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Acromegaly.pptx

This document provides an overview of acromegaly, a rare disorder caused by excessive growth hormone production in adults. It discusses that acromegaly is usually caused by non-cancerous pituitary tumors and results in enlarged hands, feet, and facial features. Diagnosis involves blood tests, imaging, and assessing for high IGF-1 and low growth hormone levels after suppression. Treatment aims to control tumor size and hormone levels and includes surgery to remove tumors, medication to block hormone production and action, and radiation therapy. The goals are to manage symptoms and risks like joint pain and heart disease.

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ACROMEGALY Presented By Ramesh Behra
Outlines • Introduction • Common Disorders Related to Endocrine Control of Growth and Metabolism • Acromegaly • Definition, Incidence, and Prevalence • Causes and Risk Factors • Pathophysiology • Clinical Manifestations • Diagnosis • Medical Management • Non-Medical Management • Prevention and Health Education • References
Introduction • The endocrine system plays a crucial role in regulating growth and metabolism through a network of glands that secrete hormones such as: • Growth Hormone (GH): Secreted by the pituitary gland, GH stimulates growth during childhood by promoting cell division and protein synthesis. • Thyroid Hormones (T3 and T4): Produced by the thyroid gland, they regulate metabolic rate, affecting energy expenditure and weight control. • Insulin: Released by the pancreas, insulin regulates glucose metabolism, promoting sugar absorption into cells. • Cortisol: Produced by the adrenal glands, cortisol influences metabolism and helps the body respond to stress.
Common disorders related to the endocrine system’s control of growth and metabolism • Diabetes Mellitus: Either due to insufficient insulin production (Type 1) or insulin resistance (Type 2). • Hypothyroidism: Inadequate thyroid hormone production, leading to fatigue and weight gain. • Hyperthyroidism: Excessive thyroid hormone production, causing weight loss and an overactive metabolism. • Cushing's Syndrome: Prolonged exposure to high cortisol levels, resulting in weight gain and other issues. • Acromegaly: Abnormal growth of bones and tissues due to excess growth hormone in adults. • Polycystic Ovary Syndrome: Hormonal imbalances affecting the ovaries, leading to weight gain, irregular periods, and infertility. • Hypopituitarism: Insufficient hormone production by the pituitary gland, impacting growth and metabolism.
Acromegaly • The term “Acro” originates from the Greek word “ákros,” signifying the highest or topmost, and “Megaly” stems from the Greek word for greatness, indicating enlargement. • Acromegaly is a rare endocrine disorder characterized by the overproduction of growth hormone (GH) after the closure of growth plates in adulthood. • It has an incidence of approximately 3-4 cases per million people per year. • Typically, it is diagnosed in adults between the ages of 30 and 50, although it can affect individuals of any age
Causes and Risk factors • Acromegaly can be attributed to various causes, including • Pituitary adenomas • Carcinoid tumors • Pancreatic islet cell tumors • Genetic conditions like McCune-Albright syndrome, MEN-1, and neurofibromatosis. • In over 90% of cases, pituitary tumors are responsible for acromegaly, but occasionally, tumors elsewhere in the body may also lead to this condition.
Pathophysiology • The development of acromegaly occurs when the pituitary gland continuously releases excessive growth hormone into the bloodstream. This, in turn, triggers the liver to produce insulin-like growth factor I (IGF-I), which promotes the growth of bones and body tissues.
Clinical Manifestations Acromegaly presents with a range of clinical signs and symptoms: • Enlarged Hands and Feet: Due to tissue and bone overgrowth. • Facial Changes: Including a prominent jaw, enlarged nose, and thickened lips. • Joint Pain: As a result of tissue enlargement. • Cardiovascular Complications: Such as hypertension and an increased risk of heart disease.
Diagnosis • Diagnosing acromegaly involves a thorough medical history assessment and physical examination, followed by specific diagnostic steps, such as measuring IGF-1 levels in the blood after fasting, conducting a growth hormone suppression test, and utilizing imaging techniques like X-rays, CT scans, and MRI to locate and assess pituitary tumors or other potential causes.
Management • The primary goals of acromegaly treatment are to manage tumor size, restore GH and IGF-I levels to normal, alleviate symptoms, and address associated health issues. • Treatment options include: • Surgery • Medication • Radiation therapy.
Medical Management • While not a cure, three categories of medications—somatostatin analogs, dopamine agonists, and growth hormone-receptor antagonists—can be used individually or in combination to manage acromegaly.
Non-Medical Management (Surgery) • Transsphenoidal operation, which involves accessing the tumor through the nasal passages and sphenoid sinus, is a commonly employed surgical method. • The objective is to remove the tumor responsible for excess growth hormone production. • Depending on the extent of tumor removal, further treatment with medication or radiation therapy may be necessary.
Non-Medical Management (Radiation) • In cases where surgery is not feasible or unsuccessful, and medications prove ineffective, radiation therapy, using high-energy x-rays or particle waves, may be recommended to target and eliminate tumor cells.
Prevention • While acromegaly is not preventable, health education can raise awareness about its symptoms, promoting early detection and intervention. • Encourage individuals with a family history of pituitary tumors to undergo regular check-ups.
References • [1] Lavrentaki A, Paluzzi A, Wass JA, Karavitaki N. Epidemiology of acromegaly: • review of population studies. Pituitary. 2017;20(1):4–9. • [2] Chanson P, Salenave S, Kamenicky P. Acromegaly. In: Fliers E, Korbonits M, Romijn JA, eds. Handbook of clinical neurology. Vol 124. 1st ed. Waltham, MA: Elsevier B.V.; 2014:197–219. • [3] Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2014;99(11):3933–3951. • [4] Paragliola RM, Salvatori R. Novel somatostatin receptor ligands therapies for acromegaly. Frontiers in Endocrinology. 2018;9:78.
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