Understanding Acromegaly: Symptoms, Diagnosis and Treatments
Acromegaly is most commonly seen in adults who have a pituitary adenoma. This adenoma produces excess amounts of Growth Hormone (GH) which affects cartilaginous tissues such as the joints in hands and jaws, as well as the tissue of the nose, ears and heart. Because this growth is occurring after the epiphyseal plates have closed it creates a disproportionate appearance which is typically the first sign in the patient. There are several immunoradio assays to test for serum levels GH, but there is evidence to suggest that these assays are not accurate enough for diagnosis. The current standard is to diagnose using an oral glucose load, levels of GH and Insulin-like Growth Factor (IGF-1). We also use MRI scans that are focused on the sella turcica to investigate the possibility of the pituitary adenoma. There are several methods of treatment including surgery, radiotherapy, radiosurgery and drug therapies that have continued to develop.
Pathophysiology of Acromegaly
The pituitary gland sits at the base of the skull and controls much of our endocrine secretions through a tightly controlled negative feedback system (Norris, 2007). Normally, growth hormone (GH) secretions act to cause bone and muscle growth (Norris, 2007). As we age there is a decline in the amount of GH our bodies produce and use mostly due to the closure of epiphyseal plates which marks the end of vertical growth (Norris, 2007). GH is also important for muscle cells to be able to take up glucose during normal metabolic processes (Norris, 2007). Insulin plays an important role in this pathway and we often see disruptions in both pathways with acromegaly (Katznelson, 2011).
Acromegaly first begins with an a...
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First I will be discussing about the thyroid gland, so the thyroid gland is a gland in the neck that secretes hormones. These hormones regulate growth and development, and metabolism. The main hormone secreted is Thyroxine. So when a person like Margie is diagnosed with hypothyroidism it means the thyroid gland does not secrete enough hormones. As many females get over the age of 50, they are more at risk of developing hypothyroidism. The symptoms
Tumors or Lesions to the Hypothalamus Patient The Hypothalamus is a small area near the base of the brain just ventral to the thalamus. It has widespread connections with the rest of the forebrain and the midbrain. Partly through nerves and partly through hypothalamic hormones, the hypothalamus conveys messages to the pituitary gland, altering its release of hormones (Kalat, 2003). Any type of damage to a hypothalamic nucleus, such as tumors or lesions, may lead to abnormalities in one or more motivated behaviors, such as feeding, drinking, temperature regulation, sexual behavior, fighting, or activity level.
ACHONDROPLASIA is known as being undersized, or less than 50in. in height. Having short limbs, a normal sized trunk, large head with a depressed nasal bridge and small face. This is a result of a disease in the thyroid gland. It can also be caused by Down syndrome or absorption, a cartilaginous tissue during the fetal stage. Hypochondroplasia, a mild form of dwarfism. Spinal tuberculosis and the deficiency of the pituitary gland secretions. Treatment with thyroxin or thyroid extract early in childhood results in normal growth and development. Somatrophin, also known as the human growth hormone is secreted by the anterior pituitary. Respiratory problems start to occur in infants. Symptoms of problems include snoring and sleeping with neck in a hyperextended condition. The limbs have rhizometic shortening. The legs are straight in infantry but when a child. He begins walking they develop a knock-knee position. When the child continues to walk legs begin to have a bowed-leg look. Occasionally, these curvatures are fixed. As the child continues to walk the kyphosis disappears and the back assumes a lordotic posture. If a delay in child’s walking occurs, the spine should be monitored closely for signs of gibbous formation. In infancy, hypercephalus can occur. Infants head circumference should be monitored close . Monthly checks of head circumference must be monitored. Radiologic studies are indicated if head circumference raises to disproportionately, or if symptoms of hydrocephalus. Child’s pediatrician should have a copy of head circumference curves for children with achondroplasia. Radiologic procedures for dwarfism include head ultrasound, C-T scan, or MRI of the head. If intervention is necessary, a ventriculoperitoneal shunt is placed relieving the pressure. Infants should also be monitored for foramen magnum compression. It is the opening at the base of the skull in which the brain stem and cervical spinal cord exit. When you have achondroplasia the foramen magnum is compressing the brain stem and spinal cord. Symptoms of narrowing include apnea the cessation of breathing and cervical myleopathy. C-T scans and MRI scans are done to examine the size of the infectious foramen magnum. A neurosurgical procedure called a foramen magnum decompression is executed to alarge foramen and alleviate further symptoms. Adolescents are at risk of getting lumbosacral spinal stenosis. The lumber spinal cord or nerve roots become compressed producing nerosurgical symptoms. Initial symptoms including weakness, tingling, and pain of the legs. Pain usually alleviated by assuming a squatting position.
The hypothalamus in the brain is above the pituitary gland. The hypothalamus releases corticotrophin (CHR) which is a chemical messenger. CHR stimulates the pituitary gland to release adrenal corticotrophin (ACTH). ACTH which is released into the blood then signals the adrenal gland. When the adrenal gland receives ACTH it is the chemical signal for cortisol production. In a normal system cortisol (an anti-inflammatory) production would st...
ACH, is an interesting disease, one that after many years of research still remains a partial mystery. The fact that a single nucleotide on one chromosome can so greatly affect an individual is astounding, especially coupled with the fact that this mutation is so homogenious in genotype and phenotype. With more skeletal dysplasias being connected to FGFR3, research has increased to fully determine and define the pathways involved with this gene. Determining the reason for such a high mutation frequency and the link to paternal age are also being looked into. Once there is more understanding of how this mutation affects the body, treatments and possibly cures can be found for these individuals.
CAH is an autosomal recessive genetic disorder and males and females are affected in equal numbers. Chromosome 6 is where the group of genes lie that causes the most common forms of CAH. Adrenocorticotropic hormones (ACTH) are released by the anterior lobe in the pituitary gland. Its role is to act on cells of the adrenal cortex which then synthesizes corticosteroids and cortisol. However, those with CAH have insufficient amounts of the enzyme 21-hydroxylase, needed to convert 17-hydroxyprogesterone (17-OHP) into cortisol.
Yale School of Medicine. (2014). Stereotactic radiosurgery/ gamma knife program. In Therapeutic Radiology. Retrieved from http://radonc.yale.edu/clinical/gamma.aspx
The endocrine system consists of six parts; pancreas hypothalamus, thyroid, pituitary gland, ovary, and adrenal gland. The pancreas is a large gland that produces hormones that regulate blood sugar; produces enzymes that break down carbohydrates, lipids, proteins, and nucleic acids; and produces sodium bicarbonate, a base that neutralizes stomach acid. The hypothalamus is a brain structure that acts as a control center for recognition and analysis of hunger, thirst, fatigue, anger, and body temperature. The thyroid is a large gland in the neck that secretes (produces) hormones regulating growth through the rate of metabolism. The pituitary gland is in the base of the skull that secretes nine hormones that directly regulate many body functions and control the actions of several other endocrine glands. The ovary ( found in females) is a gonad that produces eggs. The adrenal glands are a pair of glands located above the kidneys, which produces epinephrine and norepinephrine. The endocrine system main function is to release hormones that affect activities of other cells.
The balance of the thyroid hormone is complicated and involves the participation of different parts of the body (Kaplustin, 2010).
The thyroid is one of the most essential glands in the body. It is located in the endocrine system, and sits right in the neck just above where the collar bones meet. The thyroid gland functions to produce hormones that control how every cell in the body utilizes energy, also known as a process called metabolism. When a person's thyroid abnormally produces an excessive amount of thyroid hormones, this is a condition referred to as hyperthyroidism. The causes of hyperthyroidism are known to include: eating too much food with iodine, graves disease, inflammation due to viral infections, tumors of the testes and ovaries, taking a large amount of thyroid hormone, receiving medical imaging tests consisting of contrast dye iodine, and growth of thyroid or pituitary gland (Board "Hyperthyroidism"). With an overactive thyroid, the body tends to speed up its functions. Symptoms vary from, fast heartbeats, rapid weight loss, abnormal sweating, nervousness, and mood changes. Hyperthyroidism is normally diagnosed through a series of lab tests. If not properly taken care of, condition may worsen leading to bone and heart problems in the long run. As far as treatment is concerned, options may vary from person to person depending on age and the level of activity of the thyroid. Treatments include antithyroid medicines, radioactive iodine ablation, and the last resort, surgery. Though all treatment plans work, radioactive iodine ablation is a permanent and more reliable remedy for an overactive thyroid. Radioactive iodine ablation is in fact the most commonly used cure for people with hyperthyroidism problems in the US today. “The treatment has been around since 1942 and has been extensively used since the 1950's” ("Radioactive Iodine Treatment o...
The thyroid gland is found in the front of the neck and produces two main hormones. The hormones are called thuroxine (T4) and Triiodothyronine (T3). Together these hormones regulate the body’s metabolism by increasing energy use in cells, regulate growth and development, help to maintain body temperature and aid in oxygen consumption. These two hormones are regulated by hormones produced by the hypothalamus and pituitary gland. The hypothalamus senses changes in body’s metabolic rate and releases a hormone known as thyropin-releasing hormone (TRH). This hormone then flows through connecting vessels to the pituitary gland which signals it to release another hormone. This hormone is known as thyroid-stimulating hormone (TSH). TSH then makes its way to the bloodstream until it reaches the thyroid where it is then signaled to activate T3 and T4 production [1]. This mechanism is controlled by a negative feedback loop meaning that when there is a sufficient amount of thyroid hormones in the blood stream, this will signal back to stop production of thyroid stimulating hormones. Complications occur when the thyroid hormones keep increasing even though there is already a sufficient amount of T3 and T4 in the blood stream. This process of over expression of thryroid hormones is known as hyperthyroidism. Hyperthyroidism is a general term that includes any disease that has a consequence of an overabundance of thyroid hormones. Hyperthyroidism is a general term but there are many variant diseases that are in the hyperthyroidism category. These diseases include diffuse toxic goiter, Basedow’s disease, thyrotoxicosis, Parry’s and Graves’ disease.
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There are three major glands in the endocrine system, which are the thyroid gland, adrenal glands, the ovary and testes, and the pituitary gland. A section of the brain above the pituitary gland called the hypothalamus controls the endocrine system and communicates with...