Acromegaly

It is a disease that develops due to excessive secretion of growth hormones. Although it can occur at any age, it is most commonly seen in adults between the ages of 30-50. In case of exposure to excessive amounts of growth hormone before the growth plates close, “gigantism” develops.

Therefore, excessive height growth should be given attention in growing children. In the adult period, there is no increase in height, structural changes are in the foreground, and the disease is called "acromegaly". Although it manifests itself with different symptoms in childhood and adulthood, acromegaly also poses a risk in terms of serious health problems such as diabetes, high blood pressure, heart diseases, and deterioration in lung functions.

What Are the Symptoms of Acromegaly?

Growth is observed in the hands, feet, and many parts of the body. Shoes and rings start to look small. Coarsening of the facial lines, protrusion of the lower jaw and forehead, widening of the tooth gaps, enlargement of the nose, lips, and tongue, fat deposition and thickening in the skin, sweating, visual impairment, and headache are among the symptoms of acromegaly. Symptoms of acromegaly can be quite distressing for patients. In addition to physical symptoms, weakness, fatigue, loss of libido and changes in body image may also negatively affect the psychology of the patient.

One of the most important symptoms of acromegaly is the growth seen in many parts of the body, including the hands and feet. Shoes and rings start to look small. Other symptoms include coarsening of the facial lines, protrusion of the lower jaw and forehead, widening of the tooth gaps, enlargement of the nose, lips, and tongue, fat deposition and thickening in the skin, sweating, visual impairment, and headache.

Because the symptoms usually progress very slowly, the patient may not be aware of them, and the diagnosis is often made late.

Acromegaly Treatment

The vast majority of patients with acromegaly regain their health with the correct diagnosis and appropriate treatment. There are three types of treatment approaches: medication treatment, surgical treatment, and radiation treatment. Surgical treatment is the first approach for the majority of patients. Medication treatment is applied to patients who cannot undergo surgery or who do not get successful results despite surgical treatment. Today, there are highly effective medications used in the treatment of acromegaly. The main purpose of the treatment of acromegaly is to reduce the growth hormone and IGF-I levels to normal levels and to reduce the tumor mass. In cases where these goals cannot be achieved with surgery and drug treatment, radiation treatment is applied. Today, there are very advanced technologies in radiation treatment and they are used successfully in our country.

Cushing's Disease (Syndrome)

It is the clinical picture caused by a tumor originating from cells that secrete ACTH hormone in the pituitary gland. The ACTH hormone, which is secreted more than normal levels, causes the cortisol hormone to be secreted above the normal levels from the adrenal gland. This disease, which is more common in women than in men, occurs especially between the ages of 20-40.

What are the Symptoms of Cushing's Disease (Syndrome)?

The clinical picture is not the same in all Cushing's disease patients, and the signs and symptoms vary according to the severity of the disease. Body structure changes, and obesity, which is manifested by fat deposition in the abdomen, and thinning in the arms and legs are important in the diagnosis.

The most important findings are rounding of the face (moon face) and redness, fat accumulation on the neck, hair loss, thinning of the skin, easy bruising with bumps on the skin, the appearance of purple-colored cracks, especially in the abdomen, depression, hypertension, muscle weakness, bone weakness, and bone fractures in advanced cases.

Increased hair growth and menstrual irregularity are common in women. Not infrequently, the symptoms of the disease can be very mild. Cushing's disease should also be considered in patients with diabetes who cannot be controlled despite appropriate treatment and in cases of treatment-resistant obesity.

How is Cushing's Syndrome (Disease) Diagnosed and Treated?

Since the symptoms of the disease are similar to many diseases, it is very difficult to diagnose in mild cases. In the diagnosis, it is important to detect increased cortisol levels in the blood, urine, and, if necessary, in saliva, and to show increased or unsuppressed ACTH levels. In some patients, quite complex tests may be required for diagnosis. The most effective way of treatment is surgical removal of the tumor. In cases where surgery cannot be performed or surgery is unsuccessful, medication treatment and radiation treatment can be used. In cases where all treatment approaches are inadequate, removal of both adrenal glands is also a treatment option.

Prolactinoma

The most common pituitary tumors are prolactin-secreting tumors. Although it can be seen in both sexes, it is more common in women. Prolactin level increases in cases such as pregnancy, breastfeeding, some medications, thyroid gland failure, and kidney failure. However, prolactin elevation in prolactinomas is higher than in other causes (usually over 200 ng/ml).

What Are the Symptoms of Prolactinoma?

The most important sign of high prolactin is milk coming from the nipple spontaneously or by squeezing. This is called galactorrhea. This finding is rarely seen in men. Increased prolactin level has negative effects especially on the reproductive system in men and women. One of the most important effects is infertility. High prolactin levels affect the reproductive hormonal system at the brain level. As a result, estrogen levels drop and menstrual irregularity, a decrease in the frequency of ovulation, and vaginal dryness occur. In men, sexual dysfunctions, breast enlargement, infertility, and sexual reluctance can be seen due to decreased sperm count.

How is Prolactinoma Diagnosed and Treated?

The diagnosis of prolactinoma is made by methods such as detailed examination, laboratory tests, and magnetic resonance imaging of the pituitary gland. It is easier to diagnose than other pituitary tumors. The main purpose of treatment is to reduce prolactin levels and to reduce the tumor mass and to eliminate the complaints. The first treatment approach in prolactinoma is medication treatment. With medication treatment, prolactin decreases to its normal level in the vast majority of cases and the tumor tissue shrinks or even disappears. In rare cases, surgery and radiation treatment may be required.

Rare Pituitary Tumors

Some pituitary tumors may cause pituitary insufficiency without secreting hormones at a level that will cause any abnormality in the body, or they may press on neighboring tissues and may appear with related findings (such as headache, visual impairment). Rarely, TSH-secreting pituitary tumors may be encountered. In these patients, excessive thyroid hormones are secreted from the thyroid gland, and accordingly, a picture of hyperthyroidism occurs. Gonadotropinomas with excessive secretion of FSH and/or LH hormones are very rare. Tumors in which more than one hormone is secreted may also be encountered.