Brain Tumor, Acromegaly

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Acromegaly is a rare hormonal disorder that develops when your pituitary gland produces too much growth hormone, nearly always as a result of a noncancerous (benign) tumor. The excess hormone causes swelling, skin thickening, tissue growth and bone enlargement, especially in your face, hands and feet. Acromegaly occurs in adulthood, usually during middle age. In children who are still growing, too much growth hormone can cause a condition called gigantism that leads to an abnormal increase in height as well as excess bone growth. Because acromegaly is uncommon and physical changes occur gradually, it often isn't recognized right away. Although untreated acromegaly can lead to serious illness and premature death, available treatments can reduce your risk of complications and significantly improve your symptoms. Acromegaly is caused by a growth hormone (GH) secreting pituitary adenoma in over 99% of cases. The problems associated with acromegaly include the effects of abnormally high GH and insulin-like growth factor-1 (IGF-1) levels and in some instances by the tumor compressing the normal pituitary gland and optic nerves. Untreated acromegaly is a serious condition that can cause dramatic bone and soft tissue changes and serious cardiovascular problems. If the tumor develops before bone growth is completed in adolescence, gigantism results. Because of the serious changes resulting from GH excess, effective treatment is essential. The most obvious changes of acromegaly are external physical changes that often include enlargement of the hands (increase in ring size) and feet (increased shoe size), frontal bossing (enlargement of the forehead) and prognathism (jaw enlargement). One of the most common symptoms of acromegaly is enlarged hands and feet. You may notice that your rings no longer fit and that your shoe size or width has increased. Joint and back pain also are common. Acromegaly may also cause gradual changes in the shape of your face, such as a protruding lower jaw and brow, an enlarged nose, thickened lips, and wider spacing between your teeth. Because acromegaly tends to progress slowly, symptoms may remain undetected for up to 10 years. People sometimes notice changes only by comparing their current appearance to old photographs. Development of an underbite, spreading teeth, an enlarging tongue, increased snoring and sleep apnea are also common. Carpel tunnel syndrome and excessive sweating are also common. Additional serious problems may include hypertension, diabetes mellitus and an increased risk of colon cancer. With GH-secreting macroadenomas, there may be other problems of visual loss, headaches and pituitary gland failure including fatigue, depression, impotence and loss of libido in men and menstrual irregularities and galactorrhea (milk discharge from the breast) in women. Comparing old and recent photographs will often demonstrate dramatic changes in facial appearance. However, acromegaly is diagnosed by documenting elevated levels of both GH and IGF-1. An oral glucose tolerance test is often used to confirm excess GH production. Following hormonal testing that confirms acromegaly, an MRI of the pituitary should be performed to confirm the presence of a pituitary adenoma.


Laboratory Test Procedures:

tight fitting rings or shoes
oily skin
reddening and thickening of the skin
facial feature abnormalities
change in menstrual cycles
erectile dysfunction
blurred vision
pain in the lower back
muscle weakness
hoarse voice
swollen tongue
joint aches
joint stiffness
barrel-shaped chest
protrusion of the lower jaw so the lower teeth extend beyond the upper teeth
small skin outgrowths
sleep apnea
enlarged liver, heart, kidneys, spleen and other organs

pH - arterial blood
Glucose Tolerance 2hr (75g)
Glucose Tolerance 3hr (75g)
Glucose Tolerance 3hr Preg (100g)
IGF-1 Insulin-like Growth Factor-1
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