth hormone before and after you drink glucose. In this test, your blood levels of growth hormone are measured both before and at several points after you drink a preparation of sugar (glucose). Normally, taking in glucose causes growth hormone levels to fall. But if your body is producing too much growth hormone, levels stay high
TEST AND DIAGNOSIS
Imaging - Magnetic resonance imaging (MRI) of your brain to pinpoint the size and location of your tumor. Brain imaging may sometimes be performed with Computerized tomography (CT). If brain imaging fails to detect a pituitary tumor, your doctor may recommend additional blood work and further imaging studies of your chest or abdomen.
TREATMENTS AND MEDICATIONS
Transsphenoidal surgery- In this procedure, named for the sphenoid sinus — air pocket behind the nose — your surgeon extracts the tumor through a small incision through the back wall of the nose.
Removing the tumor surgically can quickly and effectively return growth hormone levels to normal and relieve pressure on the tissues around your pituitary gland
TREATMENTS AND MEDICATIONS
But even the most experienced surgeon may not be able to completely remove tumors that have grown large or extended into nearby blood vessels or other structures. Incomplete tumor removal may result in growth hormone levels that stay high after surgery, requiring further treatment with medication or radiation.
TREATMENTS AND MEDICATIONS
If the pituitary tumor is inaccessible to surgery, or the patient is at high risk of surgical complications. They may also need medications if their growth hormone levels stay high following surgery. The need for medications may continue for the rest of your life.
TREATMENTS AND MEDICATIONS
Medications used to lower the production of growth hormone or block its action on target tissues include:
Somatostatin analogues (SSAs). Growth hormone receptor
antagonists (GHRAs). Dopamine agonists.
TREATMENTS AND MEDICATIONS
Somatostatin analogues (SSAs). The drugs octreotide (Sandostatin, Sandostatin LAR) and lanreotide (Somatuline Depot) are synthetic versions of the brain hormone somatostatin — growth hormone release-inhibiting hormone. They can decrease growth hormone levels by blocking the pituitary gland's excess production.
TREATMENTS AND MEDICATIONS
Growth hormone receptor antagonists (GHRAs). The medication pegvisomant (Somavert) blocks the effect of growth hormone on body tissues. This medication can normalize IGF-I levels and relieve symptoms in most people with acromegaly, but doesn't lower growth hormone levels or reduce the tumor size.
TREATMENTS AND MEDICATIONS
Dopamine agonists- Cabergoline (Dostinex) and bromocriptine (Parlodel) offer another strategy to reduce growth hormone production and shrink tumors.
TREATMENTS AND MEDICATIONS
Radiation therapy can quickly stop lingering tumor cells from growing and slowly reduce growth hormone levels. It may take years for this treatment to noticeably improve acromegaly symptoms, and patient’s may continue to need medication while waiting for growth hormone levels to fall.
TREATMENTS AND MEDICATIONS
Conventional radiation therapy- This type of radiation is usually given every weekday over four to six weeks. It may take five to ten years or more for your growth hormone levels to return to normal.
TREATMENTS AND MEDICATIONS
Stereotactic radiosurgery- Radiation can also be given stereotactically, with intense, focused beams aimed at a tumor from various directions. This form of treatment damages the tumor, while still doing little damage to the surrounding areas.
Video
http://www.youtube.com/watch?v=8yDiGLqzKKA
GUESSING GAME
Arnold Schwarzenegger
NO!!!
Andre the Giant
YES!!!
NO!!!
Abraham Lincoln
YES!!!
Hulk Hogan
NO!!!
Bao Xishun
NO!!!
Antonio Silva
YES!!!
Yao Ming
NO!!!
Jocelyn Wildenstein
NO!!!
Richard Kiel
YES!!!
Primo Carnera
YES!!!
Barack Obama
NO!!!
Review Questions:
1. If Bobby, age 42, had a surgery to remove a benign tumor located at the base of the brain and the tumor was not completely removed, what course of action would you take to further treat the patient?
A. attempt a second surgery B. Assign radiation therapy C. Prescribe medication D. Both b and c
2. Brigitte, age 35, is being diagnosed with Acromegaly. She is assigned to take the IGF-1 blood level test. After she ingests the glucose, what will happen to her growth hormone level?
A. Stay high B. Increase C. Decrease D. Increase and then decrease
3. Stephany, age 15, has symptoms of enlarged hands and feet, chronic headaches, vision problems, broad facial features and irregular menstrual cycles. Which hormonal disorder will she be diagnosed with?
A. Dwarfism B. Gigantism C. Virilism D. Acromegaly
4. A patient diagnosed with acromegaly has developed precancerous growths in their…
A. Uterus B. Brain C. Colon D. Liver
5. A patient who has been diagnosed with acromegaly, will experience the following symptoms except…
A. Sleep apnea B. Arthritis C. Spinal Cord Compression D. Loss of hair
Works Cited: "Advances in the Treatment of ACROMEGALY." Innovation.org -. Web. 22
Mar. 2012. <http://www.innovation.org/index.cfm/InnovationToday/InnovationinRare
Diseases/Rare_Diseases_-_Acromegaly>. Board, A.D.A.M. Editorial. "Causes, Incidence, and Risk Factors."
Acromegaly. U.S. National Library of Medicine, 11 Dec. 2011. Web. 20 Mar. 2012.<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001364/>.
Khandwala, MD, FRCPC, Hasnaim M. "Read What Your Physician Is Reading on Medscape." EMedicineHealth. Ed. Arthur B. Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Francisco Talavera, PharmD, PhD, and George T. Griffing, MD. 16 Nov. 2009. Web. 22 Mar. 2012. <http://www.emedicinehealth.com/acromegaly/article_em.htm>.
Miller, D'hania. "Endocrine System." Practicum in Health Science I. TX, Spring.19 Mar. 2012. Lecture.
Staff, Mayo Clinic. "Acromegaly." Mayo Clinic. Mayo Foundation for Medical Education and Research, 03 Aug. 2010. Web. 20 Mar. 2012. <http://www.mayoclinic.com/health/acromegaly/DS00478>.