Adipose tissue is a connective tissue that is composed of adipocytes (fat cells). It is divided into two forms – white adipose tissue and brown adipose tissue – with different functions. White adipose tissue has the following functions: Storage or depot fat – lipid stores (triglycerides); reserves to manage up to 40 days without food … Overweight (Obesity): Adipose Tissue as an Endocrine Organ
Pathogenesis (disease development) Hyperinsulinemia may be caused by increased secretion of insulin or by peripheral insulin resistance (= decreased or abolished action of the peptide hormone insulin in peripheral tissues). Tumors (insulinomas, rare mostly benign tumors) can also lead to an overproduction of insulin. A distinction is made between acquired hyperinsulinism and congenital hyperinsulinism. In … Hyperinsulinism: Causes
The following are the most important diseases or complications that may be contributed to by acromegaly: Eyes and eye appendages (H00-H59). Visual disturbances, unspecified Glaucoma – disease of the eye with increased intraocular pressure. Endocrine, nutritional and metabolic diseases (E00-E90). Diabetes mellitus (diabetes). Increase in lipoprotein(a) Hyperlipidemia/dyslipidemia Hypertriglyceridemia (excessive triglyceride levels in the blood). Tall … Acromegaly: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height [weight gain]; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye) [enlargement of acra – body ends such as nose, chin, ears, hands (wedding ring no longer fits), … Acromegaly: Examination
1st order laboratory parameters – obligatory laboratory tests. Stage I Serum IGF-I (insulin-like growth factor-I; somatomedin) [serum IGF-I: ↑] Stage II Growth hormone suppression test after oral glucose loading (gold standard); blood samples for determination of growth hormone and glucose are taken at time points 0, 30, 60, 90, and 120 min – administration of … Acromegaly: Test and Diagnosis
Therapeutic target Inhibition of the release or action of growth hormone. Therapy recommendations Surgical resection (selective adenomectomy/removal of the tumor via an approach through the nose) is the first-line therapy. Secondary therapy: treatment with dopamine agonists, somatostatin analogues (efficient lowering of GH levels), GH antagonists, or radiatio (radiotherapy) in combination with drug therapy. Therapy monitoring: … Acromegaly: Drug Therapy
Obligatory medical device diagnostics. Magnetic resonance imaging of the skull (cranial MRI, cranial MRI, or cMRI): thin-slice images of the sella turcica in coronal and sagittal slice direction in T2 and T1 weighting with and without contrast medium – in 99% of cases, a pituitary tumor (tumor of the pituitary gland) is detectable Perimetry (visual … Acromegaly: Diagnostic Tests
1st order. Surgical resection (selective adenomectomy) is the first-line therapy; usually, surgery is performed via the transnasal or transsphenoidal approach (i.e., removal of the tumor via an approach through the nose). Despite the surgery, complete recovery subsequently occurs in only about 50% of patients. Possible complications of surgery for pituitary adenoma: Diabetes insipidus – hormone … Acromegaly: Surgical Therapy
Occasionally, radiation therapy may be required as a secondary therapy after initial surgery. However, it is very rarely used today.Radiation therapy is always performed in combination with drug therapy. The following forms of radiatio (radiation therapy) can be distinguished in acromegaly: Conventional X-ray irradiation Stereotactic radiosurgery (high-precision irradiation).
In childhood, excess STH before the closure of the epiphyseal joints (growth plates) leads to proportioned gigantism (pituitary gigantism; marked tall stature; patients often reach a height of >2 m). In adults, i.e., after completion of physiological growth, excessive STH production manifests exclusively in the head, acras (protruding parts of the body such as hands … Acromegaly: Symptoms, Complaints, Signs
Endocrine, nutritional, and metabolic diseases (E00-E90). Obesity (obesity) Autoantibodies against insulin Diabetes mellitus type 2 (age-related diabetes) – leads to peripheral insulin resistance (reduced effectiveness of endogenous insulin at target organs skeletal muscle, adipose tissue and liver). Ectopic insulin secretion – secretion of insulin from a site other than the pancreas (pancreas). Congenital hyperinsulinemia (CHI) … Hyperinsulinism: Or something else? Differential Diagnosis
Pathogenesis (disease development) Acromegaly is caused by overproduction of growth hormone (GH). The cause of this overproduction is usually a tumor. It is a somatotrophic pituitary adenoma (benign neoplasm) in 99% of cases. A distinction is made between microadenomas and macroadenomas (> 1 cm). In 2017, the World Health Organization updated the histologic grading of … Acromegaly: Causes
