The endocrine system occupies a special role in the regulatory mechanism of the human body. The endocrine system performs its functions through hormones that enter all the organs and tissues of the body, penetrating through the intercellular substance directly into the cells, or are carried into a biological system with blood. Some part of the endocrine cells is collected together. These cells form the endocrine glands the glandular apparatus. Therefore, almost any tissue of the body has endocrine cells. A group of endocrine cells forms the diffuse part of the endocrine system. It coordinates the work of all organs and systems of the body. Together with the immune and nervous systems, it regulates the growth of the organism development. It is one of the generators of energy in the body. The endocrine system is also involved in the formation of emotional reactions. It is difficult to overestimate the value of functional status of the endocrine system. The range of endocrine diseases (caused by functional disorders of the endocrine system) is very wide (Lely, Beckers, Daly, Lamberts, & Clemmons, 2005).
Acromegaly is the disease of the endocrine system, caused by the excessive production of growth hormone, somatotropin. It is characterized by disproportionate growth of skeletal bones, soft tissues and internal organs. Acromegaly occurs in both sexes. It usually occurs after the growth of the organism, mostly at the age from 20 to 40 years. Acromegaly develops gradually and lasts for many years. The disease is known since ancient times; acromegaly leads to appearance changes, facial features become larger, and the size of feet and hands increases (Lely, Beckers, Daly, Lamberts, & Clemmons, 2005).
The growth hormone is produced in the pituitary gland. The pituitary gland is an endocrine gland of a small size (not more than 1 centimeter). It is located in the base of the brain and produces vital hormones. The growth hormone in children provides processes of linear growth and the formation of bones and muscles. In adults, it controls metabolism, including carbohydrate and lipid metabolism, as well as water and salt exchange. The control over the pituitary function performs another part of the brain, which is called the hypothalamus. The hypothalamus produces substances that stimulate or inhibit the production of hormones in the pituitary gland. In a healthy human, the level of the growth hormone during the day is not the same at different times of day. It is subjected to certain fluctuations. During the day, the concentration of the growth hormone is being increased and decreased, with the highest values ??in the early morning hours. In acromegaly, there is not only the high concentration of the growth hormone, but also the normal rhythm of its release into the blood is disrupted (Jequier, 2011).
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Cells that produce the growth hormone for some certain reasons escape from the regulatory influence of the hypothalamus, and begin to multiply quicker, producing the growth hormone more actively. The long-term growth of these cells leads to the formation of a benign tumor of the pituitary – pituitary adenoma, which may be up to several centimeters. Unchanged pituitary cells can be squeezed or even collapsed. In the majority of patients with acromegaly, the pituitary tumor produces only the growth hormone. However, about a third of patients may experience the excess production of other pituitary hormones. Most often, cranial trauma, adverse course of pregnancy, acute and chronic infections (influenza or measles), psychological trauma and tumors of the central nervous system contribute to this disease. A certain role in the development of acromegaly is assigned to heredity, as the disease is very common in relatives (Lely, Beckers, Daly, Lamberts, & Clemmons, 2005).
Acromegaly is characterized by the long clinical course. Depending on the severity of symptoms, there are several steps in the development of acromegaly:
- The initial stage. There are initial and mild signs of the disease. At this stage, acromegaly is rarely diagnosed, solely on indicators of the level of the growth hormone in the blood and brain CT.
- The hypertrophic stage. There are strong symptoms of acromegaly.
- The tumor stage. There are symptoms of pressure of adjacent parts of the brain (increased intracranial pressure, nerve and eye disorders) (Jequier, 2011).
- The cachexia stage. This stage involves exhaustion as the outcome of acromegaly.
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Patients complain of dizziness, headaches, fatigue, blurred vision and pain in the joints and lower back. The patient has the peculiar appearance. There is a significant increase in upper and lower extremities. Hands and feet acquire the shovel-shaped form. There is the increase of brow, cheekbones, nose, lips and ears. A lower jaw is enlarged and protrudes. A tongue is increased and barely fits in the mouth. Voice becomes rough. Headaches appear primarily in the tumor nature of acromegaly. They are associated with the increased intracranial pressure. Quite often, in acromegaly, there are changes of the coverlet. In the initial stages of the disease, there is an increase in muscle strength, which is later replaced by a decrease in muscle volume and muscle weakness. Functions of larger internal organs in the initial stages of the disease are virtually unchanged. Later, signs of the heart, lung, and liver failure are joined. The blood pressure may increase; 50-60% of patients have impaired glucose tolerance. Sometimes, the visual acuity is reduced, narrowing the field of vision. There is a consecutive change of edema, stasis, and atrophy of the optic nerve on an eye ground, which if untreated, leads to irreversible blindness. The menstrual cycle is disturbed in almost all women. Lactation is often observed from the mammary glands, which is not associated with pregnancy and childbirth. In one-third of men, it leads to sexual potency decrease. The tumor growth causes drowsiness, thirst, polyuria and sharp rises in temperature, with a possible occurrence of epilepsy. The hearing acuity is often decreased, which makes limited the ability to work.
Acromegaly is accompanied by the development of complications of almost all organs. Very often, patients with acromegaly have cardiac hypertrophy, myocardial dystrophy, hypertension, and the heart failure. More than a third of patients develop diabetes. The dystrophia of liver, and lung emphysema may also be observed (Jequier, 2011).
In later stages (5-6 years from the onset), acromegaly may be suspected on the basis of increase of body parts, and other external signs visible at the examination. In such cases, the patient is referred to endocrinologist. The main laboratory diagnostic criteria of acromegaly is the determination of the content in the blood: the growth hormone in the morning and after the test with glucose and IGF I – insulin-like growth factor.
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At ophthalmologic examination in patients with acromegaly, the narrowing of the visual field is marked because visual pathways are anatomically located in the brain, next to the pituitary gland. The radiograph of the skull reveals an increase in the size of the sella turcica, where the pituitary gland is located. For the visualization of the pituitary tumors, computer diagnostics and MRI of the brain are conducted. In addition, patients with acromegaly are examined in order to identify various complications: intestinal polyposis and diabetes (Lely, Beckers, Daly, Lamberts, & Clemmons, 2005).
In acromegaly, the main goal of treatment is to achieve remission of the disease by eliminating the hypersecretion of somatotropin, and normalization of concentration of IGF I. For the treatment of acromegaly, modern endocrinology applies medical, surgical, radiation and combined methods. To normalize blood levels of somatotropin, its analogues are prescribed. In acromegaly, the prescription of sex hormones, dopamine agonists (parlodel and cabergoline) is needed. Later, a disposable gamma or radiation therapy is usually carried out to the area of the pituitary gland.
In the absence of adequate treatment, the life expectancy of patients is 3-4 years in the unfavorable clinical course, while at the young age, with slow development and the favorable course, it ranges from 10 to 30 years. In timely treatment, the prognosis for life is favorable, and a person may even recover (Lely, Beckers, Daly, Lamberts, & Clemmons, 2005).
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