Acromegaly - what is it? Photos, causes and treatment

Acromegaly is a disease of the pituitary gland associated with increased production of growth hormone - somatotropin, characterized by increased growth of the skeleton and internal organs, enlargement of facial features and other parts of the body, and metabolic disorders. The disease debuts when the normal, physiological growth of the body has already been completed. In the early stages, the pathological changes caused by it are subtle or not noticeable at all. Over a long period of time, acromegaly progresses - its symptoms increase, and changes in appearance become obvious. On average, it takes 5–7 years from the appearance of the first symptoms of the disease to diagnosis.

People of mature age suffer from acromegaly: usually between 40–60 years, both men and women.

Effects of somatotropin on human organs and tissues

Growth hormone is produced by pituitary cells.
The secretion of growth hormone - somatotropin - is carried out by the pituitary gland. It is regulated by the hypothalamus, which, if necessary, produces the neurosecretes somatostatin (inhibits the production of somatotropin) and somatoliberin (activates it).

In the human body, somatotropic hormone ensures the linear growth of the child’s skeleton (i.e., its growth in length) and is responsible for the correct formation of the musculoskeletal system.

In adults, somatotropin is involved in metabolism - it has a pronounced anabolic effect, stimulates protein synthesis processes, helps reduce fat deposition under the skin and enhance its combustion, and increases the ratio of muscle to fat mass. In addition, this hormone regulates carbohydrate metabolism, being one of the counter-insular hormones, i.e., increasing the level of glucose in the blood.

There is also evidence that the effects of somatotropin are also immunostimulating and increasing the absorption of calcium by bone tissue.

Causes and mechanisms of development of acromegaly

In 95% of cases, the cause of acromegaly is a tumor of the pituitary gland - adenoma, or somatotropinoma, which provides increased secretion of growth hormone. In addition, this disease can occur when:

• pathology of the hypothalamus, which provokes increased production of somatoliberin,
• increased production of insulin-like growth factor;
• increased sensitivity of tissues to somatotropic hormone;
• pathological secretion of somatotropin in internal organs (ovaries, lungs, bronchi, gastrointestinal tract) - ectopic secretion.

As a rule, acromegaly develops after injuries to the central nervous system, infectious and non-infectious inflammatory diseases.

It has been proven that people whose relatives also have this pathology are more likely to suffer from acromegaly.

Morphological changes in acromegaly are characterized by hypertrophy (increase in volume and weight) of the tissues of internal organs, the growth of connective tissue in them - these changes increase the risk of developing benign and malignant neoplasms in the patient’s body.

Acromegaly, causes, symptoms and treatment, drugs

Category: Hormonal

Acromegaly and pituitary gigantism

Hormones play a huge role in the human body. Thanks to their precise work, all cells, tissues and organs are connected into a single coherent system - endocrine, which clearly regulates all processes in the body.

The main endocrine gland is the pituitary gland, which secretes a number of hormones that control many functions in the body.

It is the malfunctions in its work caused by the excessive production of the hormone STH (somatotropic), the so-called growth hormone, which is responsible for the growth of the body, provoking the development of a disease called pituitary gigantism and the disease acromegaly.

Acromegaly is a pathological process characterized by changes in certain anatomical areas of the body due to functional damage to the anterior lobe of the pituitary gland (pituitary gland) by a tumor process, leading to increased secretion of somatotropic hormone.

In adult patients, it is characterized by processes of enlargement and anatomical changes in various parts of the face and limbs, painful joint syndrome and migraines, disorders of the reproductive system and premature mortality from various diseases (vascular, cardiac, oncological and pulmonary).

Acromegaly, a hormone-dependent disease, is a rare endocrine pathology, diagnosed in patients of both sexes after forty years, when the body stops growing.

• External changes do not occur immediately; signs of acromegaly develop gradually - over five to seven years, after the initial, true moment of development of the disease.

Causes of acromegaly - genesis factor

Acromegaly photo 1

In young years, somatotropin produced by the pituitary gland regulates the processes of musculoskeletal formation and controls the growth factor in the body. In an adult body, it controls various metabolic processes.

The production of the hormone GH is controlled by the autonomic center of the brain (hypothalamus), through integrating regulators - release hormones. Somatoliberin, which stimulates hormone production and somatostin, which inhibits its production.

In the normal state of the body, the amount of somatotropin in the blood can fluctuate and manifest itself as a maximum increase only in the early morning, which is quite acceptable. With pituitary pathology, not only does its concentration level increase in the blood, but disturbances also occur in the processes of its production.

This is due to the fact that in patients with acromegaly, the pituitary gland, under the influence of various causative factors, ignores the signals of regulation of the autonomic center, continuing the production of growth factor hormones.

Excessive amounts of growth hormone trigger the biological production of insulin-like proteins in the liver, which are important mediators of growth factors in organs and tissues.

In young years, it can cause the development of tall stature and pituitary gigantism. In adulthood, it causes the development of acromegaly, provoking uncontrolled cell growth in the pituitary gland and the formation of an adenoma (benign tumor), which increases the secretion of growth hormone.

• This process enhances all growth factors of the body.

The genesis of pituitary gigantism is characterized by uniform growth of all organs, tissue and bone structures.

Since acromegaly starts the process of disorders from the moment the growth of the body ends, at a time when the bone structures have already ossified, pathologies are manifested by disproportionate thickening (dismutation) of the skeletal bones, metabolic disorders, hypertrophy and deformation in the stroma and parenchyma of various organs.

Such dystrophic anomalies become a “launching pad” for the development of tumor processes of a benign and malignant nature. It is the pituitary adenoma that is the main genesis (cause) of acromegaly and symptoms, which manifests itself as a result of increased production of somatotropin.

Contributing factors in the causes of acromegaly may be:

• tumor processes in the area of ​​the vegetative center;
• forms of chronic sinusitis;
• mechanical brain and cranial injuries;
• genetic predisposition.

Development and signs of acromegaly, photo

Acromegaly and gigantism photo 3

Acromegaly is characterized by a gradual development of symptoms.

1. The preacromegaly stage is characterized by weak initial signs. At this stage of its course, the disease is rarely diagnosable, except that it can be indicated by anabolic hormones ( GH ) detected in a plasma analysis, or by CT analysis of the brain.
2. At the hypertrophic stage, the signs of acromegaly are clearly expressed.
3. The stage of the tumor process is manifested by signs of compression of the nerve structures responsible for visual functions, functional disorders of the nervous system, and signs of intracranial hypertension.
4. Cachexia is a stage of complete exhaustion of the body, as an outcome of the development of acromegaly.

Symptoms of acromegaly are usually caused by excessive secretion of growth hormone, or the influence of an adenomatous tumor of the pituitary gland on the nerves of the visual system and brain structures adjacent to the tumor.

With an excessive concentration of growth hormones, bright signs of external transformation of patients are characteristic, caused by a significant increase in the bones of the skull - cheekbones, forming bones of the lower jaw and arches of the eyebrows. Noted:

• Hypertrophic changes in the shape of the osteochondral skeleton of the nose and the outline of the lips, ears;
• Facial features become larger and coarser.
• Deforming and enlarging processes of the mandibular bones, leading to divergence of the spaces of the dentition, contributing to changes in the bite.
• Signs of microglossia are an increase in the size of the tongue so that there is a dental mark on it.
• Hypertrophic changes in the tongue and vocal organ (larynx), which leads to a change in the voice - it becomes low and hoarse.

The gradual progression of symptoms is not noticeable. The bones of the skull, the thickness of the fingers on the limbs and the length of the foot gradually increase.

Skeletal dystrophy, as a consequence of acromegaly, is manifested by the following symptoms:

• pathological curvature of the spine;
• barrel-shaped deformation of the diaphragm, which causes an increase in the distances between the ribs;
• hypertrophic changes in connective and cartilaginous tissues, causing limited joint movements;
• pathological enlargement of vertebral segments, when their width exceeds their height.

Excess growth hormone and exposure to adenoma lead to an increase in the secretion of skin appendages, which is manifested by hyperhidrosis and increased fat secretion. As a result, the patient’s skin becomes rough and thickened, and in certain areas there is an accumulation of deep skin folds.

Gradually, muscle growth and degeneration of muscle fiber in the heart muscle occurs, developing into myocardial dystrophy, kidneys and liver. There are signs of sleep apnea associated with hypertrophy of laryngeal tissues and failure of the functions of respiratory neurons.

Sexual dysfunctions manifest themselves:

• menstrual pathologies and signs of infertility;
• galactorrhea (discharge of milk from the nipples), not associated with pregnancy or the postpartum period;
• decreased potency in men;
• diabetes insipidus.

The growth of adenoma leads to compression of the nerve ganglia and tissues adjacent to the tumor, manifesting itself with signs of intracranial hypertension, photophobia and signs of diplopia. Pain syndrome appears in the frontal area and cheekbones, signs of vertigo and vomitus, dysfunction of the organ of hearing and impaired sense of smell, paresthesia of the arms and legs are noted.

Acromegaly greatly increases the risk of tumors in the gastrointestinal tract, uterus and thyroid gland.

In the treatment of acromegaly, the main goal is to reduce the activity of the disease by completely eliminating hypersecretion of somatotropin and stabilizing the level of insulin-like proteins.

Treatment options include surgery, medication, and radiation therapy.

Surgical removal of the adenoma is the first of all possible treatments for acromegaly. With complete removal of the adenoma, it is possible to completely normalize the secretion of somatotropin hormones and the need for other treatment completely disappears; only medical supervision is required.

But since in many situations it is not possible to completely remove the tumor, for example, due to the large size of the tumor or its inconvenient location, alternative methods are used - drug or radiation therapy.

Drug therapy is based on taking drugs that inhibit and normalize the secretion of growth hormone under the influence of tumor formation.

• The drugs "Ocreotide", "Sandostatin" and "Somatulina" - in the form of injections 1/month, or "Lantreotide" - injections 1/2 weeks are widely used in the treatment of this pathology. These drugs can significantly reduce the size of the tumor, normalize hormone levels and smooth out the symptoms of the disease in many patients.
• Daily injections of the drug Somaverta, which reduces insulin and a growth factor, are also prescribed. And an easy-to-take drug in tablets – Dostinax.
• The treatment process includes sex hormones - the drugs Parlodela, Abergina or Cabergoline.

The irradiation technique is used for residual tumor components after surgical removal of the adenoma and failure of pharmacological treatment. The method is justified as postoperative therapy and as a self-treatment method that eliminates the hormonal activity of the tumor and its growth.

It cannot be said that the prognosis for acromegaly is completely disappointing. Increased mortality occurs in patients who are not treated. The usual survival rate of patients does not exceed 60 years of age.

Surgery in the early period, when the tumor has not reached a large size, and adequate treatment of acromegaly, can prolong the patient’s life until old age.

Source: https://zdravlab.com/akromegaliya-foto-prichiny-simptomy-lechenie/

Clinical manifestations of acromegaly

Subjective signs of this disease are:

• enlargement of hands and feet;
• an increase in the size of individual facial features - noteworthy are the large brow ridges, nose, tongue (there are teeth marks on it), and an enlarged protruding lower jaw; Gaps appear between the teeth, skin folds appear on the forehead, the nasolabial fold becomes deeper, the bite changes;
• deepening of the voice;
• headache;
• paresthesia (feeling of numbness, tingling, crawling in various parts of the body);
• back pain, joint pain, limited joint mobility;
• sweating;
• swelling of the upper limbs and face;
• fatigue, decreased performance;
• dizziness, vomiting (are signs of increased intracranial pressure with a pituitary tumor of significant size);
• numbness of the limbs;
• menstrual disorders;
• decreased libido and potency;
• blurred vision (double vision, fear of bright light);
• decreased hearing and sense of smell;
• leakage of milk from the mammary glands – galactorrhea;
• periodic pain in the heart area.

An objective examination of a person suffering from acromegaly by a doctor will detect the following changes:

• again, the doctor will pay attention to the enlargement of facial features and the size of the limbs;
• deformations of the bone skeleton (curvature of the spine, barrel-shaped - increased in anteroposterior size - chest, widened intercostal spaces);
• swelling of the face and hands;
• sweating;
• hirsutism (increased male pattern hair growth in women);
• an increase in the size of the thyroid gland, heart, liver and other organs;
• proximal myopathy (i.e. changes in muscles located in relative proximity to the center of the body);
• increased blood pressure;
• measurements on the electrocardiogram (signs of the so-called acromegaloid heart);
• increased levels of prolactin in the blood;
• metabolic disorders (a quarter of patients develop signs of diabetes mellitus that is resistant (resistant, insensitive) to glucose-lowering therapy, including the administration of insulin).

9 out of 10 patients with acromegaly in its advanced stage have symptoms of sleep apnea syndrome. The essence of this condition is that due to hypertrophy of the soft tissues of the upper respiratory tract and disruption of the respiratory center, a person experiences short-term respiratory arrests during sleep. The patient himself, as a rule, is not aware of them, but the patient’s relatives and friends pay attention to this symptom. They note nighttime snoring, which is interrupted by pauses, during which there is often a complete absence of respiratory movements of the patient’s chest. These pauses last several seconds, after which the patient suddenly wakes up. There are so many awakenings during the night that the patient does not get enough sleep, feels exhausted, his mood worsens, and he becomes irritable. In addition, there is a risk of death of the patient if one of the respiratory arrests is prolonged.

In the early stages of development, acromegaly does not cause discomfort to the patient - not very attentive patients do not even immediately notice the increase in size of one or another part of the body. As the disease progresses, symptoms become more severe, eventually developing symptoms of heart, liver, and lung failure. In such patients, the risk of developing atherosclerosis and hypertension is an order of magnitude higher than in persons who do not suffer from acromegaly.

If a pituitary adenoma develops in a child when the growth zones of his skeleton are still open, they begin to grow rapidly - the disease manifests itself as gigantism.

Symptoms of acromegaly

Excessive levels of somatotropic hormone in the blood cause the following changes in the patient:

• Enlargement of the ears, tip of the nose, lips, cheekbones;
• Coarsening of facial features;
• Changes in bite as a result of divergence of teeth and the appearance of interdental space;
• Enlargement of the tongue (when examining the tongue of a patient with acromegaly, one can note the imprints of teeth on it);
• Hypertrophy of the larynx and ligaments, as a result of which the patient’s voice changes (hoarse and low);
• Thickening of fingers, increase in skull size.

All these changes in the patient’s body occur gradually and imperceptibly, which forces him to change hats, gloves and shoes several sizes larger. In addition, the patient has a significant skeletal deformation: curvature of the spinal column, changes in the chest (becomes barrel-shaped), widening of the spaces between the ribs. Connective tissue grows on all organs, which makes the patient’s movements constrained and limited. Also, due to metabolic disorders in the body, a patient with acromegaly experiences increased sebum secretion and increased activity of the sweat glands.

Due to the increase in internal organs in size and volume, the patient experiences increased muscle dystrophy, which leads to weakness, fatigue, and a rapid decrease in performance. Cardiac muscle hypertrophy and heart failure progress rapidly. According to statistics, a third of patients with acromegaly have high blood pressure and disruption of the respiratory center, as a result of which attacks of apnea (temporary stoppage of breathing) often occur.

Pronounced changes are also observed in the organs of the reproductive system. Women with acromegaly experience menstrual irregularities, infertility, and milk secretion from the mammary glands, which is not associated with the lactation period. About a third of men with acromegaly experience decreased libido and erectile dysfunction.

As the disease progresses and the pituitary adenoma increases in size, the clinical symptoms of the disease worsen: the patient complains of double vision, fear of light, hearing impairment, dizziness, paresthesia and numbness of the extremities.

Diagnosis and differential diagnosis of acromegaly

In the blood with this pathology, an increased level of somatotropic hormone will be detected.
The doctor will suspect this pathology based on the patient’s complaints, medical history (the nature of the symptoms progressing over several years) and the results of an objective examination of the patient (during a visual examination, he will pay attention to enlarged parts of the body; upon palpation, he will detect pathologically sized internal organs). In order to confirm the diagnosis, the patient will be prescribed additional diagnostic methods:

• the level of growth hormone in the blood on an empty stomach and after taking glucose (in a person suffering from acromegaly, the level of somatotropin will always be increased - including on an empty stomach; after taking glucose, the hormone level is determined three more times - after 30 minutes, 1.5 and 2 hours; in a healthy body, after taking glucose, the content of somatotropic hormone in the blood decreases, and in the case of acromegaly, on the contrary, it increases);
• Less commonly, tests are performed with thyro- or somatoliberin, which stimulate the production of growth hormone, or a test with bromocriptine, which suppresses its secretion in people suffering from acromegaly;
• determination of insulin-like growth factor - IGF-1 (the concentration of this substance in the blood plasma reflects the amount of growth hormone released per day; if IGF-1 is elevated, this is a reliable sign of acromegaly).

When determining the level of somatotropin, it is important to remember that the peak of its secretion in a healthy person occurs at night, and in the case of acromegaly this peak is absent.

The diagnosis of acromegaly is confirmed by the results of an instrumental research method - radiography of the skull: the image will visualize an enlarged sella turcica. To see the pituitary adenoma directly, the patient undergoes computed tomography or magnetic resonance imaging.

If the patient complains of worsening vision, he is prescribed a consultation with an ophthalmologist. Upon examination, the latter will detect a narrowing of the visual fields characteristic of acromegaly.

If a patient has complaints characteristic of the pathology of a specific internal organ, additional research methods are prescribed to him individually.

Differential diagnosis in case of suspected acromegaly should be made with hypothyroidism and Paget's disease.

Acromegaly - what is it? Photos, causes and treatment

Acromegaly is a disease characterized by increased secretion of somatotropic hormone (GH), disproportionate growth of skeletal bones, an increase in protruding parts of bones and soft tissues, as well as internal organs, and metabolic disorders.

The incidence of acromegaly in men and women is the same; people over 30 years of age are more likely to be affected. When hyperproduction of GH occurs at a young age, before growth is complete, proportional accelerated growth of skeletal bones is noted, and gigantism develops (height up to 190 cm is considered normal).

However, sometimes in children with open growth plates, excessive secretion of this hormone is accompanied by the appearance of acromegaloid features or the development of acromegaly.

Causes

Why does acromegaly develop and what is it? Acromegaly is a syndrome that develops as a result of excessive production of somatotropin (growth hormone) by the pituitary gland after a period of maturation and ossification of the epiphyseal cartilage. The disease is characterized by gradual pathological growth of bones, internal organs and soft tissues, especially peripheral parts of the body (extremities, head, face).

Causes of acromegaly In the vast majority of clinical cases, the cause of excessive secretion of growth hormone is a pituitary adenoma, located in the area responsible for the production of growth hormone.

Most often, tumor development is provoked by a mutation in the Gs-alpha protein gene.

This mutant protein continuously stimulates the enzyme adenylate cyclase, which leads to increased growth of cells that produce somatotropin, and as a result, to an increase in its production.

In the absence of benign tumors in the glandular tissues of the pituitary gland, acromegaly can be caused by:

• skull injuries;
• pathological course of pregnancy;
• acute and chronic infections (for example, measles, influenza, etc.);
• mental trauma;
• tumors localized in the central nervous system;
• malignant neoplasms of the left frontal lobe;
• epidermic encephalitis;
• cysts of the cistern magna, formed as a result of head injuries or as a consequence of infectious diseases;
• congenital or acquired syphilis.

It is worth noting that trauma in itself is not the cause of acromegaly; it can simply become a catalyst for the development of this growth pathology.

Symptoms of acromegaly

Symptoms appear rather slowly and increase gradually. As a rule, it takes about ten years after the first signs of the disease appear to diagnose this disease in adulthood. In the case of acromegaly, symptoms largely depend on the stage.

Experts identify the following forms of the disease:

• preacromegalic – symptoms are practically absent;
• hypertrophic – most of the symptoms of the disease appear;
• tumor – tumor growth affects nearby nerve endings, tissues and organs;
• cachectic – the most severe stage.

The frequency of occurrence of subjective signs of acromegaly when visiting a doctor is as follows:

• enlargement of hands and feet – 100%,
• change in appearance – 100%,
• headache – 80%,
• paresthesia – 71%,
• joint and back pain – 69%,
• sweating – 62%,
• menstrual irregularities – 58%,
• general weakness and decreased ability to work – 54%,
• weight gain – 48%,
• decreased libido and potency – 42%,
• visual impairment – ​​36%,
• daytime sleepiness – 34%,
• hypertrichosis – 29%,
• palpitations and shortness of breath – 25%.

When examining the patient, attention is drawn to coarsening of facial features, enlargement of the hands and feet, kyphoscoliosis, changes in hair and skin.

As a result of the enlargement of the brow ridges, cheekbones and chin, the patient's face takes on a stern appearance. The soft tissues of the face hypertrophy, which leads to enlargement of the nose, ears, and lips.

The skin thickens, deep folds appear (especially on the back of the head), as a rule, the surface of the skin is oily (oily seborrhea).

Due to the increase in internal organs in size and volume, the patient experiences increased muscle dystrophy, which leads to weakness, fatigue, and a rapid decrease in performance.

Cardiac muscle hypertrophy and heart failure progress rapidly.

According to statistics, a third of patients with acromegaly have high blood pressure and disruption of the respiratory center, as a result of which attacks of apnea (temporary stoppage of breathing) often occur.

The tongue and interdental spaces (diastema) increase, and prognathism develops, disrupting the bite. There is growth in the bones of the skull, especially the facial bones. The hands are wide, the fingers are thick and appear shortened. The skin on the hands is also thickened, especially on the palmar surface. The width of the foot increases, and due to the growth of the heel bone, the length also increases, and the size of the shoes worn increases.

The skin of the extremities is thickened, oily and moist, often with abundant hypertrichosis. Paresthesia and a feeling of numbness in the fingers often occur. In advanced cases of the disease, varying degrees of skeletal deformation occur.

Diagnostics

The diagnosis is confirmed by blood tests for hormones. All patients with acromegaly have an increased level of somatotropic hormone in the blood. In addition to laboratory tests, the patient is also shown other diagnostic methods:

• radiography of the skull;
• MRI;
• CT;
• consultation with an endocrinologist.

Diagnosis of some cases of acromegaly cannot be based solely on changes in the patient’s appearance. This is due to the fact that enlargement of facial features, limbs and body parts are signs of other diseases - gigantism, osteoarthropathy, Paget's disease.

Therefore, it is extremely important to conduct a number of additional studies if there are signs of acromegaly. In particular, an x-ray can reveal an increase in the size of the sella turcica, and tomography will help determine the true cause of this. In addition, a number of ophthalmological examinations should be carried out.

Acromegaly: photo

We offer detailed photos for viewing of what patients with acromegaly look like.

Famous people with this disease

In chronological order:

• Tillet, Maurice (1903−1954) - French professional wrestler, born in the Urals into a French family; prototype of Shrek.
• Kiel, Richard (1939-2014) - American actor 2.18 m tall.
• André the Giant (1946–1993) was a French professional wrestler and actor of Bulgarian-Polish origin.
• Struycken, Karel (born 1948) is a 2.13 m tall Dutch character actor.
• Igor and Grishka Bogdanoff (Igor et Grichka Bogdanoff; born 1949) are French twins of Russian origin, TV presenters and popularizers of space physics.
• McGrory, Matthew (1973-2005) - American actor with a height of 2.29 m.
• Valuev, Nikolai Sergeevich (born 1973) - Russian professional boxer and politician.

Read more on Wikipedia.

Treatment of acromegaly

Therapeutic measures for acromegaly are aimed at eliminating the increased secretion of growth hormone by the pituitary gland, reducing the manifestation of clinical symptoms and eliminating symptoms of the disease such as headache, impaired visual fields, etc.

This is achieved through surgical removal of the pituitary adenoma, irradiation of the interstitial pituitary region, implantation of radioactive yttrium, gold or iridium into the pituitary gland, cryogenic destruction of the pituitary gland and drug therapy (dopamine agonists and somatostatin analogues).

After the level of somatotropin decreases, not only the patient’s well-being will improve, but his life expectancy will also increase.

To date, scientists have proven that a long-term increase in this hormone leads to early mortality caused by pulmonary, cardiovascular and cancer diseases.

In any case, timely treatment of acromegaly plays a very important role, since its absence is fraught with early disability in patients of active working age and an increased likelihood of premature mortality.

Forecast

Lack of treatment for acromegaly leads to disability in patients of active and working age and increases the risk of premature mortality. With acromegaly, life expectancy is reduced: 90% of patients do not live to age 60. Death usually occurs as a result of cardiovascular disease.

The results of surgical treatment of acromegaly are better for small adenomas. With large pituitary tumors, the frequency of their relapses increases sharply.

Source: https://simptomy-lechenie.net/akromegaliya-chto-eto-takoe/

Treatment of acromegaly

The goal of treatment is to normalize the blood level of growth hormone (reducing it below 5 ng/ml) and IGF-1.

Medicinal, surgical, radiation methods, as well as combinations thereof, can be used for treatment. The choice of method depends on the size and growth rate of the pituitary tumor, the condition of the organ of vision, the level of growth hormone, the age of the patient and the presence of concomitant pathology.

For uncomplicated, non-progressive pituitary adenomas, drug therapy is recommended. Cabergoline (Dostinex) is used at a dose of 0.5 mg twice a week and bromocriptine (Parlodel) at a dose of 2.5–10 g per day. In recent years, the drug Octreotide, a long-acting synthetic analogue of somatostatin, has proven itself well, suppressing the production of somatotropin by the pituitary gland by reducing the size of the adenoma.

If the adenoma has reached a significant size, or the disease is rapidly progressing, drug therapy alone will not be enough - in this case, the patient is indicated for surgical treatment. A direct indication for surgery is rapid loss of vision. The tumor is removed through the sphenoid bone. In 85% of patients, after tumor removal, there is a significant decrease in somatotropin levels up to normalization of parameters and persistent remission of the disease. For particularly large tumors, one operation is probably not enough - as a result, only a third of patients are cured, while the rest require a second operation or continuation of therapy with other methods.

In case of contraindications to surgical treatment, impossibility of its implementation, or if the patient categorically refuses surgery, radiation therapy is performed. It is carried out by irradiating the pituitary gland with a proton beam or implanting radioactive gold into the tumor. The effectiveness of this method is about 60–80%.

Causes of acromegaly

According to doctors, the following factors can provoke disturbances in the normal functioning of the hypothalamus, and, consequently, the development of acromegaly::

• traumatic brain injury;
• mental disorders;
• complicated pregnancy and intrauterine developmental pathologies;
• past infectious or viral diseases;
• the presence of tumor neoplasms of benign or malignant origin that affect the functioning of the nervous system;
• disturbances in the activity of the endocrine system;
• increased sensitivity to somatotropin;
• pathological processes of secretion of this hormone in the area of ​​internal organs;
• traumatic injuries of the central nervous system;
• hereditary predisposition;
• pituitary adenoma;
• cystic neoplasms localized in the brain area.

Please note: According to doctors, the patient’s gender also affects the likelihood of developing acromegaly. Representatives of the fair sex are most susceptible to this pathology.

Forecast and prevention of acromegaly

In case of early diagnosis of this disease and adequate treatment, its remission is achieved by the vast majority of patients. With large adenomas, the frequency of disease relapses is quite high even after surgical treatment. If acromegaly is not treated at all, the patient’s quality of life rapidly decreases, and the risk of premature death increases: 90% of patients die before the age of 60 years.

Primary prevention of acromegaly is to prevent injuries to the head area, timely sanitation of acute and chronic foci of infection of the ENT organs. To prevent the development of complications of an already debuted disease, treatment should be started as early as possible - to bring the level of somatotropin in the blood back to normal.

Diagnostic measures

If you suspect the development of the disease, contact an endocrinologist. The doctor makes a preliminary diagnosis based on external changes and palpation. Laboratory diagnosis of acromegaly includes the following tests:

• Determination of the level of growth hormone. Blood is taken 3-5 times at time intervals of 20 minutes. up to 2.5 hours. Then the average value is calculated; in healthy people it is no more than 5 ng/ml.
• Glucose tolerance test. Blood samples are taken first on an empty stomach, then after administration of glucose, and then the level of growth hormone is compared. In patients, the concentration after taking glucose increases, in healthy people it decreases. The test is also used during treatment to assess the effect of therapy.
• Determination of IRF-1. The amount of this substance reflects the daily volume of somatotropin. In patients, the level is higher than normal.

To assess changes in the pituitary gland, a skull x-ray, MRI or CT scan of the brain is prescribed. If the patient complains of disorders of other organs, the endocrinologist additionally refers to an appointment with other specialist doctors: a cardiologist, an ophthalmologist, a gastroenterologist.