Acromegaly: Creating Real-life Giants Essay

The pituitary is stimulated to release growth hormone (GH) by growth hromone releasing hormone (GHRH) produced in the hypothalamus. It is inhibited from releasing growth hormone by growth hormone release-inhibiting hormone(GHRIH), also produced by the hypothalamus.

The source can be endogenous, the first would be Cushings disease which is a cortcotropinoma (tumour in the anterior pituitary gland) which can be a microadenoma or a macroadenoma. The second is the adrenal adenoma and adrenal carcinoma, which are tumours in the adrenal cortex

The release of growth hormone in the body is due to two hormones that has antagonistic effects found in the hypothalamus. Growth hormone-releasing hormone or GHRH activates

Gigantism is a condition which is caused by a tumor on the pituitary gland in the brain.

In adults, a tumor is the most common cause of too much GH production: Pituitary tumors. Most cases of acromegaly are caused by a noncancerous tumor of the pituitary gland. Secretion of excessive amounts of growth hormone causes the signs and symptoms of acromegaly. Symptoms such as headaches and impaired vision are resultant of the tumor mass pressing on nearby brain tissues.

The causes of hypopituitarism in the adult are represented by: pituitary tumors (54%), craniopharyngioma (12%), tumors of the central nervous system (4%), empty sella syndrome (4%), syndromes of Sheehan (3%) , and more rarely by trauma, ipofisiti, surgical iatrogenic causes, granulomatous diseases, radiation, CNS malformations,

Congenital adrenal hyperplasia is a well-known autosomal recessive disorder and the vast majority, approximately 95%, of cases are due to a deficiency of 21-alpha-hydroxylase. The other common type of CAH is caused by a deficiency of 11-beta-hydroxylase. In both types of the disorder, the adrenal gland is unable to produce sufficient amounts of cortisol and aldosterone. CAH is estimated to manifest in 1 of every 15,000 live births. In the United States, the prevalence of the disorder is lower in African-American children in comparison to Caucasians. Moreover, the decreased synthesis of cortisol results in diminished negative feedback of adrenocorticotropic hormone (ATCH) and over-secretion of ACTH. This pathological increase of ACTH in an attempt to increase serum cortisol levels is prevented because of the lack of appropriate enzymes and actually results in increased androgen

An 18-year-old woman presented with persistent bilateral lactation, excess body weight with leg swelling and unbalanced gait, and recurrent hypercalcemia. Patient experienced increasingly frequent headaches and visual field changes. Developed panhypopituitarism and central diabetes insipidus (DI) after going through with transsphenoidal resection of a pituitary macroadenoma. Patient was treated with levothyroxine (T4) for secondary hypothyroidism. She received other hormone replacement therapy, including desmopressin acetate, conjugated estrogen, growth hormone, and bromocriptine. She developed recurrent kidney stones and diagnosed with primary hyperparathyroidism. She was also found to have multiple thyroid nodules and underwent a 4-gland

If possible, surgery may be necessary to remove the pituitary tumor. After surgery, the pituitary gland may slowly start to work again and return to normal. Radiation therapy of the pituitary gland may also be used if the tumor is not completely removed. If these treatments are not successful, the adrenal glands may need to be removed to stop the high levels of cortisol from being produced, in Cushing’s Disease. (Wisse, 2013)

Cushing’s disease is a disease in which there is an increased amount of corticotropin releasing hormone (CRH) and adrenocorticotropic hormone (ACTH), which can affect the hypothalamic-pituitary secretion of Gonadotropin releasing hormone (GnRH) and luteinizing hormone (LH) can also be the cause of anovulation and presenting symptoms

As shown in Table 1 Cushing’s Disease is the most common cause of CS. This disease most commonly develops due to an ACTH producing pituitary tumor9. The increase in ACTH production leads to an increased ACTH concentration in plasma causing bilateral adrenocortical hyperplasia and hypersecretion of cortisol from the adrenal cortex. Due to the feedback mechanism as shown in Figure 1 a chronic increase in cortisol leads to the suppression of CRH and ACTH secretion.

First, before a person decides to take HGH, they need to know what HGH is. Human growth hormone, or HGH, is a protein made in the pituitary gland and is responsible for regulating growth, metabolism, and body fluids. HGH is generally produced a lot as children are growing, and

AI can be produced either by congenital or acquired pathologies.(4) Congenital causes include congenital lipoid adrenal hyperplasia (CAH) (caused by defects in STAR), P450 side chain cleavage syndrome (by mutations in CYP11A1), 3β-hydroxysteroid dehydrogenase deficiency (by mutations in HSD3B2), 21-hydroxylase deficiency (by mutations in CYP21A2), 11β-hydroxylase deficiency (by mutations in CYP11B1), 17-hydroxylase

Clinically, pituitary adenomas present with a classic semiologic triad related to hypersecretion, hypopituitarism, mass effect (headache, visual disturbances, and hydrocephalus) or as incidentalomas discovered during neuroimaging for the management of other disorders; occasionally pituitary apoplexy, or rarely as cerebrospinal fluid rhinorrhoea3.

When HGH was extracted from cadavers, only children with severe growth hormone deficiencies associated with pituitary dwarfism were given doses of the rare protein (Wilkies). Today however, HGH is in large enough quantities to treat individuals with growth hormone deficiency, Noonan Syndrome, Turner Syndrome, idiopathic short stature, children born small for their gestational age, and adults with hormone deficiency