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Nowdays, we are witnesses of growing number of reports of people with certain chronic disease.
However, apart from all of these diseases that freaquntly occur there are those who acquire a rare
chronic disease. One of these diseases is Acromegaly. What is Acromegaly? It is a rare, indisious
chronic disease caused as a result of hypersecretion known in medicine as increased secretion
of growth hormone ( GH ) in adults.
This disease occurs eaqualy in bouth sexes, and the average incidence is 3 to 4 per 100.000
inhabitants. It is most common during the third to fifth decade of life. The name ,,acromegaly,,
comes from Greek words ,,akros,, and ,, megas,, , which means the increase of distal parts of
body such as : hands, feet, nose, frontal arcade, sinuses etc.
The pituitary gland is the most important gland. Pituitary gland produces many hormones and
controls the operation of all other glands. It is located on the underside of the brain and it is a
gland with an internal secretion. This gland is formed of three basic parts : the anterior, middle
and posterior lobes.
Growth hormone ( GH ) is a polypeptide hormone that stimulates growth, cell reproduction and
regeneratin. This hormone is synthesized, stored and secreted from the cell somatotropes of
anterior pituitary. Secretion of growth hormone during the day takes in pulses with maximum
secretion at intervals of 3 to 5 hours. The largest and the most predictable pulse occurs during the
sleep abouth an hour of falling asleep.
Acromegaly is a chronic disease in which the development of the symptoms and signs carried
out gradually over a number of years (5 to 10 years) before it can establish a diagnosis. The
clinical presentation of this disease is very typical and is the result of how HR activities in
peripheral tissues and metabolism, as well as local events caused by the presence of a tumor.
Initial symptoms are manifested by soft tissue proliferation magnification of the hands and feet,
thickening of the lips and tongue, the soft parts of the nose and creating excess wrinkles on the
forehead, which leads to the characteristic of rough looking face. These changes are normally
associated with increased sweating, heat intolerance, the appearance of greasy skin, fatigue,
weakness, drowsiness, and the increase in body weight.
Symptoms of acromegaly include:
1. Large hands and feet. The hands appear as swords and feet continue to grow with
currently used shoes that come to be uncomfortable.
2. The increase in excess hands, nerves in the wrist called the median nerve can be
compressed wearing a painful condition called carpal tunnel syndrome. Even when carpal
tunnel syndrome is not considered may be a tingling sensation in the hands and feet due
to trap small nerves.
3. Thick, rough and oily skin. There are also the softening, body odor and presence of
excessive skin tags. Skin tags are tiny bits of the implementation of the skin tissue of the
skin surface and especially the neck.
4. Voice is deepening and brutalizing. This is because there is enlargement of sinuses and
vocal cords. Due to the enlargement of the tongue, structures within the neck and the
back passage may have sleep apnea or obstruction of airways during sleep well. This also
leads to weakness, fatigue and exhaustion of the day due to lack of sleep.
5. Due to the rapid growth of the facial bones may be present headaches and impaired
vision. Headaches may also indicate that increased pituitary tumor is pressing on nearby
tissues and nerves.The Growing Prolactin secretion of a pituitary hormone can lead to
galactorrhea (breast discharge) and amenorrhea (absence of periods) in women.
6. Heart disease including high blood pressure, heart failure, the heart rhythm abnormalities
and cardiomyopathies are considered common.
7. There is presence of sexual dysfunction with low sex drive or libido and impotence for
men and women of abnormal periods.
8. Arthritis can be considered common.

The diagnosis of acromegaly is typically clinically evident, and can easily be verified by
measuring the basal radioimmunoassay HR values, which are 90% in the patients greater than
10ng/ml, and in the range of from 5 to 500ng/ml. Measurement of IGF 1 plays an important role
in the diagnosis of this disease. He is a mediator of activity HR and if elevated can safely say that
this is acromegaly. Test load for glucose test is the simplest and most specific dynamic tests for
acromegaly. There are certain pathological conditions that are accompanied escesom HR and to
be distinguished from the differential diagnosis of acromegaly. These are: anorexia nervosa,
acute illness, chronic renal failure, cirrhosis of the liver, starvation, malnutrition from any cause,
diabetes mellitus type 1 etc.
All patients with acromegaly must be subjected to treatment to stop the progression of the
disease and the prevention of the late complications. The goal of treatment is the removal or
destruction of pituitary tumors, normalization secretion HR, and maintain normal functions as
adeno, and neurohypophysis. The initial treatment of choice for most patients with acromegaly is
transvenoidalna adenomektomija selective with regard to its high percentage of success, rapid
reduction in the level of HR (within 72 hours), a low incidence of postoperative hypopituitarism
as well as a low degree of operative morbidity. In the case of large tumors with ekstraselarnom
expansion in this way is not always possible to completely remove the pathological process and
the necessary surgical procedure done Transcranial. In patients in whom surgical approach has
not been fully achieved enucleation of the tumor, may also be applied to other therapeutic
measures such as radiation and drug therapy.