Transcript Acromegaly info2[1]x - Practicum-Health-Science-I-2011-2012

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Acromegaly is a rare hormonal
disorder that develops when your
pituitary gland produces too much
growth hormone. This is almost
always a result of a benign
(noncancerous) tumor. This,
however, is different from
gigantism, which is basically the
same disease, but it occurs when a
person is still young and growing.
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Acromegaly is uncommon and the
physical alterations occur over long
periods of time. Many of these
symptoms may remain unnoticed
for up to a period of 10 years.
These changes may be noticed when
seeing before and after pictures of a
person with this disorder.
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Enlarged hands
and feet
Fatigue and
muscle weakness
Larger and
broader facial
features
Underbite
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Excessive sweating
and body odor
Thick, oily skin
Enlarged liver
Enlarged heart
Enlarged kidneys
Enlarged spleen
and other organs
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Reduced sex drive
Erectile
dysfunction in men
Back pain
Menstrual cycle
irregularities in
women
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Enlarged tongue
Pain and limited
mobility in joints
Barrel Chest
Sleep Apnea
Impaired vision
Headaches
Husky Voice
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Acromegaly occurs when your body
produces too much growth hormone. The
source of the excess hormone is almost
always your pituitary gland, a small
bean-shaped structure at the base of your
brain behind your nose. Growth
hormone is one of several hormones your
pituitary gland produces.
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Pituitary tumors- Most cases of
acromegaly are caused by a benign tumor
of the pituitary gland. In addition to
producing excess growth hormone, these
tumors can press on nearby tissues as
they grow. This pressure can cause some
of the symptoms of acromegaly, such as
headaches and impaired vision.
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Nonpituitary tumors- In a few
people, acromegaly is caused by
benign or cancerous tumors in
other parts of the body, such as the
lungs, pancreas or adrenal glands.
Some of these tumors actually
secrete growth hormone. In other
cases, they produce a hormone
called growth hormone-releasing
hormone (GH-RH), which
stimulates the pituitary gland to
make more growth hormone.
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High blood pressure (hypertension)
Heart disease, particularly
enlargement of the heart muscle
(cardiomyopathy)
Arthritis
Diabetes
Precancerous growths (polyps) in
your colon
Sleep apnea, a condition in which
breathing repeatedly stops and
starts during sleep
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Carpal tunnel syndrome — tingling or
pain in your fingers caused by excess
wrist tissue pressing on nerves
Reduced production of other pituitary
hormones (hypopituitarism)
Benign tumors in the uterus (uterine
fibroids)
Spinal cord compression
Vision loss
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Measuring IGF-1- Because growth
hormone stimulates your liver to produce
IGF-1 — another growth hormone —
IGF-1 blood levels are nearly always
elevated when you have acromegaly.
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Measuring growth hormone before and
after you drink glucose. In this test,
your blood levels of growth hormone are
measured both before and at several
points after you drink a preparation of
sugar (glucose). Normally, taking in
glucose causes growth hormone levels to
fall. But if your body is producing too
much growth hormone, levels stay high
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Imaging - Magnetic resonance imaging
(MRI) of your brain to pinpoint the size
and location of your tumor. Brain
imaging may sometimes be performed
with Computerized tomography (CT). If
brain imaging fails to detect a pituitary
tumor, your doctor may recommend
additional blood work and further
imaging studies of your chest or
abdomen.
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Transsphenoidal surgery- In this
procedure, named for the sphenoid
sinus — air pocket behind the nose
— your surgeon extracts the tumor
through a small incision through
the back wall of the nose.
Removing the tumor surgically can
quickly and effectively return
growth hormone levels to normal
and relieve pressure on the tissues
around your pituitary gland
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But even the most experienced
surgeon may not be able to
completely remove tumors that have
grown large or extended into nearby
blood vessels or other structures.
Incomplete tumor removal may
result in growth hormone levels
that stay high after surgery,
requiring further treatment with
medication or radiation.
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If the pituitary tumor is inaccessible to
surgery, or the patient is at high risk of
surgical complications. They may also
need medications if their growth
hormone levels stay high following
surgery. The need for medications may
continue for the rest of your life.
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Medications used to lower the production
of growth hormone or block its action on
target tissues include:
Somatostatin analogues (SSAs).
Growth hormone receptor antagonists
(GHRAs).
Dopamine agonists.
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Somatostatin analogues (SSAs). The
drugs octreotide (Sandostatin,
Sandostatin LAR) and lanreotide
(Somatuline Depot) are synthetic
versions of the brain hormone
somatostatin — growth hormone releaseinhibiting hormone. They can decrease
growth hormone levels by blocking the
pituitary gland's excess production.
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Growth hormone receptor antagonists
(GHRAs). The medication pegvisomant
(Somavert) blocks the effect of growth
hormone on body tissues. This
medication can normalize IGF-I levels
and relieve symptoms in most people
with acromegaly, but doesn't lower
growth hormone levels or reduce the
tumor size.
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Dopamine agonists- Cabergoline
(Dostinex) and bromocriptine (Parlodel)
offer another strategy to reduce growth
hormone production and shrink tumors.
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Radiation therapy can quickly stop
lingering tumor cells from growing and
slowly reduce growth hormone levels. It
may take years for this treatment to
noticeably improve acromegaly
symptoms, and patient’s may continue to
need medication while waiting for
growth hormone levels to fall.
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Conventional radiation therapyThis type of radiation is usually
given every weekday over four to six
weeks. It may take five to ten years
or more for your growth hormone
levels to return to normal.
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Stereotactic radiosurgery- Radiation
can also be given stereotactically,
with intense, focused beams aimed
at a tumor from various directions.
This form of treatment damages the
tumor, while still doing little
damage to the surrounding areas.
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http://www.youtube.com/watch?v=8yDi
GLqzKKA
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1. If Bobby, age 42, had a surgery to remove a
benign tumor located at the base of the brain
and the tumor was not completely removed,
what course of action would you take to
further treat the patient?
A. attempt a second surgery
B. Assign radiation therapy
C. Prescribe medication
D. Both b and c
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2. Brigitte, age 35, is being diagnosed with
Acromegaly. She is assigned to take the IGF-1
blood level test. After she ingests the glucose,
what will happen to her growth hormone
level?
A. Stay high
B. Increase
C. Decrease
D. Increase and then decrease
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3. Stephany, age 15, has symptoms of enlarged
hands and feet, chronic headaches, vision
problems, broad facial features and irregular
menstrual cycles. Which hormonal disorder
will she be diagnosed with?
A. Dwarfism
B. Gigantism
C. Virilism
D. Acromegaly
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4. A patient diagnosed with acromegaly has
developed precancerous growths in their…
A. Uterus
B. Brain
C. Colon
D. Liver
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5. A patient who has been diagnosed with
acromegaly, will experience the following
symptoms except…
A. Sleep apnea
B. Arthritis
C. Spinal Cord Compression
D. Loss of hair
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