2. Outlines
• Introduction
• Common Disorders Related to Endocrine Control of
Growth and Metabolism
• Acromegaly
• Definition, Incidence, and Prevalence
• Causes and Risk Factors
• Pathophysiology
• Clinical Manifestations
• Diagnosis
• Medical Management
• Non-Medical Management
• Prevention and Health Education
• References
3. Introduction
• The endocrine system plays a crucial role in regulating growth
and metabolism through a network of glands that secrete
hormones such as:
• Growth Hormone (GH): Secreted by the pituitary gland,
GH stimulates growth during childhood by promoting cell
division and protein synthesis.
• Thyroid Hormones (T3 and T4): Produced by the thyroid
gland, they regulate metabolic rate, affecting energy
expenditure and weight control.
• Insulin: Released by the pancreas, insulin regulates
glucose metabolism, promoting sugar absorption into cells.
• Cortisol: Produced by the adrenal glands, cortisol
influences metabolism and helps the body respond to stress.
4. Common disorders related to the endocrine
system’s control of growth and metabolism
• Diabetes Mellitus: Either due to insufficient insulin production
(Type 1) or insulin resistance (Type 2).
• Hypothyroidism: Inadequate thyroid hormone production,
leading to fatigue and weight gain.
• Hyperthyroidism: Excessive thyroid hormone production,
causing weight loss and an overactive metabolism.
• Cushing's Syndrome: Prolonged exposure to high cortisol levels,
resulting in weight gain and other issues.
• Acromegaly: Abnormal growth of bones and tissues due to
excess growth hormone in adults.
• Polycystic Ovary Syndrome: Hormonal imbalances affecting the
ovaries, leading to weight gain, irregular periods, and infertility.
• Hypopituitarism: Insufficient hormone production by the
pituitary gland, impacting growth and metabolism.
5. Acromegaly
• The term “Acro” originates from the Greek word
“ákros,” signifying the highest or topmost, and
“Megaly” stems from the Greek word for greatness,
indicating enlargement.
• Acromegaly is a rare endocrine disorder
characterized by the overproduction of growth
hormone (GH) after the closure of growth plates in
adulthood.
• It has an incidence of approximately 3-4 cases per
million people per year.
• Typically, it is diagnosed in adults between the ages of
30 and 50, although it can affect individuals of any age
6. Causes and Risk factors
• Acromegaly can be attributed to various causes,
including
• Pituitary adenomas
• Carcinoid tumors
• Pancreatic islet cell tumors
• Genetic conditions like McCune-Albright
syndrome, MEN-1, and neurofibromatosis.
• In over 90% of cases, pituitary tumors are responsible
for acromegaly, but occasionally, tumors elsewhere in
the body may also lead to this condition.
7. Pathophysiology
• The development of
acromegaly occurs when
the pituitary gland
continuously releases
excessive growth hormone
into the bloodstream. This,
in turn, triggers the liver to
produce insulin-like growth
factor I (IGF-I), which
promotes the growth of
bones and body tissues.
8. Clinical Manifestations
Acromegaly presents with a range of clinical signs
and symptoms:
• Enlarged Hands and Feet: Due to tissue and
bone overgrowth.
• Facial Changes: Including a prominent jaw,
enlarged nose, and thickened lips.
• Joint Pain: As a result of tissue enlargement.
• Cardiovascular Complications: Such as
hypertension and an increased risk of heart
disease.
9. Diagnosis
• Diagnosing acromegaly involves a
thorough medical history
assessment and physical
examination, followed by specific
diagnostic steps, such as
measuring IGF-1 levels in the
blood after fasting, conducting a
growth hormone suppression
test, and utilizing imaging
techniques like X-rays, CT scans,
and MRI to locate and assess
pituitary tumors or other potential
causes.
10. Management
• The primary goals of acromegaly treatment are
to manage tumor size, restore GH and IGF-I
levels to normal, alleviate symptoms, and
address associated health issues.
• Treatment options include:
• Surgery
• Medication
• Radiation therapy.
11. Medical Management
• While not a cure, three categories of
medications—somatostatin analogs,
dopamine agonists, and growth
hormone-receptor antagonists—can
be used individually or in
combination to manage acromegaly.
12. Non-Medical Management (Surgery)
• Transsphenoidal operation, which
involves accessing the tumor through
the nasal passages and sphenoid
sinus, is a commonly employed
surgical method.
• The objective is to remove the tumor
responsible for excess growth
hormone production.
• Depending on the extent of tumor
removal, further treatment with
medication or radiation therapy may
be necessary.
13. Non-Medical Management (Radiation)
• In cases where surgery is not feasible or
unsuccessful, and medications prove
ineffective, radiation therapy, using
high-energy x-rays or particle waves,
may be recommended to target and
eliminate tumor cells.
14. Prevention
• While acromegaly is not
preventable, health education
can raise awareness about its
symptoms, promoting early
detection and intervention.
• Encourage individuals with a
family history of pituitary
tumors to undergo regular
check-ups.
15. References
• [1] Lavrentaki A, Paluzzi A, Wass JA, Karavitaki N.
Epidemiology of acromegaly:
• review of population studies. Pituitary. 2017;20(1):4–9.
• [2] Chanson P, Salenave S, Kamenicky P. Acromegaly. In:
Fliers E, Korbonits M, Romijn JA, eds. Handbook of clinical
neurology. Vol 124. 1st ed. Waltham, MA: Elsevier B.V.;
2014:197–219.
• [3] Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an
endocrine society clinical practice guideline. Journal of Clinical
Endocrinology and Metabolism. 2014;99(11):3933–3951.
• [4] Paragliola RM, Salvatori R. Novel somatostatin receptor
ligands therapies for acromegaly. Frontiers in Endocrinology.
2018;9:78.
