Acromegaly

The most common tumor is the pituitary gland, which in 20% of patients contains eosinophilic, and the others have chromophobic granules. Acromegaly may be a consequence of ependyma III of the ventricle, glioma of the hypothalamus.

The erased form of acromegaly can be due to a constitutionally conditioned hypothalamic-pituitary dysfunction. Symptoms of acromegaly can be detected in the syndrome of the "empty" Turkish saddle.

[1], [2]

Causes of acromegaly

The disease is mainly associated with hyperproduction of growth hormone, which is primarily pituitary, caused by the development of an autonomous tumor, or has a hypothalamic origin, associated with excessive secretion of the STG-releasing factor or with insufficient secretion of somatostatin. The latter view is supported by the possibility of a pituitary tumor with hypersecretion of growth hormone as a result of the long-term stimulation of the STG-releasing factor.

[3], [4], [5], [6], [7],

Symptoms of acromegaly

Symptoms of acromegaly usually appear after 20 years, develop gradually. Early signs of acromegaly - swelling and hypertrophy of the soft tissues of the face and extremities. The skin thickens, the severity of the skin folds increases. Increasing the volume of soft tissues makes it necessary to constantly increase the size of shoes, gloves, rings.

Often there are generalized hirsutism, increased pigmentation, the appearance of cutaneous fibrous nodules, increased skin greasiness, increased sweating. Bony changes join later, develop more slowly, consist in thickening of the cortical layer of bones, the formation of bone outgrowths, thorns at the end of the phalanges.

As a result of hypertrophic arthropathy, often the phenomenon of arthralgia and deforming arthritis. The enlargement of the lower jaw leads to prognathism, protrusion of the lower incisors, and the widening of the spaces between the teeth. There is a proliferation of the facial skeleton, an increase in the size of the bony sinuses, hypertrophy of the vocal cords, leading to a coarsening of the voice. If hypersecretion of growth hormone begins in childhood, then there is a proportional increase in growth with the development of true gigantism, which, as a rule, is accompanied by hypogonadism. Perhaps a combination of gigantism with phenomena of acromegaly, which indicates a fairly long time for the onset of the disease. Patients often have signs of viscromegaly, most often in the form of cardio- and hepatomegaly. Quite a common sign is the various tunnel syndromes (more often the carpal canal) that result from the growth of the surrounding nerves of ligaments and fibrous tissue.

As a rule, acromegaly is combined with varying degrees of signs of hypogonadism, obesity, diabetes.

Among patients with typical acromegaly, individuals with an acromegaloid condition characterized by mild or transitory signs of acromegaly should be isolated. The acromegaloid state, or, in the words of N. Dishing, "fleeting acromegaly", is characteristic for periods of hormonal rearrangements: pubertal, pregnancy, menopause. Individual signs of acromegaly may occur in cerebral obesity, diabetes insipidus, idiopathic edema, syndrome of the "empty" Turkish saddle.

Differential diagnosis of acromegaly

It should be borne in mind the possibility of ectopic production of growth hormone bronchogenic lung cancer, as well as carcinoid tumors. Some of these tumors contain the STG-releasing factor.

[8], [9], [10]

Treatment of acromegaly

There are three approaches to therapy - surgical, radiation and pharmacological. The first two approaches are applied in the presence of a tumor process. Pharmacotherapy with estrogens and progesterone, as a rule, does not give sufficient effect. Use drugs that affect the metabolism of neurotransmitters in the central nervous system (L-DOPA, parlodel, fisenil, metergoline, cyprogentadine). L-Dopa has the ability to rapidly suppress the secretion of STH in acromegaly. Widely used therapy with bromocriptine (parlodel) at a dose of 10-15 mg / day. Depending on the tolerance for an indefinitely long time. There are reports that parlodel remains active in suppressing hyper-secretion of STH even with continuous admission for 7 years. Parlodel is not only able to inhibit the secretion of STH, but also has antitumor activity. Parlodel treatment should be recommended in case of tumor processes with contraindications to surgery and radiation therapy. It is mainly used for hypersecretion of STH and the absence of a tumor process. Treatment of acromegaly with cyprogentadine (peritol, deseril) is a long time in a dose of 25 mg / day.