Acromegaly is the condition of the body in which individual parts of the body are pathologically increased. Deals are associated with excessive production of growth hormone (somatotropic hormone). This process occurs as a result of tumor lesions of the front lobe of the pituitary.
One of the serious accuracy of acromegaly may become diabetes mellitus, even more aggravating the course of the disease.
As a rule, the disease is manifested in adult people and is characterized by a significant consolidation of some features. In addition, symptoms will be marked:
- an increase in the feet and hands;
- regular pain in the head;
- pain in the joints;
- sex and reproductive dysfunction.
The high level of growth hormone is the cause of too early mortality of patients from various concomitant diseases.
Acromegaly begins its development immediately after stopping the growth of the body. Symptoms of the disease grow gradually and after a long time, a noticeable change in the patient's appearance occurs. If we talk about the temporary framework, the disease is diagnosed only after 7 years after it starts.
Acromegalia is equally affecting men and women. The average age of patients is 40-60 years.
This disease is quite rare and is observed about 40 people per million people.
The causes of the occurrence of illness
As noted, the production of a somatotropic hormone occurs due to the work of human pituitary. In childhood, the hormone is responsible for the process of forming bones and muscle skeleton, as well as linear growth. In adults, he controls the metabolism in the body:
- carbohydrate;
- lipid;
- water salt.
Growth hormone production is regulated by a hypothalamus, which produces special neurospets:
- somatolyberin;
- somatostatin.
If we talk about the norm, then the concentration of somatotropin in the blood of a person for 24 hours significantly fluctuates. Maximum hormone level reaches in pre-understanding hours.
Patients with acromegaly will suffer not only to the increase in blood growth hormone, but also problems with adequate rhythm of its development. The cells of the pituitary gland (its front line) are not able to obey the influence of the hypothalamus and their rapid growth occurs.
The active growth of pituitary cells is the causes of benign neoplasm - the adenoma of pituitary glands, which is extremely quickly producing somatotropin. The size of the iron tumor may exceed the volume of the gland itself. In addition, normal pituitary cells are squeezed and destroyed.
Around half of the cases with a pituitary tumor, only somatotropin is produced. In 30 percent of the patients, additional prolactin production was marked, and the remaining patients will suffer from secretion:
- A-subunit;
- luteinizing;
- thyrotropic;
- follicularity Hormones.
In 99 percent of the cases of adenoma, the pituitary gland will become a prerequisite for acromegaly. The causes of the adenoma:
- neoplasms in the hypothalamus;
- card and brain injuries;
- sinusitis (inflammation of the sinuses of the nose) in the chronicle.
Heredity is assigned a significant role in the development of the disease due to the fact that it is most often the relatives suffer from the most often.
In children and adolescents against the background of rapid growth arises giantism. It is characterized by an excessive and relatively uniform increase in bones, fabrics and all internal organs.
As soon as the physiological growth of the child is stopped and the skeleton is wired, violations of the proportions of the body according to the type of acromegaly (disproportionate thickening of bones, the consolidation of internal organs), as well as characteristic failures in metabolic processes.
When symptoms of the disease begin to be observed, hypertrophy of parenchyma and stromas of some organs will immediately be discovered:
- intestines;
- hearts;
- pancreas;
- liver;
- lungs;
- spleen.
It is the problems with the pancreas - these are the causes of the development of diabetes in such patients. The growth of connective tissue becomes a prerequisite for sclerotic changes in the above-mentioned organs, increasing significant threats to the start of development of tumors. These can be benign or malignant endocrine neoplasms.
Stages of illness
The disease is characterized by perennial and sluggish flow. Symptoms will be expressed depending on the degree of disease:
- precryegalia - the first symptoms are usually expressed weakly. At this stage, illness is extremely difficult to reveal. It becomes possible only on the basis of blood test indicators for a somatotropic hormone and computer tomography of the brain;
- hypertrophic stage - the beginning of the bright severity of symptoms of acromegaly;
- the stage of the tumor - the patient begins to feel the symptoms of compresses in the neighboring brain departments (growth of intracranial pressure, as well as problems with nerves and eyes);
- cachexia - the outcome of the illness (exhaustion).
Symptomatics of the disease
The symptoms of the illegality of acromegaly can be caused by an excessive concentration of hormone somatotropin or the effect of the adenoma of the pituitary gland on the eye nerves and located near the structure of the brain.
The overaffect of growth hormone provokes the characteristic changes in the appearance of patients and the flaws of the person. It may be an increase in cheekbones, lower jaws, abnormal arcs, ears and nose. As the lower jaw grows, there is a deformation of the bite due to the divergence of the gaps between the teeth.
The disease can be observed by a significant increase in language (macro-rose). Language hypertrophy causes voting changes. Significant problems with voice ligaments and larynx can begin. It all happens almost imperceptibly for the most sick person.
In addition to these symptoms for acromegaly, it is characterized by thickening the phalange of the fingers, a significant increase in the bones of the skull, stop, as well as brushes.
As this process is developing, there is a need to purchase hats and gloves for several sizes more than it was previously required.
The disease causes the deformation of the skeleton:
- spinal curvature;
- increase in the size of the chest;
- expansion of the gaps between the ribs.
As a result of hypertrophy of cartilage and connective tissues, a limited movement of joints is observed, as well as arthralgia. Manifestations of diabetes can be revealed, for example, excessively frequent urination.
If there is no treatment, the disease causes excess sweating and the selection of the saline, which is due to the increased operation of the relevant glands. Skin covers in such patients thicken, compacted, and can also be collected in the folds on the heads under the hair.
In case of disease, the muscles occurs, as well as internal organs. Patients begin to suffer from:
- weakness;
- increased fatigue;
- progressive reduction in performance.
Against the background of this, the hypertrophy of myocardium is developing, replacing myocardiodystrophy and rapidly increasing heart failure.
Approximately 1/3 patients will have problems with arterial pressure. In 90 percent will develop the so-called sleepy apnea syndrome. This pathological condition is directly related to hypertrophy of soft tissues of respiratory tract, as well as failures in the normal operation of the respiratory center.
Quite often, the disease disturbs normal sexual function. In the female half of patients with a substantial rebupping of prolactin and the lack of gonadotropin will develop a menstrual cycle, as well as infertility. A galathery will be marked - the state when milk is released from the thoracic glands in the absence of pregnancy and the lactation period.
Approximately 30 percent of men will significantly reduce the sexual function. In addition, such symptoms are the reasons for what will evolve. This ailment arises against the background of the high secretion of antidiuretic hormone.
With increasing neoplasm in the pituitary and squeezing of nerve endings, such symptoms will occur:
- shots in the eyes;
- dizziness;
- loss or partial reduction of hearing;
- numbness of the upper and lower extremities;
- painful sensations in the forehead and cheek;
- photophobia;
- frequent vomit urge.
People suffering from acromegaly are in the zone of increased risk of developing neoplasms in the thyroid gland, the uterus, as well as the digestive tract, especially if there is no treatment.
What could be complications?
The course of the disease Acromegaly is often accompanied by the development of serious complications from almost all organs. Maximum often it may be such ailments:
- arterial hypertension;
- heart failure;
- heart hypertrophy;
- myocardianiodistrophy.
Practically in 1/3 cases occurs or even the second type of flow. In addition to diabetes, emphysema of lungs and liver dystrophy can begin. If there is no treatment, then with hyperproduction of growth factors, neoplasms occur in various organs. Tumors can be both benign and malignant.
What is needed to identify acromegaly?
As already noted, on early stages This disease can only be detected by chance. If the acromegaly is present for more than 5 years, then in such later stages it can be suspected against the background of increasing some parts of the body, as well as based on the symptoms described above.
If you suggest an acromegaly, you need to seek advice to the doctor an endocrinologist. He recommends the delivery of appropriate analyzes to confirm or eliminate the alleged diagnosis.
The main laboratory criteria for identifying the disease are some blood components:
- IRF І (insulin-like growth factor);
- somatotropic hormone (it is performed in the mornings immediately after the test on the concentration of glucose).
Treatment
With acromegaly, the treatment will be aimed at achieving remission of the disease by eliminating the excessive production of somatotropin and bringing to the norm of the level of concentration of IRF І.
Treatment of disease in modern medicine, and in particular endocrinology, can be based on:
- medicated;
- radiation;
- surgical;
- combined methods.
To adjust blood indicators, it is necessary to make analogs of somatostatin, overwhelming the production of growth hormone. In addition, with the disease, treatment is needed on the basis of genital hormones, dopamine agonists.
The most efficient way of therapy will be considered surgical. It provides for the disposal of the neoplasm at the base of the skull through a wedge-shaped bone.
If the adenoma is small, then in about 85 percent cases, treatment will bring normalization of state and remission.
With significant tumor sizes, the positive dynamics after the first operational intervention will be approximately 30 percent of cases. Not excluded when surgery and death
The acromegaly is a disease of a neuroendocrine character, the development of which is due to the excessive intensive production of somatotropin, which is popular in the people of growth hormone. At the same time, as a rule, only individual parts of the patient's body increase. This pathology is extremely rare and gives a patient a lot of torment, both physical and psychological nature.
Brief characteristic pathology
Acromegaly develops, as a rule, with tumor neoplasms localized in the front share of the pituitary gland responsible for the production of somatotropin. In patients suffering from this pathology, facial features change (become larger), the brushes and the size of the foot increase. In addition, the pathological process is accompanied by painful articular and, there are violations in the work of the reproductive system.
Important! This disease, as acromegaly, is subject to only adult patients. Pathology begins to develop at the end of puberty and growth of the body!
According to statistical data, patients in the age category from 40 to 60 years are subject to the greatest degree of acromegaly. The pathological process is characterized by a gradual, slow motion. In most cases, diseases are diagnosed after 6-7 years since its development began, which makes it difficult for subsequent treatment.
Doctors allocate the following stages of the development of the pathological process:
- In the first stage, the disease flows in a latent, hidden form, and it is possible to identify changes only when conducting.
- At this stage, symptoms characteristic of pathology manifests itself particularly bright.
- In the third stage there is an increase in the tumor neoplasm located in the front share of the pituitary gland. At the same time, neighboring brain departments are squeezed out, which causes the manifestation of specific signs, such as violations of the visual function, nervous disorders ,.
- The last fourth stage of acromegaly is characterized by the development of cachexia and the full depletion of the patient's body.
Increased concentration of somatotropin contributes to the development of cardiovascular, pulmonary and oncological diseases, which often become the cause of the death of patients suffering from acromegaly.
Causes of acromegaly
Provice violations in normal operation of the hypothalamus, and, consequently, the development of acromegaly, according to doctors, the following factors can:
- mental disorders;
- complicated pregnancy and intrauterine development pathology;
- suffered infectious or viral diseases;
- the presence of tumor neoplasms of benign or malignant origins that affect the work nervous system;
- violations in the activities of the endocrine system;
- increased sensitivity to somatotropin;
- pathological processes of secretion of this hormone in the field of internal organs;
- traumatic damage to the central nervous system;
- hereditary predisposition;
- adenoma pituitary
- cystic neoplasms localized in the brain area.
Note: According to physicians, sexuality The patient also influences the likelihood of acromegaly. The most given pathology is subject to a fair sex.
Symptoms of acromegaly
As a rule, the symptoms of acromegaly manifests itself in the second stage of the pathological process. Signs of this disease are sufficiently specific, and therefore not to notice them difficult.
In most cases, the following clinical symptoms are manifested in patients with acromegaly:
Note: Almost all patients with diagnosed acromegaly show features characteristic of diabetes mellitus, which is associated with endocrine disorders.
In addition, patients with acromegaly change the structure of the skeleton, the intercostal intervals increase, the vertebral pole is curved, and the chest cell becomes noticeably more and wider.
The representatives of the fine sex are noted and, possibly an early onset. In men suffering from this ailment, an erectile function disorder occurs, develops. The reproductive system with acromegaly is seriously affected, therefore, as a rule, people with such a diagnosis have problems with natural conception.
What is dangerous pathology?
In addition to the fact that the acromegalia spoils the appearance of the patient and significantly reduces the quality of his life, in the absence of proper treatment, this pathology can also provoke the development of extremely dangerous complications.
In most cases, the long-term course of acromegaly leads to the appearance of the following concomitant diseases:
Note: Almost half of the patients suffering from acromegaly marks the development of such a complication as.
Disorders of visual and hearing functions, characteristic of this pathology, can cause the patient's complete deafness and blindness. And these changes will be irreversible!
Acromegalia repeatedly increases the risks of the appearance of tumor malignant neoplasms, as well as various pathologies of internal organs. Another dangerous sick complication of acromegaly is a respiratory stop syndrome, which, mainly, occurs in a state of sleep.
That is why a patient who wishes to save his life, when the first signs pointing to the acromegaly should apply for professional help to a qualified specialist - an endocrinologist!
How to identify the disease?
In most cases, a specialist can suspect the presence of acromegaly in the appearance of the patient, characteristic of symptoms and during the analysis of the collected anamnesis. However, for the formulation of an accurate diagnosis, determining the stage of the pathological process and the degree of damage to internal organs, the following diagnostic studies are prescribed:
- to identify the indicators of the hormone of somatotropin;
- brain;
- Skull.
Important! The main diagnostic method is to analyze the somatotropin using glucose. If the pituitary is functioning normally, glucose contributes to a decrease in somatotropin indicators, otherwise the hormone level, on the contrary, is growing.
To identify concomitant complications provoked by the development of acromegaly, such additional diagnostic measures are held:
- laboratory study;
- internal organs.
After the comprehensive diagnostics, a specialist can not only put accurate diagnosis, but also identify the presence of concomitant diseases, which allows the patient to be prescribed the most complete and adequate for a particular case therapeutic course!
Methods of treatment of acromegaly
The main task of physicians in the diagnosis of acromegaly is to achieve a resistant remission, as well as normalize the processing processes of somatotropin.
For these purposes, the following methods can be used:
- receiving medication;
- radiation therapy;
- surgery.
Important! In most cases, effective struggle with this disease requires comprehensive combination therapy.
Conservative methods
To suppress the excessive intensive production of growth hormone patients prescribe a course hormone therapy using artificial somatostatin analogues. Often patients are prescribed by such a drug as bromocriptine aimed at producing dopamine, overwhelming the process of synthesizing the Somatotropin hormone.
In the presence of characteristic complications and concomitant diseases, appropriate treatment is carried out, the scheme of which is developed for each patient individually.
Good results showed the use of radiation therapy. This procedure is an impact on a damaged pituitary portion of specific gamma rays. According to statistics and clinical studies, the effectiveness of this technique is about 80%!
One of the most modern methods conservative anti-acryegaly - X-ray therapy. According to experts, the effects of X-ray waves contribute to the active suppression of the growth of tumor neoplasms and the production of somatotropin. The full course of radiotherapy allows to achieve the stabilization of the state of the patient and eliminate the symptoms characteristic of the acromegali, even the features of the patient are somewhat thinned!
Surgical methods for treating acromegaly
Surgical intervention in acromegaly is shown in significant sizes of tumor neoplasm, the rapid progression of the pathological process, as well as in the absence of the effectiveness of conservative therapy methods.
Important! Surgical operation is one of the most effective methods of combating acromegaly. According to statistical data, 30% of the operated patients have completely cured from diseases, and in 70% of patients there is a persistent, long-term remission!
Surgical intervention with acromegaly is an operation aimed at removing the pituitary tumor tumor. In particularly difficult cases, it may be necessary to conduct a re-operation or an additional course of drug therapy.
How to warn your pathology?
In order to prevent the development of acromegaly, doctors are advised to adhere to the following recommendations.
Acromegaly - rare and dangerous disease, fraught targets near complications. However, timely diagnosis and competent, adequate treatment allows you to achieve a stealing remission and return the patient to a full-fledged, usual life!
Sovin Elena, Medical Observer
Acromegaly - a pathological process, in which the functionality of the front lobe of the pituitary is disturbed. The disease acromegaly manifests itself after the end of growth is accompanied by the expansion of the front parts of the skull, stop and brushes.
The provocateur of acromegaly is an increase in the concentration of somatotropic hormone. The development of the disease in adolescence is called giantism.
Root causes and stages of acromegaly
The hypophysia is produced by a somatotropic hormone (STG), which is responsible for the formation of a musculoskeletal skeleton in childhood, and in adults conducts control over the water-salt metabolism.
In patients with acromegaly, there is a violation of the production of this hormone and an increase in its blood concentration. The adenoma of the pituitary gland with acromegaly occurs during the growth of the pituitary cells.
Samoa frequent cause Acromegalia experts consider precisely a pituitary adenoma that can be formed in the presence of hypothalamus tumors, head injuries, chronic sinusitis. The hereditary factor is played in the development of acromegaly.
For acromegaly, it is characterized by a perennial course, its manifestations depend on the development stage:
Precryegaly is characterized by a minor increase in the level of hardening, as a result of which there are actually no signs of manifestation of pathology;
Hypertrophic stage - observed clearly pronounced symptoms of the disease;
For the tumor stage, an increase in intracranial pressure and violations in the work of the visual and nervous system is characterized;
Cachexia - observed the patient.
Due to long-term development, there are no external signs in the first stage of acromegaly.
Clinical manifestations
The symptoms of acromegaly in children and adults include:
Soreness in the spinal column and joints due to their destabilization and development of arthropathy;
Excessive masculine type in women;
Expansion of the gaps between the teeth, an increase different parts faces, thickening of skin;
The emergence of fertilous growing growths;
Increasing thyroid gland;
Reduction of working capacity, fatigue;
Development of cardiovascular pathologies that can lead to death;
Development of diabetes;
Impairment of pigmentation of skin;
Disruption of the respiratory system.
With accommodation of the pituitary, there is a squeezing of healthy cells provoking:
Reduced potency and libido in men;
Infertility, violation of menstruation in women;
Frequent migraines that are non-drugic treatment.
Diagnostation
The diagnosis of acromegaly and giantism is possible on the basis of data: MRI of the brain, symptoms, the radiography of the foot, biochemical parameters.
Among the laboratory studies, the concentration of the STG and the insulin-like growth factor-1 is distinguished. Normally, the StG level is no more than 0.4 μg / l, and the IRF-1 correspond to the normative indicators according to the floor and the age of the surveyed. In case of deviations, it is impossible to exclude the presence of the disease.
Foot radiography is carried out to assess the thickness of its soft tissues. Refer values \u200b\u200bin men up to 21 mm, in women - up to 20 mm.
If the diagnosis is already installed, the study of the pathogenesis of acromegaly and determination of deviations in the work of the pituitary gland and hypothalamus are carried out.
Computer tomography of the organs of the small pelvis, chest, rolleroshin, the organs of the mediastinum are carried out in the absence of pathologies of the pituitary and presence of biochemical and clinical manifestations of the disease acromegaly.
Therapeutic measures for acromegaly
The main purpose of therapeutic measures with such pathology is to normalize the production of somatotropin, that is, bringing it to the state of remission.
For this purpose, such techniques are used:
Surgical therapy is used in two types: transcranial and transphenoidal. The choice is carried out by neurosurgeon. Operational intervention is carried out to remove microenomes or partial resection of macroenomes.
Rauchery irradiation is carried out in the absence of effect after surgical therapy, gamma knives can be used, a protone bundle, a linear accelerator.
During drug therapy, such groups of drugs are used: somatotropic hormone antagonists, the analogues of somatostatin, dopaminergic agents.
The combined treatment method is used according to the recommendations of the doctor.
The choice of therapeutic measures should be carried out in conjunction with a specialist who studied the pathogenesis of acromegali, symptoms and the results of the biochemical studies of the patient.
According to statistics, surgical intervention is considered the most effective, about 30% of the operated fully recovered, and the rest comes with a resistant period.
Timely carry out the treatment of diseases affecting the nasopharynx;
Avoid traumatizing the head.
If you have any questionable signs, consult an endocrinologist. Do not independently carry out diagnostics and the more treatment.
Symptoms
Clinical manifestations of acromegaly are due to increased production of somatotropin - a specific growth hormone, which is synthesized by the pituitary gland, or diseases causing the development of tumor formations (adenoma of pituitary glands, brain tumors, metastases from remote organs).
The causes of the development of the disease lies in the hyperproduction of a somatotropic hormone, which is a primary-pituitary character, or has a hypothalamic origin.
It is believed that the pathological process, which develops at an early age, the advantage in the adolescence is called giantism. A characteristic feature of giantism in children is the rapid and proportional growth of organs, fabrics, skeleton bones, hormonal changes. A similar process, developing after the cessation of the body's growth, is more adult called acromegaly. The characteristic symptoms of acromegaly are the disproportionate increase in organs, tissues and bones of the body, as well as the development of concomitant diseases.
Signs of giant in children
Early signs of acromegaly (giantism) in children can be revealed after some time after the start of its development. Externally, they are manifested in the enhanced growth of the limbs that are unnaturally thicken and become loose. At the same time, it is possible to notice that the encoder bones increase, the abnormal arcs, the hypertrophy of the nose, forehead, language and lips occurs, as a result of which the features of the face are changing, becoming more rude.
Internal disorders are characterized by edema in the structures of the throat and nasal sinuses, which causes a change in voice timbre, making it lower. Some patients complain about the appearance of snoring. In the photo, acromegalia in children and adolescents is manifested by high growth, unnaturally increased parts of the body, elongated limbs due to uncontrolled bone expansion. The development of the disease is also accompanied by hormonal changes, the symptoms of which are:
increased sweating;
hypersecretion of sebaceous glands;
improving blood sugar;
increased calcium content in the urine;
probability of development of a biliary disease;
the swelling of the thyroid gland and a violation of its functioning.
Often, at an early age, there is a characteristic growth of connective tissues, which causes the appearance of tumor formations and changes in the internal organs: heart, liver, lungs, intestines. Quite often can be seen in the photo of newborn children with neck acromegaly, a characteristic feature of which is the lengthening of the breast-crooked mastoid muscle.
Symptoms of acromegaly in adults
The hyperproduction of a somatotropic hormone causes pathological disorders in an adult organism, which lead to a change in its appearance, which can be clearly seen in his photo or with personal contact. As a rule, this is manifested in the disproportionate growth of individual parts of the body, including the upper and lower extremities, brushes, stop, skull. Also, as in children, in adult patients, the forehead changes, the nose, the shape of the lips, the abnormal arcs, the bones, the lower jaw, resulting in the intersubic gaps. Most patients have a macroglossee - a pathological increase in language.
The symptoms of acromegaly, the reasons for which in adults in most cases acts the adenoma of the pituitary gland, refers to the deformation of the skeleton, in particular, the curvature of the spinal column, an increase in the chest with the subsequent expansion of intercostal spaces, a pathological change in joints. Hypertrophy of cartilage and connecting tissues leads to limiting the mobility of the joints, resulting in arthralgia.
Often patients complain of frequent headaches, quick fatigue, muscle weakness, reduced performance. This is due to an increase in muscle size with subsequent muscle fiber dystrophy. At the same time, the appearance of myocardial hypertrophy, which turns into myocardiodystrophia, causing the development of heart failure.
Patients who progress the symptoms of acromegaly are often given characteristic changes in appearance that make them similar to each other. However, internal organs and systems are also subject to change. So in women, the menstrual cycle is broken, infertility develops, a galathery - the release of milk from the nipples against the absence of pregnancy. In many patients, independently of gender and age is diagnosed with a sleepy apnea syndrome, in which a strong snoring is developing.
In the absence of treatment, as a rule, the forecast remains disappointing. The progression of pathological disorders leads to complete disabilities, and also increases the risk of premature death, which happens as a result of heart disease. The life expectancy of patients with disease acromegaly is significantly reduced and does not reach 60 years.
Diagnostics
Diagnose acromegaly is quite simple, especially in the later stages, since the external manifestations are specific. However, there is a certain category of diseases whose symptoms are largely similar to the signs of acromegaly. For differential diagnosis and confirmation (or exceptions), the presence of acromegaly is assigned to the consultation of the endocrinologist, as well as the conduct of visual, laboratory and instrumental methods for diagnosing acromegaly.
Visual examination of the patient
Before appointing the necessary diagnostic procedures and proper treatment, the doctor collects anamnesis, determines the hereditary predisposition to the development of this disease, and also conducts an objective examination - palpation, percussion, auscultation. Based on the results of the primary inspection, the necessary diagnostic procedures are assigned.
Laboratory diagnostic methods
For the diagnosis of acromegaly, traditional methods of laboratory studies are used: blood test and urine. However, the most informative and therefore often used of them are considered to determine the accuracy of the hormones in the blood: the STG - somatotropic growth hormone, and the insulin-like growth factor - IFR-1.
Determination of StG
Confirmation of the development of giantism or acromegaly is an increased content in the blood of somatotropin - growth hormone, which is produced by the front fraction of the pituitary. A distinctive feature of the production of hardware is cyclical, therefore, a multiple blood fence is practiced for testing its level:
in the first case, a threefold fence is made at an interval of 20 minutes., after which the serum is mixed and determined by the average level of STG;
in the second case, a fivefold blood fence is made at an interval of 2.5 hours, but the level is determined after each receipt of blood portion. The final indicator is obtained by averaging all values.
Confirmation of the diagnosis of acromegaly is possible when the hormone level is exceeded by 10 ng / ml. The disease can be excluded if the average value does not exceed 2.5 ng / ml.
Definition of the level of IFR-1
Another informative screening test is considered to determine the level of hormone IFR-1. It has high sensitivity and specificity, since it does not depend on daily oscillations as somatotropin. If the level of the IFR-1 level in the blood exceeds the norm, the doctor may diagnose acromegaly. However, this test must be carried out in a complex with other studies, since the IFR-1 value may vary under the influence of some factors:
be reduced in case of violations of liver, hypothyroidism, excess of estrogen, starvation;
be elevated as a result of hormone therapy, as well as with increasing insulin level in the blood.
Glucosotolerant test
In case of questionable results, a test definition test is carried out to clarify the diagnosis using glucose. It is measured by the basal level of somatotropin, after which the patient is proposed to receive a glucose solution. In the absence of acromegaly, glucose sample shows a decrease in the secretion of the STG, and with the development of the disease, on the contrary, its increase.
Instrumental diagnostic methods
To clarify the diagnosis of acromegaly and identifying the nature of its origin, the doctor often resorts to the instrumental methods of diagnosis.
CT or MRI.
The main and highly informative method of diagnostics is CT or MRI, which allows you to identify the adenoma of the pituitary gland, as well as the degree of its prevalence on regional organs and tissues. The procedure will be caused using a contrast agent that accumulates in modified tissues, which simplifies the study procedure and allows you to determine the characteristic changes in the pituitary or hypothalamus.
In the process of conducting diagnostic measures, many patients are interested in how often MRI should be done with acromegaly. This procedure is usually carried out at the hypertrophy of individual parts of the body, deployed clinical appearances, and later, on the tumor stage, when the patient complains of increased fatigue, head, muscle and articular pains, as well as other concomitant manifestations.
Radiography skull
This procedure will be submitted to identify the characteristic X-ray manifestations of acromegaly, as well as signs of the development of the pituitary adenoma:
an increase in the size of the Turkish saddle;
development of osteoporosis;
increase in pneumotization of the sinuses;
two-door walls.
In the process of radiography in the early stages of the disease, these features may be absent, therefore other, often auxiliary, diagnostic methods are assigned:
stop X-ray, which allows you to determine the thickness of soft tissues in this zone;
inspection of an ophthalmologist to identify edema, the state and atrophy of optic nerves, which often leads to blindness.
If necessary, the patient prescribe a survey for the identification of complications: diabetes mellitus, intestinal polyposis, nodal goiter, adrenal hyperplasia, etc.
Treatment
Acromegaly refers to diseases, the treatment of which cannot be postponed for later. Excessive production of growth hormone can lead to early disabilities and reduce the chances of a long life. If there are first symptoms, you need to consult a doctor. Only the doctor after all surveys can diagnose the disease and assign proper treatment.
Goals and methods
The main objectives of the treatment of acromegaly is:
reducing the secretion of somatotropin (growth hormone);
reducing the development of an insulin-like growth factor IFR-1;
reduction of pituitary adenoma;
removal of the tumor.
Treatment is carried out in the following ways:
medication therapy;
surgical intervention;
radiation therapy.
After clinical studies, the doctor chooses the most appropriate method, taking into account the course of the disease and the individual characteristics of the patient. Often, acromegaly, the treatment of which requires a thorough approach, is carried out comprehensively, combining different techniques.
Surgical intervention
The most effective method of treatment of acromegaly is the operation to remove the adenoma pituitary. Doctors recommend surgical intervention and microenome, and at the macroenome. If the rapid tumor growth is noted, the operation is the only chance for recovery.
Operational intervention is carried out in one of two ways:
Minimally invasive method. The tumor is removed quickly without cuts in the head and trepanation of the skull. All surgical actions are carried out through the nasal hole using endoscopic equipment.
Transcranial method. This method of carrying out the operation is used only if the tumor reached large sizes and the removal of adenoma is impossible through the nose. And the operation and the rehabilitation period is complex, since the trepanation of the skull is carried out.
Sometimes acromegaly after the operation returns. The smaller sizes are tumor, the greater the chances that the remission period is long. To reduce risks, a medical examination is required in a timely manner.
Medical therapy
Doctors prescribe drugs for complex treatment of illness. In the form of monotherapy, medicines are prescribed extremely rarely, as they contribute to a decrease in the production of growth hormone, but cannot be completely cured from the disease.
Most often, drugs are prescribed in such cases:
if surgery did not give results;
if the patient refuses surgical intervention;
if there are contraindications for the operation.
Reception of drugs helps reduce the tumor in size, therefore, sometimes medical therapy is prescribed before surgery.
For the treatment of acromegaly, drugs of the following groups are used:
the analogues of somatostatin (octreets, landslide);
blockers of the Somatotropic Hormone receptors (Pegvisant).
Reception medicinal preparations It is carried out only by appointing a doctor. Self-treatment, as well as folk remedies may aggravate the course of the disease.
Radiation therapy
Radiation therapy in the treatment of acromegaly is rarely used, since it has a frequent complication - the development of hypocituitarianism. Complication may manifest a few years after therapy. In addition, the result in most cases when using this method does not occur immediately.
The following methods of radiation therapy are currently applied:
remote;
gamma knife;
protonotherapy.
The use of radiation therapy is necessarily accompanied by the reception of drugs.
Medicine
The term "acromegaly" disease denotes that this disease arising from a person who has been broken by the production of growth hormone, namely the manifestations of the reinforced reproductive function of the somatotropic hormone after the ripening period. As a result, the proportionality of the growth of the entire skeleton, internal organs and soft tissues of the body is disturbed (this is due to nitrogen delay in the body). Especially pronounced acromegaly on the limbs of the body, face and the whole head.
This disease occurs in women and men after the completion of the growth period. The prevalence of the disease ranges from 45-70 people per million people. Children's body, this disease amazes extremely rarely. In rare cases, in growing children, this excess of growth hormone leads to a state, the so-called "giantism". This change is characteristic of the excessive increase in body weight and bone growth.
Since the acromegaly is not found very often, and the disease passes gradually - to identify this ailment in the early stages is not easy.
All this is caused not only because of the violation of the growth hormone, but also the change in other functions of health:
-
Dysfunction of adrenal cortex.
Endocrine.
Pancreas.
As a result of the acromegaly, the metabolism is disturbed, which in most cases leads to diabetes and carrys a huge danger to human life. But it is not worth upset, there are certain medical manipulations that are capable of significantly alleviate the symptoms and reduce the further development of acromegaly.
Symptoms of acromegaly is slow and weakly-free manifestation of the clinical development of the disease. This ailment arises due to violations hormonal background By changing appearance, as well as deterioration of well-being. There are patients who identified this diagnosis only after 10 years. The main complaints of patients is the increase in the ear shells, the nose, the limbs of the arms and legs.
In the development of an effective struggle against the disease, is the prevention of two main consequences: malignant neoplasms and the pathology of the cardiovascular system. There are four basic method of getting rid of this ailment:
SST analogues (long (samatulin and sandostatin LAR) and short action - Sandostatin Okroeditte).
Antagonists STG.
Dopamine agonists (ergolin and non-ergoline preparations).
Surgical method. Qualified doctors completely remove tumors. This method allows you to quickly get the result. There are some complications after surgery.
Radiation therapy or irradiation. Most often, this method is used in the case when surgical intervention did not help. Also, irradiation there are central disadvantages: the visual nerve is affected, the secondary tumor of the brain.
Medical method. Acromegaly is treated with the following three types:
Combined. Due to this method, the maximum positive feedback is achieved.
Medicine
But as experience shows, doctors still adhere to medication treatment. This method less negatively affects the human body.
The list of medical drugs to combat the consequence of acromegaly exists sufficient quantity:
Genfastat - homeopathic remedy.
Okrid - means of a mucolotic nature.
Parlodel - MIBP-bacteriophage.
Sandotatin - beta - aadrenoblocator.
Sameatulin is an antiseptic agent.
In most of these drugs, the active ingredient is oscillating. All dosages and treatment regimens are prescribed only attending physician.
Folk remedies
Treatment of acromegali folk remedies is an excellent preventive measure, which should be coordinated with a specialist to achieve the maximum effect. In this case, it is an endocrinologist.
What should be remembered when using folk agents in the treatment of acromegaly
Useful to strengthen the body and acceleration of the recovery process will be ragners and teas prepared from plants and herbs as:
-
root part of licorice and ginseng;
-
linden flowers.
Acromegaly, folk remedies in the treatment of which are applied solely after agreeing with the doctor, is quite amenable to relief. It must be remembered that the infusions and teas from herbs are unacceptable to maintain for a long period of time. They should be used within 24 hours after insistence and filtering.
This is explained by the fact that if they stand for a long time, they will lose all therapeutic, reducing characteristics and, even worse, can cause significant harm. In the treatment of acromegaly folk recipes This is unacceptable, because any negative impact will affect the body and the activity of the thyroid gland, which is given by one of the main roles in this case.
The obligatory stage, which also needs to coordinate with a specialist is dietherapy. It allows you to strengthen the body, accelerate metabolism and increase the degree of resistance to the body.
The most sought-after recipes
If you have acromegaly, folk recipes will help to stop some symptoms of the disease. One of the most popular recipes is a mixture consisting of pumpkin seeds, grasses of primrose, grated root part of ginger, sesame seeds and 1 tsp. Honey. Presented mixing must be used for 1 tsp. four times during the day. If after 14-16 days there is no positive shifts in the process of treatment, it is necessary after consulting with the endocrinologist to correct the composition or abandon the use of this fund.
Restoration with acromegaly people recipes implies the use of plant fees. The presented medicinal composition includes such ingredients as:
-
calendula;
cottonweed;
herbs of the horizon;
Plant mixing (at least 10 gr.) Brew 200 ml. boiling water. Used the presented tool is required by 40-50 ml. Before meals and do it, it is necessary at least 4 times within 24 hours.
It should be noted that application folk remedies And recipes in the process of treating acromegaly is definitely useful. This is explained by the positive effect on the work of the endocrine gland. However, the main emphasis in the treatment of acromegaly should be made not only for recipes, but also on the use of medicines, surgical methods of recovery. With a correct combination of the presented methods, the result will be 100%.
Information is referenced and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.
Acromegaly is a very serious illness with equally important causes and symptoms. If you look at the photo of people with such a disease, then the problem is immediately striking.
Therefore, in this article we will consider this ailment in more detail. In addition to the reasons and symptoms, you will learn how to diagnose. We also consider the main methods of treating this disease in more detail.
Acromegaly it is that disease
- This is a syndrome, which is characterized by chronic hyperproduction of growth hormone (GR) in persons with complete physiological growth. That is, men and women.
Gigantism - This is the same pathology, only it is manifested in childhood. Also distinguished by the fact that children are very randomly growing bones, fabrics and organs.
Acromegaly - Causes and symptoms with photos
Below we will look at what acromegaly have causes and symptoms with photos. Please pay attention to the complications of this disease. There are a lot of them.
Causes of acromegaly
Considering the reasons for acromegaly, it is worth saying right to say that in 99% of cases - this is a pituitary adenoma ( tumor in the brain). There may also be an ectopic secretion of somatolyberin / somatotropic hormone.
The reason for the accommodation of the adenoma pituitary Well, do not exclude hereditary forms:
- McKun-Albright syndrome
- Family acromegaly
- Carnation complex
- Men-1 syndrome
Related diseases that will first of all cause patient's death with such a disease:
- Ischemic heart disease (IBS)
- Overstructive sleep apnea syndrome (SAAS)
- Hyperparathyroidism
- Nodes of the thyroid gland
- Polyps of intestines
- Neoplasia
Here are the main symptoms of acromegaly:
- (growth hormone directly acts on sweat glands, increasing their number and activity)
- Welcome voices (due to an increase in the volume of soft tissues, including in the area of \u200b\u200bvoice ligaments)
- Snoring and apnea in a dream (due to an increase in the volume of soft tissues of the upper respiratory tract)
- The narrowing of the fields of view (this is due to the increasing adenoma and the pressure of the humans of the optic nerve)
- Headache (due to the producing pituitary tumor)
- Macrogness (when conversing, you chew words because it swells the language)
- Pain and restriction of joint mobility
- Somatomegaly (all parenchymal organs enlarged)
- High Power (Debut Diseases)
- Muscular weakness (long-term acromegaly)
- Violation of the menstrual cycle in women
- Reduced libido in men
- Diplopia
- Arthralgia, Arthropathy
- Diastema
- Prognathism
With the narrowing of the fields of view, drivers usually say that from a certain moment they began to short. The cars themselves arise from nowhere because a person does not see late eyes.
If the patient goes the road, then the cars may arise from it now. Often such people find themselves in an emergency.
In everyday life, a person can simply stumble upon the corners and not notice the approaching objects if it does not look right in front of him.
In the macro-police in the language there may be traces of hemorrhages because a person regularly bites it with his teeth.
Hemorrhage in language The defeat of the joints with acromegaly has several stages:
- Edema, increased joints, mobility limitation
- The destruction of the joint (in the future it can atrophy and deform)
Mass effect of complications
So, let's start with the mass effect of complications. This is when the tumor grows and shy other pituitary cells. That is, the products of other hormones decrease.
First we will have secondary adrenal insufficiency. The main symptoms is weakness and weight loss.
When doctors revealed the disease, they can carry out additional diagnostics:
- Daily urine analysis for free cortisol
- Test with insulin hypoglycemia. Insulin and glucose is introduced in the blood. This incentive should increase growth hormone and cortisol. They cause hypoglycemia. If this does not happen, then something is wrong.
Also possible secondary hypothyroidism. Basic symptoms:
- Weakness
- Moderate weight gain
Lab diagnostics:
- TSG (primary hormone) will be elevated
- Free T4 will be lowered
Secondary hypogonadism. Its main symptoms is a decrease in libido and a disturbance of the menstrual cycle.
Nonachar diabetes - a person can observe polyuria, polydipsea or weight loss.
Diagnostics:
- Plasma Opelness More than 300 Mosmol / kg
- Urine osmolay less than 300 mosmol / kg
- Low urine density per day (less than 1.008 g / l)
For hydrocephaliya Man complains of weakness, gaitness, headache, involuntary urination or loss of consciousness. In this case, the MRI of the brain is carried out.
MRI brain May also be observed increase intracranial pressure. Headache is localized in the frontal, temporal and behind the orphanage. It is usually not acute and not sharp.
Eveny
Now consider the second effect (swelling) when the growth factor affects the organs and the growth of the connective tissue. The first will be breathing disorders. The most common complaint is the night apnea.
Apnea with acromegaly That is, humans increase the language, as well as connecting tissue in the larynx. In the lying position, all this squeezes the respiratory tract.
As a result, a night apnea appears. The man breathes badly, constantly waking up and snoring. It is also observed not rash and anger in the morning.
Still observed arterial hypertension. Diagnosis, the doctor measures blood pressure and conducts daily monitoring of blood pressure.
Also possible acromegalic cardiomyopathy. As a rule, a person does not complain, since such a process passes without symptoms. Therefore, the doctor will not be able to immediately understand until the ultrasound of the heart is done.
I. lesions of the peripheral nervous system. If the nerve swelling and squeezing the connective tissue develops, then the person is painful and paresthesia. Diagnostics make MRI.
Now consider metabolic disorders:
- Liver:
- - Stimulation of gluconeogenesis and glycogenolysis
- - Stimulation of the accumulation of triglycerides
- Fatty fabric:
- - Stimulation of lipolysis
- Muscles:
- - reinforce the accumulation of free fatty acids
- - Development of insulin resistance
- Pancreas:
- - Insulin synthesis stimulation
- Bones:
- - increasing bone exchange
Sugar diabetes is still observed.
For osteopathy Osteoporosis is possible. Especially if human has hypogonadism. Also observed compression fractures of the vertebrae.
For arthropathy Under the action of growth hormone, the cartilage tissue of the joint and soft circle elements (muscles, connecting tissue) increase. Next, there are various ulcerative processes and shy deformation.
Under the action of hormone growth increases and thyroid. For such a case, a nodal colloidal proliferative goiter is characterized. For diagnosis, an ultrasound and fine-game aspiration biopsy is carried out.
Diffuse and nodal goiter The intestinal polyphs include:
- Colorectal cancer
- Adenomatous polyps
- Dolichokolon
The uterus mioma can also increase under the action of growth hormone.
Also increases risk development of cancer Prostates, mammary glands, intestines, lungs and thyroid glands. As a diagnosis, an ultrasound, CT, radiography, biopsy and endoscopic methods are carried out.
In case of running cases and in the development of external changes, humans also occur psychological disorders. Especially strongly affect women. This is social isolation and a decrease in physical activity.
Photo of acromegaly
Below I present you a selection of photos of acromegaly. You can see sick women in men. To enlarge simply click on the picture.
Now let's talk about the diagnosis of acromegaly. It is a heavy, systemic neuroendocrine disease caused by excessive growth of growth hormone.
In the image below you see a patient with pituitary giganticism, as well as with the developed acromegaly after closing growth zones.
Sick acromegaly Please note that a person has a cane. Most likely, he hurts the joints. He also sludge. It is such an appearance that is usually associated with patients of this disease.
Clinical picture of the disease (classic signs):
- Enlargement of brushes and stop
- Lubration and enlargement
- Rude, thick, oily skin
- Welcome votes
- Macrogness ( man sticks words)
- Increase the lower jaw and abnormal arc
Such signs are available in patients with an already running disease. Below drawing with classic signs of acromegaly.
At the moment, acromegaly can be diagnosed in the early stages. That is, when it has not yet caused changes in the person, as well as the enlarges of the brushes and stop.
If the patient has one or more of the above signs, then this reason to exclude acromegaly. In order to exclude it, it is enough to make blood test to the IFR-1 and the growth hormone.
The diagnosis is confirmed if:
- Concentration of IFR-1 on an empty stomach above reference values
- Growth hormone on an empty stomach of more than 1 ng / ml
If you got a normal IFR-1 and a growth hormone of more than 1 ng / ml, then it is worth spending oral glucose-bearing test (PGTT) with growth hormone:
- Blood on the growth hormone take an empty stomach
- In 5 minutes, drink 75 g of anhydrous glucose or 82.5 glucose monohydrate dissolved in 250 - 300 ml of water
- Not allowed to smoke during the text and 3 hours before him
- After 30, 60, 90, 120 minutes re-take blood on growth hormone
- To exclude diabetes mellitus at points 0 and 120 minutes take blood on glucose
Contraindication for the test is the presence of diabetes.
If, according to the results of the test, the growth hormone in none of the taken points is not reduced below 1 ng / ml, then it confirms acromegaly. If the growth hormone at least in one of one point below 1 ng / ml, then it is not our disease.
If the acromegaly is confirmed according to the results of hormonal blood test, it is necessary to visualize the source of production of growth hormone.
With MRI, regardless of the clinical picture and the duration of the flow, can be detected by the microphiz of less than 1 cm.
Microenoma pituitary less than 10 mm You can detect the macroen (10 - 25 mm).
Macroenoma more than 1 cm You can also find a patient a giant adenoma (more than 25 mm).
Giant adenoma more than 25 mm Laboratory diagnostics of acromegaly
The laboratory diagnosis of acromegaly is a random growth hormone, which should be more than 1.0 ng / ml. With a high imnetic method, this is more than 0.4 ng / ml. At the same time, there are five-time blood taking with an interval of 30 minutes.
Also watching insulin-like growth factor 1 (IRF-1), which reflects the daily somochetrophin secretory status, regardless of meals. Therefore, it is diagnostically most convenient.
IRF-1 (age-related regulations for both sexes)
| Age (years) | Normal value (NG / ml) |
|---|---|
| 20 — 25 | 116 — 358 |
| 25 — 30 | 117 — 329 |
| 30 — 35 | 115 — 307 |
| 35 — 40 | 109 — 284 |
| 40 — 45 | 101 — 267 |
| 45 — 50 | 94 — 252 |
| 50 — 55 | 87 — 328 |
| 55 — 60 | 81 — 225 |
| 60 — 65 | 75 — 212 |
| 65 — 70 | 69 — 200 |
| 70 — 75 | 64 — 188 |
| 75 — 80 | 59 — 177 |
| 80 — 85 | 55 — 166 |
It can be seen that with age, the insulin-like growth factor is reduced. Also positive results Possible during liver failure.
Estrogens negatively affect the binding of growth hormone with peripheral fabrics.
The minimum level of growth hormones against the background of oral glucose-beaded test is also a laboratory criterion.
Concentration of growth hormone Increasing growth hormone in each of the points more than 0.4 ng / ml with a highly sensitive imnunometric method will indicate pathology. After all, cm should decline when glucose in the blood. Well, its increase will indicate the autonomous nature of the secretion of growth hormone.
Instrumental diagnostics
If analyzes were confirmed in the laboratory, doctors guide the patient for the instrumental diagnosis of acromegaly. It will be an MRI pituitary with contrast. At the same time, tomographs must be at least 1.5 T.
If there are contraindications to MRI, then computed tomography with contrast.
If we did not find the pituitary adenomas, but in laboratory data there is an increased secretion of the growth hormone, then computed tomography of the chest (light, thymus) and abdominal cavity (trap, pancreas) for searching for ectopic somatolyberin adenocarcinoma (STL).
But there are also cases of ectopic secretion of a somatotropic hormone, which was in the islands of the pancreas and lymphocular tissue.
Additional laboratory studies are held to confirm the ectopic secretion of somatolyberin:
- Chal must be more than 300 pg / ml
- In addition, we additionally look at the presence of prolactin because the tumor can be mixed and secreted not only growth hormone. This is necessary to determine the nature and aggressiveness of the adenoma.
Treatment of acromegaly is a pretty problematic, complex and expensive procedure. It requires an individual approach to each patient.
Most patients (about 80%) need to conduct conservative (drug) therapy. Such a high percentage of patients dictates the need to achieve hormonal control of the disease. And also preventing the progression of various complications, achieving the mortality rate comparable to the overall population, which is the main ultimate goal of treatment.
To control the acromegaly, complex therapy is always necessary, including the suppression of the hormone hyperection of growth hormone, reducing the levels of IFR-1 and control of tumor growth.
For the treatment of acromegaly, surgical, pharmacological and radial methods of therapy are used. However, whatever ways were used, they all should be aimed at achieving biochemical control values:
- STG no more than 2.5 ng / ml (no more than 1 μg / l with a highly sensitive method of determination) - in the treatment of SRLS
- Min. STG / OGTT less than 1 ng / ml (less than 0.4 μg / l) - after adenomectomy
- Normalization of the IFR-1
Trial test with octreotide
For the beginning, trial treatment with octreotide with acromegaly is carried out. This allows you to identify whether the receptors are in the adenome. If there are no there, then most likely adenoma there are rather aggressive.
In general, in general, somatotropinomas are inclined to grow more. They grow rather than growing growth hormone. At least until middle age. But in people for 50, they are usually softer.
But how to guess?
Here you need an objective method in order to confirm the peculiarity of the disease in different age groups. Accordingly, a test with octreotide was used.
Test with octreotide
It allows you to find out how the patient suffers the octreotide. Side effects of such a medicine:
- nausea
- vomot
- diarrhea
As can be seen from the table, 50 μg is introduced for the first time. Nevertheless, even with the introduction of such a gentle dose, anyway, a patient may develop a side effect.
The one who cannot suffer a short octreotide is most likely not suffer and long. Only this adventure will be 28 days, and not on 4 - 5. Therefore, for such cases you need to know the pre-portability of the drug patient.
In general, this method is useful for differential diagnosis. We can solve the following tasks:
- Is it worth preparing the patient to prepare for analogues of somatostatin to the operation. After all, someone they will not help. Only be able to reduce the symptoms.
- Someone has a big adenoma. She would like to reduce it. However, we do not know whether the octreotide will help or not. Here it helps the sample. If the IFR-1 decreased by less than 30%, then it is believed that the person did not respond to the sample. If more than 60% of the suppression, then this is a very good result. This suggests that a person can even lead to conservative therapies.
The first and only method that can cure the patient once and forever, is surgical treatment of acromegaly. Removing adenomose, you can fully cure a person. He will no longer need medicines and additional help.
The longer the disease flows, the worse.
Below the drawing that says that no one climbs into the brain itself. Climb into the nose. Clean the front wall of a wedge-shaped sinus. Then there are the front wall of the Turkish saddle and turn out to be where the pituitary gland.
As a rule, with such an operation use endoscopic access. It passes through the nose and remove the adenoma. The pituitary itself is not deleted. He, if possible, is not affected.
Thus, the operation is minimized as possible and localized in the desired area. That is, no one removes adrenal through the head. It is carried out only in very rare cases when a huge adenoma threatens human life.
But even very large adenomas are not always removed, as they can go into the brain. Therefore, after their removal, large problems may arise. Then you have to scrape a piece of brain, which is also not very good.
That is, if the patient is alive, more or less healthy and can be supported by medication, then sometimes adenomose is better not to touch.
But the principle is next.
The first place of operation is only she can radically cure a person. If the doctors see that the operation will not be able to radically cure (for example, adenoma worst sleepy arteries siphons), sometimes it is necessary to remove a piece of volume to improve the flow and help on treating medication.
The chance of the cure of microenomes with surgery is 70%. For macroentera, it is 30%. It is noteworthy that it is very difficult to reveal the acromegaly. A person can live 10 - 15 years with such a disease. Therefore, doctors detect it not at an early stage of the disease.
Therefore, during the late treatment, a person needs not only to treat from acromegaly, but also from a heap of other diseases.
Acromegaly is a frequent illness. The official prevalence of such a disease is 40 people per million. But the costs of each patient exceed 2 - 3 million rubles per year. This is an expensive disease.
I also note that testing tests for IFR-1 is also not cheap. With complaints, do not always do doctors, since it is economically unprofitable.
I note that in Germany they tried to carry out such tests to each patient. The prevalence of such a disease was 1000 per million. That is, much more than official statistics.
Medical treatment of acromegaly
There are also medicated treatment of acromegaly. It consists of three methods:
- Analogs of Somatostatin
- Dopamine receptor agonists
Indications for primary drug therapy:
- Availability of contraindications for surgical treatment
- Categorical failure
- Expected unsatisfactory outcome of the operation (pronounced lateral growth of adenoma)
- Guarantee of the preservation of all the functions of the hypophus
Analogs of Somatostatin
Somatostatin analogs are Sandostatin LAR, Somatulin Atezhel, Pasyrotide. They are needed for constant treatment. People respond to them in 80% of cases. The cost of treatment with such drugs is somewhere from 35,000 rubles per month. And this is not including the treatment of other diseases.
In Russia, 4 drugs were registered from the group of self-supporting analogues:
- Somatulin Atezhel (Lanreotide, Original Preparation, Ipsen, France)
- Sandostatin LAR (octreotide, original drug, Novartis, Switzerland)
- Octreotide-Long (Otreotide, F-Synthesis, Russia)
- Octreotide depot (octreotide, pharmaceutical, Russia)
Drug formal forms of the Lanreotide and the Otreotide of long-scale acts are mainly affected by the Somatostatin receptors of the 2nd subtype, and have approximately equal efficacy.
However, the Lanreotide and octreotide differ in the method of reception, which may affect the convenience for the patient.
Durable durable durable forms are produced in ready-to-use pre-filled syringe tubes, the contents of which are injected subcutaneously. Durable forms of octreotide lasting before intramuscular injection require dilution.
Approximately 75% of patients with acromegaly, which previously received Otreotide LAR every 4 weeks, was observed a normal level of IFR-1 after switching to somateulin 120 mg, with introduction every 6 or 8 weeks.
With the help of various studies, it was revealed that an increase in the interval between the injections of the drug while maintaining the therapeutic effect makes it possible to significantly simplify the injection mode and increase the preference of patients of therapy.
There is also a domestic experience of using the drug. 65 patients translated on Lanreotide Atezhel According to the following scheme:
- Patients initially receiving 10 mg of octreotide once in 28 days, were translated on the injection of 120 mg of somatulin Audezhil once in 56 days
- Patients originally receiving 20 mg of octreotide once in 28 days were translated on the injection of 120 mg of somatulin Audezhel once every 42 days
- Patients originally obtained by 30 or 40 mg of octreotide once in 28 days, were translated on the injection of 120 mg of somatulin Audezhel once in 28 days
In a number of patients, the transition from an octreotide for somatulin, the atezhil increased the effectiveness of long-term therapy, which was manifested in the normalization of biochemical indicators (in 12 out of 50 initially decomposed patients) and a moderate decrease in the size of the adenoma of the pituitary gland (in 19% of patients).
In this group of observation, there were 10 patients who, by transferring to somatulin, a car 120 mg was able to increase the intervals between the administration of the drug to 42 (in 8 patients) or 56 days (in 2 patients) without losing efficiency.
Thus, the optimal use of monotherapy or combination therapy makes it possible to achieve biochemical remission in most patients suffering from acromegaly. At the same time, characterizing persistent efficiency and safety during long-term use.
Under the condition of good compliance with patients to therapy for the loss of efficiency over time against the background of drug therapy, it is rare.
I would also like to affect the drug Pacireotide. Its efficiency is compared with octreotide, since the latter acts mainly to type 2. Pasireotide receptors is a multi-analog and acts almost on all subtypes of the receptor.
As the interim results were shown in the study of this drug, a group of patients on the treatment of a Pacireotide preparation to a greater extent reaches normal IRF-1 level values.
However, it is worth saying that very often against the background of taking this drug in patients with acromegaly develops such by-effectlike induction violations carbohydrate exchange Either the deterioration of the condition of carbohydrate exchange in already existing violations.
As a result, patients constantly need to control carbon and assign hypoglycemic therapy, which worsens the quality of human life.
Dopamine receptor agonists
Dopamine agonists are usually cabbergoline. This method is used when the analogues of somatostatin in the maximum dose do not give results.
Cabergoline is always 0.5 mg in a tablet. You should not use more than 3 mg per week, as the effectiveness disappears. You can use up to 7 mg, but just a large amount does not give good results.
About 80% of patients receiving monotherapy by Pegvisanta reaches normal levels of IRF-1 levels. In the event of not achieving normal values, it is recommended to combine Pegvisant with Cabergolin.
Receptor blockers to growth hormone
Growth hormone receptor blockers are very expensive drugs that will cost you about 80,000 rubles a week. It is used only for the most severe patients who did not help previous options for treating acromegaly.
Such drugs block the effect of growth hormone on the periphery and thereby reduce the IFR-1. That is, the effect is excellent.
But the problem is that only these drugs are used for nowhere is considered not safe. When they block the production of IFR-1, the pituitary gland is inevitably trying to synthesize even more growth hormones. And this can provoke the growth of the adenoma.
Therefore, such blockers are usually used in combination with analogs of somatostatin.
Radiation therapy with acromegaly
If the previous methods do not help, then begins to use radial therapy in the treatment of acromegaly. It is mostly gamma knife and cyber knife.
Radiation therapy in the treatment of acromegaly The effectiveness of radiation therapy is about 30%. But it is worth saying that with patients' treatment defective in plans, this method will not be superfluous.
Previously, protonotherapy was still used, but now it is not carried out. Protonotherapy - This is one bundle of particles, which is sent through the pituitary. That is, it strides through all organs and fabrics. It is still here to add that in almost all cases PHIPPOPUITUTARISM is developing.
Mostly use more modern methods. Such as the gamma-knife and cyber-knife. They differ in that the beam does not pose any threat to the surrounding tissues.
But the rays are somewhat and they all intersect at one point where the adenoma is located. Accordingly, they have a therapeutic effect. In fact, they burn it.
In fact, such treatment is very simple. The most important thing is that the doctor can suspect and revealed this disease. In addition, he needs to convey to the patient the need for treatment.
Despite the fact that people with acromegaly miserably notice the change in their appearance, there are special issues for patients who reflect the essence of the process. That is, when the doctor asks whether the appearance has changed, then people are usually not recognized.
Another problem is that they cease to be photographed.
Therefore, doctors should understand that if a person is not photographed, does not participate in contests, it does not go outside, then this is an alarming signal.
As a result, people are desocyalized.
And when they explain that they are not alone with such problems, then only at this stage a person can become much easier. Therefore, the doctor needs to properly prepare his patient.
Why change appearance? There are two factors that make growth hormone:
- GR causes swelling of all tissues
- Over time, it causes depositing of the conjunctive tissue. In the future, this can lead to apoptosis of cells. And then there is already fibrosis. If he happened, then it is irreversibly. If a person in the early stages of edema, then everything is reversible. Therefore, this is another reason to diagnose not by external, but by metabolic problems. For example, a headache, fatigue, sweating, and so on.
That's all!
Now you know what acromegaly is and what its causes and symptoms are. Also reviewed photos. Plus, we talked about the diagnosis and treatment of such a disease. In general, be healthy!
