Acromegaly

Acromegaly is a rare chronic endocrine disease which affects approximately 70 persons per million (Ben-Shlomo & Melmed, 2008) .The most common cause is a primary autonomous growth hormone (GH) secreting pituitary adenoma. Increased mortality is usually associated with cardiac hypertrophy, hypertension and congestive heart failure.
The example I have chosen is from a case study. It is of a 21 year old male, with digital overgrowth (large hands), prognathism (extended jaw line) and diastema (a cleft between two teeth) 182 cm in height and 94 kgs his vitals were within normal range and the only additional abnormal findings were coarsening of facial features. Cardiovascular examination and abdominal examination were normal. ( Aparci et al, 2006)
Lab results showed a GH and insulin like growth factor-1 (IGF-1) levels of 34ng/ml and 443ng/ml respectively, indicating Acromegaly. (Normal range is 0-1ng/ml and 116-358ng/ml) An EKG showed left ventricular hypertrophy which was confirmed with transthoracic echocardiography and a dynamic MRI showed a left sided macro adenoma of the pituitary. ( Aparci et al, 2006)
He underwent surgical removal of the tumor without any pharmacological intervention and was followed up closely with a cardiologist. ( Aparci et al, 2006)
GH is synthesized and has pulsatile secretion from the somatotroph cells of the anterior lobe of the pituitary gland. Its secretion is regulated by the hypothalamus which is stimulated by GH releasing hormone (GHRH) this causes an Inhibition by somatostatin so that circulating GH stimulates synthesis and secretion of insulin-like growth factor 1 (IGF-1) from the liver. IGF-1 inhibits GH secretion at the pituitary and hypothalamus level creating a negative feedback loop. Symptoms are related to both excess of GH and IGF-1 secretion and to the expanding pituitary mass. (ARUP Consult, n.d) Both GH is partly regulated by a ‘short’ feedback loop i.e. it can feedback directly on the hypothalamus to inhibit its...