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ACROMEGALY

ACROMEGALY

To be reported by:
Mr. Elder Pascual Paed

To be reported to:
Mr. Mikhail “Milo” Almirol
Definition

• is a syndrome that results when the


pituitary gland produces excess
growth hormone after epiphyseal
plate closure at puberty.

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• Facial aspect of a patient with acromegaly.
The cheekbones are obvious, the forehead
bulges, the jaw is enlarged and facial lines
prominent. The forehead and overlying skin
is thickened, which may lead to frontal
bossing.
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• As compared with the hand of a typical
person (left), the hand of a patient with
acromegaly (right) is enlarged, the fingers
are widened, thickened and stubby, and
the soft tissue is thickened.

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• Mandibular overgrowth leads to
prognathism maxillary widening, teeth
separation and jaw malocclusion.

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• Photo of teeth showing classic teeth
gapping due to acromegaly on lower
jaw.

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Several Types
• Pituitary-tumor-caused acromegaly
• Non-pituitary-tumor-caused
acromegaly
• Ectopic acromegaly
• Acromegaly due to growth hormone-s
ecreting pituitary adenoma

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Incidence Rate:

• 816 per year, 68 per month, 15 per


week, 2 per day, 0 per hour, 0 per
minute, 0 per second

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Prevalence

• Estimated 40-60 people per 1 million


population have acromegaly in the US

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Risk Factors

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Causes
• Pituitary adenoma - the overproduction of
growth hormones is caused by a benign
tumor of the pituitary gland.

• Other tumors - acromegaly is caused not


by pituitary tumors but by tumors of the
pancreas, lungs, and adrenal glands.

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Causes
• Pituitary gigantism - This condition of
growth hormone excess is rare in children
and is referred to as pituitary gigantism,
because the excessive growth hormone
produces excessive growth of bones and
the child can achieve excessive height;
from 2.1 to 2.7 m (6'11" to 8'11") in
stature by adulthood if left untreated.

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Pathophysiology
Increased GHRH from
If decrease can hypothalamus.
lead to ‫׀‬
hyperplasia of Hypothalamus Will
chondrocytes stimulate pituitary to
and it will release GH
differentiate
‫׀‬
into bones and
also to other GH act to release IGF-1 from
tissue
Liver that helps on growth and
‫׀‬
development.
Will lead to
hyperplasia and
hypertrophy

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Signs and Symptoms

• Soft tissue swelling visibly resulting


in enlargement of the hands, feet,
nose, lips and ears, and a general
thickening of the skin.

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Signs and Symptoms

• Soft tissue swelling of internal


organs, notably the heart with
attendant weakening of its
muscularity, and the kidneys, also the
vocal cords resulting in a
characteristic thick, deep voice and
slowing of speech

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Signs and Symptoms
• Generalized expansion of the skull at
the fontanelle
• Pronounced lower jaw protrusion with
attendant macroglossia (enlargement
of the tongue) and teeth gapping

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Signs and Symptoms
• Mild Symptoms - initially, the onset of acromegaly
is often slow and insidious
• Headaches
• blurred vision
• enlarged hands
• enlarged feet
• bone overgrowth
• swollen hands
• swollen feet

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Priority Nursing
Diagnosis

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Common Complication
• Severe headache
• Enlarged heart
• Hypertension
• DM
• Heart Failure
• Kidney failure
• Compression of the optic chiasm leading to loss of
vision in the outer visual fields (typically bitemporal
hemianopia)
• Increased palmar sweating and sebum production
over the face (seborrhea) are clinical indicators of
active growth hormone (GH) producing pituitary
tumors. These symptoms can also be used to monitor
the activity of the tumor after surgery although
biochemical monitoring is confirmatory.

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Diagnostic Tests
• Medical imaging
• Medical laboratory
• CT scan - of pituitary or other
organs, seeking the tumor
• GHRH blood test - useful to detect
non-pituitary tumors

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Diagnostic Tests
• Other pituitary hormones have to be
assessed to address the secretory effects
of the tumor as well as the mass effect of
the tumor on the normal pituitary gland.
They include TSH .
• IGF1 provides the most sensitive and useful
lab test for the diagnosis of acromegaly.

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Diagnostic Tests
• Growth hormone blood test (fasting)
• Oral glucose tolerance test
• MRI scan - of pituitary or other
organs, seeking the tumor

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Managements
• Medical Managements
• bromocriptine (Parlodel®).
(uses to reduce both GH secretion and
tumor size. )
• octreotide (Sandostatin®).
is a synthetic form of a brain hormone,
somatostatin, that stops GH production.

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Surgical
• Endonasal Transphenoidal surgery - reaching the
pituitary through an incision in the nasal cavity
wall. The wall is reached by passing through the
nostrils with microsurgical instruments.
• Transphenoidal surgery - during which an incision
is made into the gum beneath the upper lip.
Further incisions are made to cut through the
septum to reach the nasal cavity, where the
pituitary is located.

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Nursing Management
• Instruct the client to take bromocriptine
orally.
• octreotide must be injected under the skin
every 8 hours for effective treatment.
• Provide safety
• Physical Assessment
• Monitor Vital Signs
• Monitor I & O’s

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Preventions

• None, but early treatment may


prevent complications of the disease
from getting worse.

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Reference
• Acromegaly and Gigantism". Merck.com.
http://www.merck.com/mmhe/sec13/ch162/ch162e.html.
Retrieved 2010-10-26.
• Link text, Historical footnote in regards to Marfan's.
• Wikipedia.com
• Ask.com
• Googlephilippines.com
• About.com

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Q&A
• 1. is a syndrome that results when the
pituitary gland produces excess growth
hormone after epiphyseal plate closure at
puberty.

A. Macromegaly Syndrome
B. Acromegaly Syndrome
C. Micromegaly Syndrome
D. NOTA

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Answer to 1
B. Acromegaly - is a syndrome that
results when the pituitary gland
produces excess growth hormone
after epiphyseal plate closure at
puberty.

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2. initially, the onset of acromegaly is
often slow and insidious

A. Primary Symptoms
B. Slight Symptoms
C. Mild Symptoms
D. Severe Symptoms

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Answer to 2.
• C. Mild Symptoms - initially, the
onset of acromegaly is often slow and
insidious

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• 3. during which an incision is made into
the gum beneath the upper lip. Further
incisions are made to cut through the
septum to reach the nasal cavity,
where the pituitary is located.

A. Transphenoidal surgery
B. Endotracheal surgery
C. Pituitary Imagery Surgery
D. Endonasal Transphenoidal surgery

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Answer to 3
• A. Transphenoidal surgery -
during which an incision is made into
the gum beneath the upper lip. Further
incisions are made to cut through the
septum to reach the nasal cavity,
where the pituitary is located.

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• 4. Mandibular overgrowth leads to _________,
__________, and _________.

A. prognathiasm mandilary sharpening, teeth


darkening, jaw lock
B. prognosism maximal shortening, teeth
overgrowth, jaw malocclusion
C. prognathism mandilary widening, teeth
separation, jaw malocclusion
D. prognathism mandilary obstruction, teeth
separation, jaw formation

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Answer to 4
• C. Mandibular overgrowth leads to
prognathism maxillary widening,
teeth separation and jaw
malocclusion.

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5. Which of the following is/are the
effect/s to the teeth of the pateint
having acromegaly syndrome in the lower
jaw.

A. Whitening of the teeth


B. Yellow Forming Spots on the teeth
C. Darkening of the gums and teeth
D. Gapping Of the teeth

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Answer to 5
• D. Gapping Of the teeth

• Photo of teeth showing


classic teeth gapping
due to acromegaly on
lower jaw.

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THANK YOU!

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