So, let’s figure it out.
A little about gigantism
Gigantism is a neuroendocrine disease caused by chronic over secretion of growth hormone by the anterior pituitary gland in patients with incomplete physiological growth. It is important to note that in the absence of timely diagnosis and adequate treatment, after the end of puberty, children with gigantism develop all the typical symptoms of acromegaly.
What is the disease characterized by?
Gigantism is characterized by proportional growth of skeletal bones in length, leading to a significant increase in the linear growth of the child.
How is gigantism diagnosed?
The diagnosis of “gigantism” is established on the basis of clinical manifestations and X-ray data of the skull and hands, as well as on the basis of analysis of the results of the level of human growth hormone.
What is the reason for gigantism?
In most cases, gigantism is caused by excessive primary secretion of the anterior lobes of the pituitary gland of growth hormone (pituitary adenoma), which occurs due to gene mutations in the α-subunit of the G-protein (the appearance of the Gsp-oncogene).
Under the influence of growth factors, collagen production, proliferation of cartilage increases, which leads to the growth and thickening of soft, bone and cartilaginous tissues with damage to the skin, soft tissues (coarseness of facial features, thickening of the fingers, seborrhea, acne, hirsutism, sweating) and the skeletal system (diastema, prognathism, frontal hyperostosis, diseases of the temporomandibular apparatus, osteoarthritis, dorsal kyphosis). Almost all organs and systems of the body are involved in the process.
What treatment is needed for this disease?
Treatment of gigantism is reduced to the removal or destruction of the adenoma.
Pituitary gigantism
This rare condition occurs when growth hormone hypersecretion begins in childhood, even before the epiphyseal growth zones are closed. The growth rate of the skeleton and the maximum achievable growth increase, but the bones are practically not deformed. However, soft tissue edema and peripheral nerve enlargement can be observed. Delayed puberty or hypogonadotropic hypogonadism with a characteristic eunuchoid body structure is common.
Acromegaly: what is it?
Acromegaly is a condition caused by increased and continuous production of growth hormone by the pituitary gland.
Growth hormone acts on almost all organs and systems in the body. In approximately 99% of patients with acromegaly, the increased production of growth hormone is due to a benign tumor (pituitary adenoma).
Hypersecretion of growth hormone leads to acromegaly. Most often, acromegaly occurs between the ages of 20 and 40, but its development is observed both at the age of over 50 and between the ages of 10 and 15. Therefore, the diagnosis of acromegaly is usually made only at a fairly mature age. According to statistics, there are 50-70 cases of such diseases per 1 million of the population.
How does the disease manifest itself?
If the hypersecretion of growth hormone begins after the closure of the epiphyseal growth zones, it first of all manifests itself clinically by coarsening of facial features and hypertrophy of the soft tissues of the hands and feet. The general appearance changes, patients have to increase the size of rings, gloves and shoes. The patient’s photographs taken at different ages help to monitor the course of the disease in dynamics.
In adults with acromegaly, the body is covered with coarse hair, the skin is thickened and often dark in color. The size and function of the sebaceous and sweat glands are increased, which is why patients often complain of excessive sweating and unpleasant body odor.
Due to the proliferation of laryngeal cartilage, the voice becomes low and hoarse. The tongue is often enlarged, and its folding is intensified. Over time, the cartilage of the ribs grows, which gives the chest a barrel-shaped appearance. The cartilage tissue of the joints reacts quite early to an excess of growth hormone by proliferation with possible necrosis and erosions. Patients often complain of joint health and there are cases of degenerative arthritis leading to disability.
How is acromegaly treated?
Treatment for acromegaly includes surgery, radiation therapy, and drug suppression of growth hormone secretion. Ablative therapy is indicated in most cases.
Gigantism and acromegaly usually result from a pituitary adenoma that secretes excess growth hormones; in rare cases, they are caused by non-pituitary tumors that produce growth hormone-releasing factor.
What is the difference between gigantism and acromegaly?
Gigantism occurs when growth hormone hypersecretion begins in childhood, even before the epiphyseal growth zones are closed.
Acromegaly associated with growth hormone hypersecretion begins in adulthood; at the same time, various anomalies of bones and soft tissues develop.
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