Acromegaly – causes, symptoms, diagnosis, treatment
Acromegaly develops in adults, after growth period. Occurs in both sexes, with a slight predominance in females, affecting the people aged 20 to 40 years.
In terms of etiology, the hypersecretion of somatotrope hormone (GH) may be due to a pituitary adenoma (a benign tumor developed in the gland) with hypersecretion of growth hormone, a hipotalamic hyperplasia resulting an excess of somatoliberine (neurohormone that is secreted by the hypothalamus and regulates the hormone secretion of anterior pituitary gland), or an excess of ectopic somatoliberine (which has a different abnormal origin) that comes from a lung cancer, thyroid medullary carcinoma.
Clinically, acromegaly is a disease that has a slow onset, the patient may notice an increase of the extremities (hands, feet), which forces him to change gloves and shoe number. Physiognomy begins to change. To these it can be added a series of symptoms such as headache, joint pain.
The state period is characterized by a series of signs and symptoms: morphological, endocrine, nervous.
– Morphological syndrome – the skull lengthens in antero-posterior direction and vertically; forehead is low, eyebrows arch is accentuated, the lower jaw is massive, undershot and because of that overgrowth the teeth are removed each other, the nose is big, big lips and rolled out, ears grow in size, the tongue is hypertrophied occurring difficulties in speech, vocal cords and larynx hypertrophy will have the result a harsh and hoarse voice, the hands are large and wide , feet are large, wide and flat, the neck is short, the backbone is curved (cervico-dorsal kyphosis), chest is wide, sternum is bold and prominent, large basin, internal organs are enlarged, the skin is rough, thickened, hair is coarse, rough, women may develop hypertrichosis (abnormal hair growth);
– Endocrine syndrome – the male genitals are hypertrophied but despite this, the sex appetite is decreased and virility is diminished; in women occur menstrual cycle disturbances, which may include the installation of amenorrhea (absence of menstruation), reducing the volume of the uterus, breasts may atrophy or may be hypertrophic and secrete milk (somatotrope hormone excess is accompanied by excess of prolactin that stimulates lactation);
– Nervous syndrome – these patients frequently complain about joint pain and headache, symptoms that result in slowing the ability to concentrate and reduce work capacity;
– Tumor syndrome – characterized by headache (headache) and visual disturbances.
Investigations necessary for the diagnosis of acromegaly are metabolic (determination of glucose, free fatty acids, triglycerides, phosphorus, calcium elimination), hormonal (somatotrope hormone dosage, which is very high, and other hormones to assess the remaining pituitary function), and imaging (CT, magnetic resonance imaging).
Patients with acromegaly may develop a series of heart-related complications: acromegaly cardiomyopathy , ischemic heart disease, hypertension), metabolic (diabetes, hypercalciuria, hyperlipidemia), anterior pituitary failure (with subsequent affecting of all peripheral endocrine glands) and increased malignancy (these patients frequently develop colon cancer).
Regarding treatment, neurosurgery can be performed (with good results in small pituitary adenomas), medication (Bromergocriptine, octreotide which has good efficacy on decreasing somatotrope hormone values and decreasing the tumor volume) or high voltage targeted radiotherapy.