Endocrinology / / April 26, 2016
Acromegaly - a disease characterized by disproportionate growth of the skeleton, soft tissues and internal organs and a number of metabolic disorders associated with excessive production of growth hormone by the pituitary gland.
The disease was first described in 1886 by Marie.
etiology of the disease is unknown.The literature describes a number of patients with acromegaly development can be expected to be associated with an infectious process in the diencephalic region.It takes a very cautious and critical attitude to the instructions on the development of acromegaly after injuries and infections.The chronological coincidence in time of these factors with the development of acromegaly, noted in rare cases, the disease does not yet right for the recognition of their etiological significance.
are a few cases of acromegaly after pregnancy, which they attach to the etiological significance in the development of the disease.Undoubted role in the development of the disease has a genet
reasons (pathogenesis) of acromegaly
in the pathogenesis of the disease has major importance overproduction of growth hormone eosinophilic cells of the anterior pituitary.Typically, the source of increased production of growth hormone is eosinophilic pituitary adenoma, but describes patients who overproduction of growth hormone was associated with hyperplasia of eosinophil cells without the formation of adenomas.Eosinophilic cell adenoma can occur not only within the sella, but also outside it - from the remnants of embryonic germ adenohypophysis in the back of the throat or in the underlying bone.Medical literature cited in Acromegaly cases without pituitary tumors in which these were not investigated region are unreliable.
excess growth hormone is the cause of metabolic disorders and hyperplastic processes in all organs and tissues of the body.
can assume that, along with increased production of growth hormone, in some patients with acromegaly improved products and lactotropic hormone.The consequence is gynecomastia in men and pathological lactation in women observed in some patients.However, there is evidence that growth hormone itself has lactotropic action.
In the initial stages of the disease there may be signs of increased function of the thyroid gland, adrenal cortex and gonads, or associated with an increase in production of thyroid-stimulating, adrenocorticotropic hormone and gonadotropin, or depending on the direct action of growth hormone on the prostate.However, in the future, in connection with the destruction of the anterior pituitary growing tumors often develop implicit or explicit failure of these glands of internal secretion.
Another group of symptoms depends on the intracranial tumor growth puts pressure on the optic chiasm, sella diaphragm and - in rare cases - in the diencephalic region and leading to increased intracranial pressure.These symptoms are the same as in inactive growth hormone tumors.
Pathological Anatomy and simpotmy acromegaly
The vast majority of patients with acromegaly is found anterior pituitary tumor composed of eosinophilic cells.The tumor may be small, it does not cause destruction of the Turkish saddle, but in some cases reaches a considerable size - up to 4 cm in diameter..
histological structure of the tumor is different.There are patients with acromegaly are two types of tumors - "typical", is small in size (0.8-2 cm), consisting of acidophilic cells with well distinguishable beads, and "atypical"."Atypical" adenomas often are large, different structure polymorphism.They consist of groups of moderate staining of eosinophilic cells, weakly granular acidophiles and deprived of granules cells indistinguishable from hromofebnyh.In both types of adenomas marked pleomorphism of the nuclei, areas of necrosis, fibrosis and small round calcified bodies.dividing the figures do not show up in the "typical" adenomas and are available in half "atypical" adenomas.The "typical" adenomas as opposed to "atypical" found high levels of growth hormone."Typical" adenomas are more common in elderly patients with a long duration of the disease and slow its progression.They rarely cause narrowing of the visual field.
There are some observations, which have acromegaly patients with malignant tumors were identified.Symptoms of acromegaly in these patients usually had for many years before his death, and for a long time there was no evidence of progressive tumor growth.
- pituitary dwarfism
- chromophobe pituitary adenoma
- Cindromy defeat hypothalamic area, accompanied by violation of the production of hormones of the anterior pituitary
- Adipozo-genital dystrophy, clinical
- Morgagni syndrome - Stewart - Morel(MORGAGNI - MOREL - STEWART)
- tumors of the anterior pituitary
Pathological changes in other organs and tissues are reduced mainly to the processes of hypertrophy and hyperplasia.The skin thickens mainly due to the development of connective tissue.Increases the size of the sebaceous and sweat glands.Marked increase in the number of cellular elements and kind of swelling in the subcutaneous adipose tissue.Muscle hypertrophy, in which there are degenerative changes.Due to the proliferation of periosteal bone ossification and thicken, there are growths of bone - osteophytes.Often the bone demineralization, softening them, which is associated with an increased calcium release).
articular cartilage thicken.In connection with the growth of bone in the joints sometimes occurs erozirovanie articular cartilage, leading to the development of osteoarthritis original.Joint capsule and ligaments thicken.
Dimensions and weight of internal organs significantly increased.We describe a case where the patient with acromegaly kidney weight 400 g ,.Heart - 1250 g, liver - 2300 g, spleen - 1150 Patient acromegaly, liver weight was 7500 g, kidney - 600 and 550 grams, the heart - 900 bowel length increased.