Endocrinology / / May 04, 2016
Gigantism - a disease characterized by excessive, more or less proportional to the growth of the skeleton and other organs and tissues due to increased production of growth hormone by the anterior pituitary.
abnormally high growth may be due to excessive stimulation of growth hormone or growth hormone may depend on the unusually long duration of the growth period.Growth may continue longer than normal in patients with hypogonadism who fails to timely develop gonads and there is no ossification of the epiphyseal cartilage.Possibly, in these patients, in addition to the growth period of elongation, and is set to a compensatory increase in activity of the anterior pituitary gland to increase not only the production of gonadotropins, and growth hormone.
However, hypogonadism increase in growth does not reach the degree which is observed in the real giants of the pituitary.This form of disease is not included in the concept of gipofiearnogo gigantism.
In assessing tall as a pathological need to consider r
boundaries of normal human growth - relative value.It is considered a giant growth above 200 cm.
Etiology and pathogenesis . Massalongo put forward the idea that the gigantism - a disease of the same nature as that of acromegaly.Basically this idea is acceptable and considered acromegaly and gigantism as age variants of the same process.In cases where the disease begins in adulthood after already come ossification of epiphyseal cartilage, developing the typical characteristic of acromegaly with periosteal growth of the skeleton.At the beginning of the disease before puberty, it appears gigantism.
The fact that in very rare cases, children in pre-adolescent overproduction of growth hormone causes a disproportionate skeletal development and thickening of soft tissues, whereas normally in children with gigantism, the changes are missing, and akromegaloidnye traits manifest only later, do not contradict thethe unity of acromegaly and gigantism.Perhaps the differences in the clinical manifestation of the disease depends on some individual characteristics of tissue response to the action of growth hormone.
Because acromegaly and gigantism are variants of the same process, the etiology and pathogenesis of these diseases should be considered together, and the data that are given above in relation to the etiology, pathogenesis and pathological anatomy of acromegaly generally apply to the gigantism.
clinical picture of gigantism. Gigantism is a rare disease, occurring in both sexes, is more common in men.Patients with pituitary gigantism are usually born with normal weight and height.Enhanced growth can occur at any age, most often in prepubertal and pubertal period.
addition to guidance on accelerated growth, patients sometimes already in the early stages of the disease complain of headaches related to the pressure of the tumor on surrounding tissues.
On examination, patients first drew the attention of their high growth.Often there is some disparity in the development of the skeleton: the limb is usually relatively longer than the body;skull sizes are relatively small.
predominance of finite length over the length of the body in patients with gigantism, perhaps due to the fact that eosinophilic pituitary adenoma exerts pressure on the anterior pituitary, which leads to a decrease in the production of gonadotropins.Late and incomplete development of gonads in some patients causes gigantism and delayed ossification of the epiphyseal cartilage.Ossification of the epiphyseal cartilage of some giants does not come up to the age of thirty.In a later age in pituitary giants are usually in the more or less akromegaloidnye features -.. Thickening of the flat bones, prognathism, kyphosis, etc.
skin is usually normal color giants and humidity.Thickening of the skin and its increased greasiness may occur later in life, when the symptoms of acromegaly are beginning to get over the symptoms of gigantism.Hair thickened head.In cases where hypogonadism is not expressed, especially if the disease started in late adolescence, there is increased growth of hair on the body.In patients with early manifested hypogonadism vegetation on the pubic hair and armpits is scarce.
muscular system in the early stages of the disease are often well developed, there is increased muscle strength.Later, as the disease progresses and growth eosinophilic adenoma, there is muscle weakness.Sometimes from the very onset of the disease is marked weak development of the muscular system.
- pituitary dwarfism.The clinical picture
- chromophobe pituitary adenoma
- tumors of the anterior pituitary
- clinical picture of acromegaly
- Diagnosis and differential diagnosis of acromegaly
- treatment of acromegaly
- Diagnosis and differential diagnosis of gigantism
- Treatment gigantism
Dimensionsinternal organs are increased in proportion to the growth and usually there are no signs of their functions.
As in patients with acromegaly in patients with gigantism is often enlarged thyroid gland, sometimes with signs of hyperthyroidism.Some patients have exophthalmos.
In cases where the disease from the very beginning is not accompanied gipogenitalizme, in the early stages there may be symptoms improve gonadal function - increase libido and potency in men, macro genitosomiya.Increasing the size of the external genitalia with the most can be attributed to a direct effect on their growth hormone.Further progressive hypopituitarism usually leads to a decrease of gonadal function.In rare cases, pituitary gigantism, hypogonadism in women is usually manifested in the early stages of the disease;menstruation does not occur quickly or terminated.
Violation of carbohydrate metabolism - lower carbohydrate tolerance - usually absent at the beginning of the disease, but may occur in the future, when gigantism essentially becomes acromegaly.Visual impairment
- bitemporal gemioanopsiya - childhood usually absent because at this stage eosinophilic adenoma usually does not reach a considerable size;at a later age often observed narrowing of the visual field.
sella often slightly expanded at the beginning of the disease, and gradually - as pituitary adenoma growth - there radiological evidence of its destruction.
In rare cases, the compression of the hypothalamus or the germination of the tumor in patients with gigantism may appear symptoms of dysfunction diencephalic centers - diabetes insipidus, obesity, various autonomic disorders.