Acromegaly

EXTREME ENLARGEMENT !!!

What is acromegaly ???

Acromegaly is a syndrome where there is excessive production of growth hormone by a rumour in the anterior pituitary gland which is called adrenal adenoma. It can also be caused by tumour present in pancreas, lungs and adrenal glands which are responsible to produce GHRH (Growth Hormone Releasing Hormone)

Some symptoms of acromegaly

  • Enlarged hands and feet
  • Coarsened, enlarged facial features
  • Coarse, oily, thickened skin
  • Excessive sweating and body odor
  • Small outgrowths of skin tissue (skin tags)
  • Fatigue and muscle weakness
  • A deepened, husky voice due to enlarged vocal cords and sinuses
  • Severe snoring due to obstruction of the upper airway
  • Impaired vision
  • Headaches
  • Enlarged tongue
  • Pain and limited joint mobility
  • Menstrual cycle irregularities in women
  • Erectile dysfunction in men
  • Expansion of skull at the Fontanelle
  • Enlarged liver, heart, kidneys, spleen and other organs
  • Increased chest size

Tests

  • Growth hormone level
  • Insulin growth factor
  • Abnormal bone growth
  • Pituitary MRI may show tumour
  • Tests may show enlarged hearts

Treatments for acromegaly

Surgery
Doctors can remove most pituitary tumors using a method called transsphenoidal surgery. In this procedure, your surgeon works through your nose to extract the pituitary tumour.



Medications
Drugs used to lower the production or block the action of GH include:

  • Somatostatin analogues. The drugs octreotide (Sandostatin) and lanreotide (Somatuline Depot) are synthetic versions of the brain hormone somatostatin. They can interfere with the excessive secretion of GH by the pituitary, and thus can produce rapid declines in GH levels.
  • Dopamine agonists. The medications cabergoline and bromocriptine (Parlodel) are taken as pills. In some people, these drugs can lower levels of GH. The tumor may decrease in size in some people taking a dopamine agonist or somatostatin analogues.
  • Growth hormone antagonist. The medication pegvisomant (Somavert), a growth hormone antagonist, acts to block the effect of GH on body tissues



Radiation
Your doctor may recommend radiation treatment when tumor cells remain after surgery. Radiation therapy destroys any lingering tumor cells and slowly reduces GH levels. It may take years for this treatment to noticeably improve acromegaly symptoms.


Radiation therapy can be done by two methods


  • Conventional radiation therapy. This type of radiation therapy is usually given every weekday over a period of four to six weeks. You may not realize the full effect of conventional radiation therapy for 10 or more years after treatment.


  • Stereotactic radiosurgery. Also known as Gamma Knife radiosurgery, stereotactic radiosurgery can deliver a high dose of radiation to the tumor cells in a single dose while limiting the amount of radiation to the normal surrounding tissues. This type of radiation may bring GH levels back to normal within three to five years.


Diagnosis

If acromegaly is suspected, medical imaging and medical laboratory investigations are generally used together to confirm or rule out the presence of this condition
MINAL SHAH, MEET AKBARI, AKSHAT DESAI, JEHAN SHAH & HITARTH RAJA