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The endocrine system is a complex group of glands that can communicating,

controlling, and coordinating bodys work. Glands are organs that make hormone.
Hormones are special chemicals that made by one cell or a group of cells.
Bloodstream carries the proper types of hormones to specific target. Different
hormone cause different effect.
This is the picture of our bodys glands. As you can see, there are many types
of glands and they produce different hormones. But this time Ill only explain about
pituitary gland. Pituitary gland is a small oval-shaped organ at the base of the brain
that releases many types of hormones. One of it called Growth Hormone.
This is the location of the pituitary gland. This is its shape. Growth hormone
stimulates growth in childhood and also maintaining health body composition. In
adults it is also important for maintaining energy, muscle strength and bone health.
Acromegaly is a rare hormonal disorder that develops when your pituitary
gland produces too much growth hormone. Acromegaly comes from Greek words.
Acro for extremities and megaly is for enlargement. As the name suggest,
acromegaly can be recognized by abnormal growth of the hands, feet, as well as
enlargement of the facial features.
Acromegaly is different than gigantism, although both conditions can have a
similar cause. Acromegaly occurs in adulthood, when the long bones of the legs
and arms have stopped growing. Gigantism occurs in childhood.
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 improve the symptoms.
Ill explain about the epidemiology of Acromegaly. First is the frequency.
Acromegaly is more common than gigantism, with an incidence of 3-4 cases per
million people per year and a prevalence of 40-70 cases per million population (in
United States)
Mortality/Morbidity. For individuals with acromegaly, the mortality rate is 2-3
times of the general population. For persons with acromegaly, the most frequent
causes of death are cardiovascular and respiratory complications.

No predilection of race has been reported. IGF-1 excess equally affects men
and women. And the mean age for onset of acromegaly is in the third decade of life.
Hormones that play a key role in Acromegaly are Growth Hormone, Insulinlike Growth Factor 1 (IGF-1) and Somatostatin.
This is a picture that explain about the relation between three hormones that
I mentioned earlier. GH is produced by the pituitary glands. When a person has
acromegaly, abnormally high levels of GH are released by the pituitary. This will
causes changes in physical characteristics and other aspects of your body. IGF-1
made mostly in liver. IGF-1 levels rise whenever GH levels rise. Together, they can
also cause many signs and symptoms of acromegaly. Somatostatin is produced by
the hypothalamus. Its able to control the amount of GH in the body.
Tumor is the most common cause of excess growth hormone. There are two
types of tumor. First is pituitary tumor, noncancerous tumor located on the pituitary
gland. This causes excess in producing GH. The second is nonpituitary tumor. Its
tumor that located in other parts of the body, such as lungs, pancreas, or adrenal
gland. Some of these tumors actually secrete growth hormone, or a hormone called
growth hormone-releasing hormone (GH-RH), which stimulates the pituitary gland to
make more growth hormone.
Now we will see the symptoms. As you can see in this picture, a person with
acromegaly may have a bigger hands and feet, larger and boarder facial features,
protrusion of the lower jaw, widely spaced teeth,thickened-oily skin, and excessive
sweating and body odor. You can see the pictures on the next slide.
Here are the pictures. The feet is bigger than normal. The teeth are widely
spaced. This is a person with Acromegaly, he has a large hands. His facial features
are also enlarged. He also has thick and oily skin.
This is an illustration picture. This is the women before she has Acromegaly.
This is the women with Acromegaly. You can see the change of her facial features.
The forehead is wider and prominent, the nose and mouth are also larger than
before. The shape of her face is also changed.

Person with acromegaly also may have skin tags, fatigue and muscle
weakness, enlarged tongue, back pain, and pain and limited mobility in joints.
They may also have increased chest size, so their chest looks like a barrel like
this. And then goiter, and enlarged of other organs.
It also can be a deepened, husky voice due to enlarged vocal cords and
sinuses, severe snoring and frequent brief interruptions in nighttime breathing
(sleep apnea) because of tissue swelling that blocks your upper airway. Menstrual
disorders and sexual dysfunction is because excess GH/IGF-1 will cause gonadal
dysfunction or gonadotropin deficiency. Gonadotropin is a hormone produced by
pituitary, include luteinizing hormone (LH) and Follicle stimulating hormone (FSH)
that control menstrual cycles and ovary in women and sperm production in men.
Next is hypertension (high blood pressure). Hypertension can increase the
risk of cardiovascular complication. GH excess would interfere cardiac morphology,
systolic function, and diastolic function, which were independent from the presence
of hypertension. Excess GH/IGF-1 can cause insulin resistance so the insulin cant
work. That will cause type 2 diabetes (diabetes mellitus).
Local tumor can cause headache and visual problems occur because of
compression of the optic chiasm by the enlarged pituitary.
How can we diagnose an Acromegaly? We can measure the level of IGF-1 in
the blood. This is an effective screening test because IGF-1 level rises whenever GH
level rises. Next, your blood levels of growth hormone are measured both before
and after you drink glucose. Normally, taking in glucose causes growth hormone
levels to fall. But if your body is producing too much growth hormone, levels stay
high. The last is imaging using MRI or Magnetic Resonance Imaging. You will know
the size and location of your tumor.
Therapy and treatment. Doctors treat acromegaly caused by benign tumors
of the pituitary gland with surgery, medications and radiation. Doctors can remove
many pituitary tumors using transsphenoidal surgery. Your surgeon extracts your

tumor through a small incision through the back wall of your 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.
Medication will used if your pituitary tumor is inaccessible to surgery, or
you're at high risk of surgical complications. You may also need drugs if your growth
hormone levels stay high after surgery. You may need medication for the rest of
your life. Three types of drugs are now available for the treatment of GH excess
somatostatin analogues, GH receptor antagonists, and dopamine agonists. These
medications do not cure the disorder but reduce levels of GH or IGF-1.
Your doctor may recommend radiation treatment if tumor cells remain after
surgery and medication is ineffective in reducing your growth hormone levels.
Although pituitary radiation can achieve complete remission, its disadvantage is the
time needed to reach that goal. Conventional radiation therapy may take 10 years
or longer to be fully effective. Newer methods of focused delivery (stereotactic
radiosurgery) such as gamma knife and proton beamoften affect an earlier
remission than the conventional method.
The conclusion is Acromegaly is a rare hormonal disorder that develops when
your pituitary gland produces too much growth hormone. Acromegaly can be
recognized by abnormal growth of the hands and feet, as well as enlargement of the
facial features. Although untreated acromegaly can lead to serious illness and
premature death, available treatments can reduce your risk of complications and
significantly improve your symptoms. This is the end of my presentation. Thank