Gigantism - causes, symptoms, diagnosis and treatment. Growth criteria for women

Gigantism is a disease that progresses due to increased production of growth hormone by the pituitary gland (gland internal secretion). This causes rapid growth of the limbs and torso. In addition, patients often experience decreased sexual function and developmental inhibition. If gigantism progresses, there is a high probability that the person will be infertile.

IN medical literature The term “macrosomia” is also used to refer to this pathological condition. Gigantism in children begins to progress at a time when physiological processes ossification has not yet been completely completed. More often, the disease is diagnosed in males aged 7 to 13 years, but it is possible that the first symptoms may appear during puberty. Pathology arises and develops rapidly throughout the entire period of body growth.

Typically, by the end of puberty, an individual's height reaches 2 meters. For women, this figure may be slightly lower – up to 1.9 meters. It is also worth noting that the proportionality of the body parts is not impaired. What is noteworthy is that usually the parents of patients with gigantism have quite normal height. Medical statistics such that on average the disease is diagnosed in 3 people out of 1000.

Etiology

The main reason for the progression of gigantism is increased production of the hormone somatotropin by the pituitary gland. This is usually observed with hyperfunction or hyperplasia of this endocrine gland. There can be many reasons for damage to the pituitary gland. As a result of exposure to adverse etiological factors its functionality is impaired, which negatively affects the condition of the entire human body.

The main causes of damage to the pituitary gland:

tumor of the adenohypophysis, benign or malignant;
TBI varying degrees heaviness;
intoxication;
progression of neuroinfections;
the presence of central nervous system diseases in a person.

Varieties

In endocrinology, the following types of gigantism are distinguished (by type of disorder):

true. In this case, there is a proportional increase in all parts of the body. It is worth noting that there are no developmental deviations;
acromegalic. The patient experiences rapid growth of the limbs, face and torso, but at the same time certain areas of the bones increase in size more than others;
cerebral. Characteristic signs– rapid growth with simultaneous impairment of intelligence. This form of the disease usually progresses in a person after severe brain damage;
partial. It is also called partial, since certain parts of the body enlarge in a sick person;
splanchnomegaly. Increased production of somatotropin leads to an increase in vital organs;
half. His characteristic feature– enlargement of body parts from only one half of the body;
eunuchoid. The main reason for its progression is a decrease in the production of sex hormones. As a result, the genital organs cease to function normally. If, against this background, the production of growth hormone also increases, then the patient’s sexual characteristics disappear, the limbs lengthen disproportionately and the growth zones in the articular joints remain open.

Hand of a patient with acromegaly (a) and hand of a healthy person (b)

Symptoms

The progression of gigantism is actually difficult not to notice, since the main characteristic symptom is the rapid growth of the torso and limbs. But patients with this disease also experience the following symptoms:

memory loss;
decline visual function;
headache varying degrees of intensity;
dizziness. This symptom occurs because with gigantism, all internal organs increase in size at approximately the same rate. But this does not concern the heart. Because of this this is vital important organ simply does not have time to fully supply blood disproportionately big body;
pain in the limbs, especially in the joints;
fatigue;
At the beginning of the progression of the disease, an increase in muscle strength is observed, but as it progresses, it decreases.

Symptoms of the acromegalic variety of the disease:

all the above symptoms also persist;
low voice;
the sternum and pelvic bones become thicker;
hands and feet grow;
if you ask a person to smile, you can notice an increase in the gaps between the teeth;
getting bigger lower jaw, and also brow ridges.

In the event that, against the background of the progression of gigantism, pathologies of other organs have developed endocrine system, then the patient may experience the following symptoms:

early termination or complete absence menses;
increasing the volume of urine excreted, extreme thirst– such symptoms are observed against the background or;
decreased sexual function in men;
when the patient has hyperfunction of the thyroid gland, body weight decreases, but at the same time appetite increases;

At least once, any of us had to meet in a crowd a person whose height compared to the background ordinary people looked unnaturally small.

For most people, such people cause bewilderment and sincere surprise - why did this happen, and how at the level modern medicine similar diseases is it possible in principle?

Dwarfism has a second name - pituitary dwarfism. With this pathology, physical development is disrupted, primarily human growth.

Dwarfism in equally affects both male and female populations. As a rule, with this diagnosis, the height of such people does not reach 130 cm.

So, dwarfism is endocrine disease, which is characterized by reduced production of growth hormone, which becomes the cause of defective physical development internal organs and human skeleton.

A few facts about dwarfism

The main task of the endocrine system is to provide the body with hormones that regulate its functions.

The central organs of this system are the pituitary gland and hypothalamus, the peripheral organs are thyroid gland, adrenal glands and gonads.

The pituitary gland produces somatotropin - this hormone has a direct effect on the growth and development of the body.

It improves growth bone tissue, promotes bone mineralization, enhances metabolic processes in the body, which leads to a greater release of energy necessary for full growth and development.

Causes of dwarfism

The main cause of pituitary dwarfism is a hereditary predisposition.

According to statistics, the probability of having a sick child in a family where blood relatives There are cases of dwarfism - at least 50%. You will agree that the figure is quite high, since every second child is doomed to be born with this disease.

The second reason is the general underdevelopment or damage to the endocrine system, namely its central parts - the pituitary gland and hypothalamus.

This may include intoxication of the body, severe viral or bacterial infections, autoimmune diseases, traumatic brain injuries, neoplasms and surgical operations on one of these organs.

The third reason comes down to the low susceptibility of body tissues to perceive growth hormone - this also becomes a cause of dwarfism. In this case, the level of somatotropic secretion in the blood is usually normal.

Symptoms of dwarfism

Against the background of pituitary dwarfism, due to the influence of pathogenetic factors, not only the production of growth hormone is disrupted, but also a number of other hormones produced by the endocrine glands - the pituitary gland and hypothalamus.

This is the reason for the diversity clinical signs in this category of patients.

So, modern endocrinology identifies individual species dwarfism:

the true form of the disease, which is characterized by insufficient concentration of somatotropin in the blood or the impossibility of its physiological effect on the tissues and organs of the body;
a mixed form of the disease, in which there is not only a lack of somatotropic hormone in the body, but also a deficiency of thyroid hormones produced by the thyroid gland, or the effect of sex hormones on the reproductive system.

With true dwarfism, the newborn is born with physiological normal indicators height and weight.

Usually parents begin to notice that the child is lagging behind his peers in growth.

At the same time, the proportions of the body remain correct, the torso and limbs look harmonious, only they are smaller in size.

Thus, a child’s obvious growth retardation with true dwarfism is combined with the following symptoms:

the shape of the head is small and neat, the forehead protrudes forward, the nose is slightly flattened - the face is more reminiscent of a doll's;
the skin is thin and pale in appearance;
adipose tissue is unevenly distributed throughout the body: fat is mostly deposited selectively on the abdomen, chest and pubis;
the muscular system is underdeveloped;
the genitals are fully developed in both men and women, but the organs themselves are small in size;
Intellect with true dwarfism is fully preserved.

If the development of dwarfism was preceded by problems with the thyroid gland, namely its reduced functional activity, then the disease is complemented by disruption of the functioning of organs and systems subordinate to the activity of the thyroid gland.

This pathology is called hypothyroidism.

It is characterized by the following symptoms:

thickening skin, they become dry and cold to the touch;
swelling of subcutaneous fat throughout the body;
round face with narrow eye slits;
weak dull hair;
rare weak pulse, heart rhythm disturbance;
with severe hypofunction thyroid gland symptoms of mental disability are detected.

Dwarfism can also be associated with sexual infantilism or underdevelopment of the reproductive system.

In this case, the genitals remain undeveloped and there are no secondary sexual characteristics.

IN adolescence the disease proceeds as in children who have only insufficient quantity somatropin, that is, the symptoms will be the same, but later they will be accompanied by features of sexual infantilism:

underdevelopment of the external genitalia in male patients: small penis, underdeveloped scrotum, absence hairline in the pubic area, in the armpits and on the face, the voice does not break, remains childish;
female patients complain of primary amenorrhea (absence of menstruation), they have underdevelopment of the labia and mammary glands, and lack of pubic hair;
Regardless of gender, patients are prone to obesity, particularly in the hips and abdomen.

Treatment of dwarfism

To date, pituitary gland transplantation and X-ray therapy of the pituitary zone are performed to treat this disease. minimal doses irradiation, but these methods cannot be called highly effective.

The main thing with this disease is extremely important to maintain mental health child, as he can encounter a lot of negativity from others.

It's about psychological support a patient who needs to accept his peculiarity and learn to live with what he has.

An experienced psychologist will help the patient understand this. As for prevention, there are no generally accepted measures to prevent dwarfism.

Somatotropic hormone, ACTH, FSH, LH, TSH and prolactin: the role of hormones of the anterior pituitary gland in the body

The article is devoted to a number of biologically active substances, such as growth hormone, ACTH, FSH, LH, TSH and prolactin produced by the anterior pituitary gland. Here we consider the functions, reasons for the increase and decrease in their concentration, as well as normal values laboratory research hormonal background.

The information is presented in a form accessible to a wide range of readers; there is a video in this article and photo materials.

Anatomy of the pituitary gland

Pituitary gland, - small gland internal secretion, whose weight normally does not exceed 0.5 grams, is an intermediary between nervous system and metabolism. It is located in the so-called sella turcica, a process sphenoid bone and looks like two beans linked together.

It consists of three parts:

Middle (mainly connective tissue);
Posterior (neural tissue and a little cellular elements);
Front ( endocrine cells, producing a large number of different hormones).

The pituitary gland is divided not only into anatomical, but also into functional parts:

Adenohypophysis, which includes the anterior and middle lobes.
Neurohypophysis, consisting of only one posterior lobe.

The anterior part of the organ, through the hormones it secretes, fundamentally influences the development and functioning of the entire organism, including by regulating the activity of the thyroid gland.

It contains several types of active cellular elements, differing in structure and tasks performed:

Interesting! Not all chromophobe cells remain as such throughout their existence, since they are, in a way, the starting material for degeneration into acidophilic and basophilic. Therefore, their number is significantly higher than others - up to 60% total number, present in the anterior lobe of the pituitary gland.

Hormones of the anterior pituitary gland

Active cells of this part of the gland synthesize a whole series hormones:

prolactin;
thyrotropin;
somatotropin;
adrenocorticotropin.

These biologically active substances exert their influence on the body by regulating the work of a number of peripheral endocrine glands. This ability is called tropic influence, and such substances are called tropic hormones.

Somatotropin

This substance has a second name - “growth hormone” and is a protein that contains almost 190 amino acid residues.

Area of responsibility in the body:

Regulation of tissue growth;
Disposal of decomposition products;
Accelerating the growth of the human body;
Stimulation protein synthesis in various tissues;
Regulation of lipid and carbohydrate (energy) metabolism.

Growth hormone standards vary greatly depending on the age before a person reaches the age of nineteen:

Age (years)	Normal for women (mIU/l)	Norms for men (mIU/l)
Up to 3	1.30 – 9.10	1.10 – 6.20
3 – 6	0.30 – 5.70	0.20 – 6.50
6 – 9	0.40 – 14.00	0.40 – 8.30
9 – 10	0.20 – 8.10	0.20 – 5.10
10 – 11	0.30 – 17.90	0.20 – 12.20
11 – 12	0.40 – 29.10	0.30 – 23.10
12 – 13	0.50 – 46.30	0.30 – 20.50
13 – 14	0.40 – 25.70	0.30 – 18.50
14 – 15	0.60 – 26.00	0.30 – 20.30
15 – 16	0.70 – 30.40	0.20 – 29.60
16 – 17	0.80 – 28.10	0.60 – 31.70
17 – 19	0.60 – 11.20	2.50 – 12.20
After 19	Less than 10.00	Less than 10.00

Excessive production of the hormone in mature age may lead to acromegaly, -pathological condition in which the jaws, ears, brow ridges, and limbs grow too quickly. And, if somatotropin was released excessively large quantities Since childhood, gigantism develops, in which people grow above 200 cm, but at the same time have weak muscle tone and get tired quickly. Their lifespan rarely lasts more than 30 years.

The opposite of this pathology is dwarfism, in which a child from childhood does not receive enough somatotropic hormone in required quantity. With it, even an adult patient is not taller than 100 cm, while his body is proportional, and intellectual abilities saved.

Thyroid-stimulating hormone

In my own way chemical structure TSH is a glycoprotein.

His main task in human body is to control the processes occurring in the thyroid gland:

Organ growth;
Synthesis of thyroid hormones;
Accumulation of iodine in follicles.

Excessive synthesis of thyrotropin stimulates the production of thyroid hormones, which, in turn, can cause hyperthyroidism and thyrotoxicosis; these pathologies are characterized by a number of general and specific symptoms:

Arrhythmias;
Sweating;
Nervousness;
Exophthalmos;
Increased risk of diabetes mellitus.

This condition must be treated by a doctor; self-medication can lead to dire consequences.

A decrease in the release of thyrotropin leads to a drop in the concentration of T3 and T4, and, further, to hypothyroidism, manifested by the following symptoms:

Apathy;
Constipation;
Obesity;
Dry skin;
Declining ability to remember.

The release of TSH can be influenced according to the principle feedback, thyroxine and triiodothyronine, the synthesis of which depends on thyrotropin. That is, the more T3 and T4 in the blood, the less the pituitary gland produces TSH.

Output thyroid-stimulating hormone intensifies under the influence of:

Tumors that secrete this hormone;
Primary hypothyroidism (the feedback principle is implemented).

A decrease in TSH production is caused by:

Primary hyperthyroidism;
Decreased performance of the pituitary gland;
Taking artificial thyroid hormones.

Interesting! Temperature influences the rate of thyroid-stimulating hormone synthesis environment. As soon as it gets cooler, TSH production accelerates.

Reference values of the hormone reach a maximum in newborns and gradually decrease until the onset of puberty, during which they stabilize and do not change throughout life.

They are shown in the following table:

Interesting! The content of the hormone during the day fluctuates in accordance with a special daily rhythm: the most TSH in the blood is observed between 2 and 4 a.m., in the morning there is another peak, but smaller, at 6 a.m. The hormone is lowest in the evening, between 5 and 6 p.m. For middle-aged women and older males, the peak concentration of TSH throughout the year is observed in December.

Gonadotropic hormones

This group includes two hormones produced by basophilic cells of the adenohypophysis - LH (luteinizing) and FSH (follicle-stimulating). Their sphere of influence covers the activity of the human gonads.

Follicle stimulating hormone

In males it is biological active substance is produced continuously and evenly, as for women, their production of FSH has a certain cyclicity - it increases in phase I menstrual cycle.

Under the influence of this hormone, sperm and eggs are formed and mature. In addition, FSH in men is involved in the formation of seminiferous tubules and also maintains prostate health.

The growth of the egg occurs, under the influence of follicle-stimulating hormone, inside the follicle, and the cells of which it consists secrete estrogens, which suppress, according to the feedback principle, the synthesis of FSH.

In women in different periods Throughout life, the secretion of the hormone varies greatly, these fluctuations are reflected in the table below:

Interesting! Physical activity has an ambiguous effect on people - in some it stimulates FSH production, and for others, it reduces.

The concentration of follicle-stimulating hormone may increase due to the presence of:

orchitis;
uremia;
smoking;
menopause;
alcoholism;
pituitary tumors;
influence of x-ray irradiation;
insufficiency of the glands of the reproductive system caused by for various reasons, - genetic failures, autoimmune aggressions, castration performed through radiation or surgery.

But a drop in FSH levels can be caused by:

obesity;
fasting;
pregnancy;
lead poisoning;
surgical interventions;
decreased performance of the pituitary gland or hypothalamus.

The reference values of this hormone experience serious fluctuations, depending on the phases of puberty and the menstrual cycle in women, they are reflected in the table:

Age (years)	Floor	Content (mU/ml)
Up to 1	AND	0.490 – 9.980
-//-	M	< 3.500
From 1 to 5	AND	0.600 – 6.120
-//-	M	< 1.450
From 6 to 10	AND	< 4.620
-//-	M	< 3.040
From 11 to 14	AND	0.190 – 7.970
-//-	M	0.360 – 6.290
From 15 to 20	AND	0.570 – 8.770
-//-	M	0.490 – 9.980
Over 21	AND	1.370 – 100.600
-//-	M	0.950 – 11.950

Both insufficient and overproduction FGC, as well as a disproportion between follicle-stimulating and luteinizing hormones lead to infertility due to the fact that germ cells stop maturing. Women childbearing age Normally they have an LH/FSH ratio of 1.5 to 2.

Luteinizing hormone

This biologically active substance also regulates the functioning of the gonads. Its task is to stimulate the synthesis of sex hormones in both sexes: in women, progesterone, and in men, testosterone.

In addition, luteinizing hormone controls the process of ovulation and normal ripening corpus luteum in the fairer sex, and in men, it affects the functioning of the testicles, including the creation of sperm.

Just as with FSH, in representatives of the stronger sex the release of LH always occurs at the same level, while in the weaker sex it is cyclical (increases during ovulation and falls in the second phase, demonstrating the most low level at the end of the follicular phase). During pregnancy, the concentration of LH falls, and in older people of both sexes, from 60 to 90 years old, it increases. During postmenopause are recorded highest levels luteinizing hormone.

LH increases due to:

Stress;
Gonadal insufficiency;
Presence of a pituitary tumor;
PCOS with an LH to FSH ratio of 2.5.

And the concentration of this hormone decreases in the following conditions:

Anorexia nervosa;
Genetic problems such as Kallmann syndrome;
Declining functionality hypothalamus and/or pituitary gland.

Age (years)	Floor	Hormone content (mU/ml)
<1	AND	<3.290
-//-	M	<6.340
1 – 5	AND	<0.270
-//-	M	<0.920
5 – 10	AND	<0.460
-//-	M	<1.030
10 – 14	AND	<15.260
-//-	M	<5.360
14 – 20	AND	<15.970
-//-	M	0.780 – 4.930
More than 20	AND	1.680 – 56.600
-//-	M	1.140 – 8.750

In adult women, serious fluctuations in LH levels are observed, depending on the phase of the cycle:

In the luteal - from 0.610 to 16.300 mU/ml;
In the follicular - up to 15,000 mU/ml;
In the ovular - from 21,900 to 56,600 mU/ml;
In postmenopause - from 14,200 to 52,300 mU/ml.

Lack and excess of LH, as well as an imbalance of LH with FSH, often makes it impossible for the maturation of germ cells, and for untimely consultation with a doctor about this, too high a price may be paid - infertility.

Adenocorticotropic hormone

ACTH is a polypeptide produced by active cells of the adenohypophysis. Stimulation of its synthesis occurs due to the influence of external influences that lead to stress and cause the release of adrenaline into the blood.

The target organ for ACTH is the adrenal cortex, which, under the influence of this hormone, increases the synthesis of glucocorticoids; in addition, its sphere of influence includes:

Control of the breakdown of fats, glycogen and proteins;
Increased production of testosterone, estrogens, progesterone and cortisol;
Stimulation of the synthesis of nucleic acids and protein compounds of the adrenal cortex;
Triggering the fight-or-flight reflex during stressful situations by dramatically increasing cortisol production.

In addition to stress, its production increases under the influence of:

pain;
injuries;
fright;
Cold;
bleeding;
hypoglycemia;
pregnancy;
strong emotions;
hypothermia;
severe infections;
pituitary tumors;
time zone changes;
adrenal tumors;
surgical interventions;
increasing physical activity;
adrenal insufficiency;
low carbohydrate diets;
taking certain medications.

Interesting! The release of ACTH depends on the time of day - in the morning (between 600 and 800) the maximum value is observed, and in the evening (between 2100 and 2200) its concentration drops to a minimum.

A drop in ACTH production can be caused by the following factors:

adrenal tumors;
lymphocytic hypophysitis;
autoimmune attack on the pituitary gland;
taking certain medications;
pituitary tumors that do not secrete hormones;
high concentration of hormones secreted by the adrenal cortex;
infectious or traumatic lesion of the pituitary gland and/or hypothalamus;

One of the most common pathologies that develops against the background of excess production of adrenocorticotropic hormone is Itsenko-Cushing's disease.

Its main symptoms are:

hypertension;
hyperglycemia;
decline in immunity;
local obesity.

The main manifestation of insufficient ACTH synthesis is severe immune disorders. This acquired immunodeficiency condition requires immediate treatment, since there is a threat of various infectious and other pathologies that can not only undermine the health, but also take the life of the patient. Therefore, the instructions given by the endocrinologist and immunologist must be strictly followed.

The normal ACTH level for both children and adults is considered to be from 9.00 to 52.00 pg/ml, or in SI units, from 2.00 to 11.00 pmol/liter.

Prolactin

This biologically active substance is a luteotropic hormone, which contains about two hundred amino acid residues. It is also called mammotropin.

Prolactin in the human body is responsible for organizing the following functions:

lactation;
maturation of the corpus luteum;
development of mammary glands;
decreased tissue consumption of glucose;
stimulates hair growth on the head.

Control of prolactin synthesis is carried out using two types of neurotransmitters:

Inhibitors (dopamine, gamma-butyric acid, somatotropin, gastrin).
Stimulants (endorphins, acetylcholine, oxytocin, serotonin, thyrotropin and others).

An increase in prolactin is caused by the following reasons:

PCOS;
sleep;
sex;
lactation;
masturbation;
pregnancy;
liver cirrhosis;
pituitary tumors;
nipple irritation;
diseases of the pituitary gland;
stressful situations;
oral contraception;
chronic prostatitis;
rich protein foods;
psychological stress;
pathologies of the hypothalamus;
renal failure;
premenstrual period;
medical manipulations;
chest injuries;
galactorrhea-amenorrhea syndrome;
estrogen-producing tumors;
various medications;
ectopic foci of hormone production;
hypoglycemia that developed against the background of hunger;
hypothyroidism, due to which prolactin and TSH are increased;
congenital and acquired pathologies of the adrenal cortex.

A high concentration of prolactin can prevent a woman from conceiving and giving birth to a child or reduce potency, deteriorate sperm quality and cause gynecomastia in a man. Insufficient secretion of it can cause the cessation of milk secretion during lactation.

Age-related variations in prolactin are shown in the following table:

Women's blood serum contains more prolactin than men's. In pregnant women, by the 8th week the hormone level increases until the 3rd trimester, when it reaches its maximum. Immediately after the birth of a child, its content drops and rises again at the beginning of lactation.

Daily biorhythms of hormone production

The release of prolactin occurs in waves, 15 times throughout the day at 95-minute intervals. During daylight hours, most of the hormone in the blood serum is detected towards the middle of the day, and towards evening its concentration decreases. But most of this biologically active substance is released in women - at night, from 100 to 500, and in men in the morning, at 500.

Interesting! For maximum prolactin production, darkness is needed, even with the light of a small night light this is impossible. Therefore, people who sleep with lights on often wake up in the morning insufficiently rested. But this is not the worst consequence. Insufficient production of prolactin disrupts the normal functioning of the body's reproductive function. For this reason, couples planning to conceive should sleep long enough at night and in the dark.

To correctly prescribe treatment tactics, both active and inactive forms of prolactin are determined.

Rules for donating blood for hormones

As a rule, when determining hormonal status, biological material (venous blood) is collected for TSH, prolactin, LH, FSH, on days V – VII of the cycle.

Actions that are prohibited to be done before taking tests, along with the restriction time, are indicated in the table below:

Since endocrine disruptions can lead to serious illnesses, the examination should not be shelved. Whatever hormones show a significant decrease or increase in their levels - T4, prolactin, somatotropin or any others, you should immediately contact an endocrinologist and receive complete and effective treatment from him, which can prevent the development of pathology and return a person to a full life.

All major diseases, dysfunctions and anomalies of the pituitary gland

The pituitary gland is an important regulator of the hormonal activity of the human body. Violations on its part are manifested by hyperfunction and hypofunction. Simply put, either he works overtime when he is not asked, or he is lazy to synthesize the necessary substances.

Hyperfunction of the pituitary gland

In the first case, disorders are manifested by the following diseases:

1 Increased production of somatotropic hormone - gigantism and acromegaly. The development of a particular disease is associated with age. Gigantism develops in childhood and adolescence, during bone growth. Body growth is relatively proportional, but exceeds established norms. Growth in men over 200 cm, and in women over 190 cm is considered pathological. Acromegaly, when the pituitary gland is malfunctioning, occurs already during the period of ossification of the growth zones during maturity and old age.

2 Excess adrenocorticotropic hormone - Itsenko-Cushing's disease. It manifests itself as dry and pale skin, a kind of obesity (moon-shaped face, obesity of the upper shoulder girdle), muscle weakness (due to muscle atrophy). Bright red stretch marks are often visible on the skin.

Patients suffer from arterial hypertension and pustular rashes on the skin. Characteristic changes in the genital area: menstrual irregularities and hirsutism (male pattern hair growth) in women, impotence in men. Patients' mental status changes: they are prone to depression, mood swings, and psychosis.

3 Increased secretion of prolactin - persistent galactorrhea - amenorrhea syndrome. This disease of the pituitary gland occurs in young women of childbearing age, and is extremely rare in children, the elderly and men. Patients most often consult a doctor with complaints of infertility and menstrual irregularities. A woman either cannot get pregnant at all, or loses the child in the early stages (7-10 weeks).

4 Genital disorders are also determined - anorgasmia, decreased libido, pain during or after sexual intercourse. Another typical symptom is galactorrhea (discharge of colostrum from the mammary glands). The flow of milk can be drip or stream; with a sluggish, long-term disease, it sometimes stops.

In addition to the main ones, there are accompanying symptoms: depression, headaches, lethargy, asthenia (dizziness, fainting).

Hypofunction of the pituitary gland

Lack of somatotropic hormone - dwarfism. It is not difficult to recognize the disease, since obvious growth retardation and developmental delays in the child are immediately noticeable. Patients also have pale, dry, wrinkled skin, and underdeveloped genitals. Intelligence does not suffer with this pathology.
Hypopituitarism (panhypopituitarism) is a decrease or total absence of all hormones produced by the pituitary gland. Symptoms are variable: brittle hair and nails, changes in skin color (dryness, yellowness, wrinkling), changes in sexual desire, swelling. In severe cases, osteoporosis occurs, leading to fractures. It also has a destructive effect on the nervous system, developing apathy, lethargy, insanity and dementia.
Secondary hypothyroidism is a decrease in the production of thyroid hormones due to pathology of the pituitary gland.

There are many reasons for the development of pituitary dysfunction. Medicinal substances, infectious diseases, neoplasms and congenital anomalies, injuries and medical interventions are a small part of them.

Symptoms of pathologies

A little higher, we examined functional diseases of the pituitary gland associated with changes in hormone secretion. Now let's talk about anatomical and physiological changes and corresponding diseases.

The growth of gland tissue is called hyperplasia. In this case, the pituitary gland is large, it puts pressure on the sella turcica and, as a result, increases its size, which can be diagnosed on MRI. The degeneration of enlarged cells leads to the formation of adenoma - a benign tumor. The symptoms are equivalent to hyperfunction of the pituitary gland.
Neoplasms – cysts, tumors (malignant and benign). Clinical signs will appear:

symptoms of increased intracranial pressure - headaches, dizziness, decrease and change in visual fields, insomnia, irritability
the occurrence of hydrocephalus (in common parlance dropsy) - cessation of the outflow of cerebrospinal fluid from the ventricles of the brain, a very dangerous condition requiring immediate neurosurgical intervention. The clinic is bright - headache, nausea, vomiting, delusional disorder of consciousness, sudden stop breathing
hormonal imbalance of the pituitary gland (hypo-, hyperfunction)

Hypotrophy or empty sella syndrome is a decrease in the mass of the gland, up to complete disappearance. Occurs with brain tumors, injuries, and can also be a congenital defect. The symptoms correspond to the picture of panhypopituitarism.

We examined the most significant pathologies of the pituitary gland and were able to verify that even the slightest changes on its part entail severe and sometimes irreversible consequences.

Gigantism- a disease in which there is an increased production of somatotropin (growth hormone), which in turn leads to excessive proportional growth of the limbs and torso.

General information about gigantism

Gigantism- a disease in which there is an increased production of somatotropin (growth hormone), which in turn leads to excessive proportional growth of the limbs and torso. In men with this disease, the height exceeds 200 cm, and in women - 190 cm. It is more often observed in men aged 7-13 years (puberty) or during puberty and continues throughout the entire period of physiological growth. The child's growth indicators and growth rate exceed the norms for this age and gender.

Gigantism should not be confused with tall stature. Parents of persons suffering from this disease are predominantly of normal height.

Symptoms of gigantism

Patients have characteristic complaints: high growth and significant growth rates, weakness, fatigue, decreased performance and performance at school, headaches, dizziness, pain in the limbs, and sometimes blurred vision. Muscle strength may be increased at first, but subsequently decreases significantly.

An objective examination, that is, upon examination, reveals: high growth, proportional physique, normal sexual development, but its delay is often noted. Possible disorders of the thyroid and pancreas. There are no pronounced changes in other endocrine glands and internal organs.

Causes of gigantism

The disease is based on increased production of somatotropin, which can develop with the following lesions:

adenohypophysis tumors;
neuroinfections (this is an infectious (bacterial or viral) disease of the central nervous system, such as meningitis, encephalitis, meningoencephalitis);
intoxication (poisoning with toxins);
traumatic brain injuries.

Also the reason gigantism there may be a decrease in the sensitivity of the receptors of the epiphyseal cartilage (the part of the bone in which its growth in length occurs) to sex hormones, as a result of which bone growth zones remain open for a long time (that is, with the preserved ability for further growth) even after the end of puberty (7 -13 years).

Complications of gigantism

The main complication is acromegaly.

Diagnosis of gigantism

Laboratory studies for gigantism without significant changes, however, the content of somatotropin in the blood is increased.

As instrumental studies, radiography and computed tomography of the brain are used. Pathologies are detected in pituitary tumors. In the presence of a growing adenoma (benign tumor) of the pituitary gland, an increase in the size of the sella turcica (the part of the skull where the pituitary gland is located) is observed. Radiographs of the hand bones reveal a lag in bone age from the passport age. With a growing adenoma, there is a limitation of visual fields (deterioration of vision).

With continued active production of somatotropin after skeletal maturation, acromegaly is formed.

For gigantism, the examination is the same as for acromegaly.

Treatment of gigantism

Modern treatment methods, which involve a combination of hormonal drugs and radiotherapy, in many cases give positive results. In case of tumor damage to the pituitary gland, surgical intervention is indicated. Treatment is basically the same as for acromegaly.

Gigantism
Gigantism (or macrosomia) is more common in adolescent males,
is determined already at the age of 9-13 years and progresses throughout
period of physiological growth.
With gigantism, the child’s growth rate and performance indicators are much higher than
anatomical and physiological norm and by the end of puberty they reach more than
1.9 m for women and 2 m for men while maintaining relatively proportional
physique.
The incidence of gigantism ranges from 1 to 3 cases per 1000 population.
Parents of patients suffering from this pathology are usually of normal height.
Gigantism should be differentiated from hereditary tall stature.

Classification
- acromegalic – gigantism with signs of acromegaly;
- splanchnomegaly or gigantism of internal organs - accompanied by an increase in
size and weight of internal organs;
- eunuchoid - gigantism in patients with hypogonadism (hypofunction or complete
cessation of the functions of the gonads), manifests itself as disproportionately elongated
limbs, open growth zones in the joints, absence of secondary reproductive organs
signs;
- true – characterized by a proportional increase in body size and
absence of deviations in physiological and mental functions;
- partial or partial – gigantism with enlargement of individual parts of the body;
- half - gigantism, accompanied by an increase in one half of the body;
- cerebral – gigantism caused by organic damage to the brain and
accompanied by intellectual impairment.

Acromegalic gigantism

Eunuchoid gigantism

True gigantism

Partial gigantism

Half gigantism

Cerebral gigantism
(Sotos syndrome)

Etiology
Hyperplasia and hyperfunction of pituitary cells producing
somatotropic hormone (growth hormone).
Increased secretion of growth hormone can occur with
lesions of the pituitary gland as a result of gland tumors (pituitary adenomas),
intoxication, neuroinfections (encephalitis, meningitis,
meningoencephalitis), traumatic brain injuries.
Often the cause of gigantism is a decrease in sensitivity
epiphyseal cartilages, which ensure the growth of bones in length, to
influence of sex hormones. As a result, the bones take a long time
retain the ability to increase in length, even in post-puberty
period.

Symptoms of gigantism
The jump in body length increase with gigantism occurs at 10-15 years.
Patients are characterized by high growth and the rate of its increase,
complain of fatigue and
weakness, dizziness, headaches, blurred vision, pain in
joints and bones. Decreased memory and performance leads to
deterioration in school performance. Gigantism is characterized
hormonal disorders, mental and sexual disorders
functions (infantilism).
In women with gigantism, primary amenorrhea or early
cessation of menstrual function, infertility, in men
- hypogonadism. Other hormonal manifestations of gigantism
include diabetes insipidus, hypo- or hyperthyroidism, and diabetes mellitus.
There is first an increase in muscle strength, and then muscle
weakness and asthenia.

Complications of gigantism
With gigantism, it is possible to develop arterial
hypertension, myocardial dystrophy, cardiac
insufficiency, emphysema, dystrophic
liver changes, infertility, diabetes,
dysfunction of the thyroid gland.

Diagnosis of gigantism
The diagnosis of gigantism is established on the basis of an external examination
patient, laboratory results, radiological,
neurological and ophthalmological studies.
In case of gigantism, a high content of growth hormone in the laboratory is determined.
blood.
X-rays are used to identify pituitary tumors.
skull, CT and MRI of the brain. In the presence of a pituitary adenoma
an enlarged sella turcica (bed) is determined
pituitary gland). X-rays of the hands show discrepancies
between bone and passport age. For ophthalmic
examination of patients with gigantism reveals a limitation
visual fields, congestion in the fundus.

Treatment of gigantism
The principles of treatment of gigantism are similar to the treatment of acromegaly.
To normalize the level of growth hormone in gigantism, analogues are used
somatostatin, for faster closure of bone growth zones - sex hormones.
Etiological treatment of gigantism in pituitary adenomas involves
the use of radiation therapy or their surgical removal in combination with
drug support with dopamine agonists.
With the eunuchoid type of gigantism, treatment is aimed at eliminating sexual
infantilism, acceleration of skeletal ossification and cessation of its further
growth. Treatment of partial gigantism includes orthopedic correction for
the help of plastic surgery.
The combined treatment of gigantism used by endocrinologists combines
hormonal and radiation therapy and allows you to achieve positive
results in a significant number of patients.

Prognosis and prevention
gigantism
With adequate treatment for gigantism, the prognosis for life is relatively
favorable. However, many patients do not live to old age and
die from complications of the disease.
Most patients suffering from gigantism are infertile, their
working capacity is sharply reduced.
Parents should be concerned about a sharp, significant
increase in child growth during puberty compared to
his peers. Timely medical intervention will allow
prevent complications.

Nanism
Pituitary dwarfism (GN) -
disease with absence or
decrease in somatotropic activity
adenohypophysis as a result of production
abnormal growth hormone or due to a violation
it tissue sensitivity.
Frequency - 1:15,000-1:20,000 in Russia; to
1:4 000 - in America, Africa and
Middle East. Pituitary dwarfism
more common in young men.

Etiology and pathogenesis
True pituitary dwarfism is always hyposomatotropic. Reasons:
skull injury,
autoimmune process,
irradiation,
infection (toxoplasmosis)
tumor of the hypothalamic-pituitary region,
"empty sella" syndrome
genetic defect of growth hormone, somatomedins and their receptors, deficiency of somatoliberin.
In 65-75% of patients, GN is idiopathic.
"Pituitary infantilism" is caused by craniopharyngiomas or autoimmune
a process that destroys regulatory cells. This form is common in adolescents.

Etiology and pathogenesis
Having been born normal, patients grow well until 3-4 years of age, but then
growth slows down sharply, maintaining childlike proportions forever.
With congenital GH deficiency, growth retardation - from the first months
life.
Hypostature is proportional (the head may have a slightly larger
relative size, forehead protruding) and is accompanied by
microsplanchnia and deviations in psychomotor and sexual development
(gonadotropin deficiency).
Decreased TSH secretion causes hypothyroidism. Shortage
counterinsular hormones cause hypoglycemia.

Classification
Congenital GH deficiency:
Hereditary
Idiopathic deficiency of releasing hormone.
Developmental defects of the hypothalamic-pituitary system (ectopia, hypoplasia, aplasia
pituitary gland).
Acquired GH deficiency:
Tumors of the hypothalamus and pituitary gland (adenoma, craniopharyngeoma, etc.).
Tumors of other parts of the brain (glioma of the optic chiasm).
Injuries.
CNS infections (encephalitis, meningitis).
Hydrocephalus, symptom of an “empty” sella turcica, cysts.
Vascular pathology of the central nervous system (aneurysms, etc.).
Radiation damage to the head and neck.
Toxic consequences of chemotherapy.
Infiltrative diseases (histiocytosis X, sarcoidosis).
Transient – constitutional growth retardation, late puberty, psychosocial
nanism.
Peripheral resistance to the action of growth hormone:
Deficiency of GH receptors (Laron syndrome, African pygmy dwarfism).
Biologically inactive growth hormone.
Resistance to IPF-1.

Symptoms
Characterized by short stature with general diminutiveness and small features
“doll” face with a sunken nose. A relatively large forehead causes
suspicion of hydrocephalus.
Characteristic features include small hands and feet, and sometimes hypoplasia of the nails. They can
have sparse thin hair. Eyelashes are elongated. The timbre of the voice is childish, high,
shrill (miniature larynx). The skin is pale, tender, thin, early
grows old (heroderm). Wrinkles on the face give dwarfs the appearance of gnomes.
Due to hypothyroidism - chilliness and constipation. General obesity is extremely rare, most often excess fat on the torso. Patients get tired quickly (muscle weakness). Often
note relative hypogonadism with absence or weak
secondary sexual characteristics.
Late puberty. Young men often have cryptorchidism, testicular hypoplasia,
micropenis; in girls - menstrual irregularities, often with an underdeveloped uterus and
ovaries.

Symptoms
Patients can start families, but are usually childless. They are closed
negative, experience inferiority, have poor contact with
peers, are offended by the nickname “Lilliputian” and like to be called
"small". Self-esteem is reduced. Increased need for
parental care. Capricious, like children. School performance is often
bad. Maturity of judgment is combined with infantile behavior,
reasoning, moralizing. For genetic forms
With pituitary dwarfism, the psyche is more stable.

Complications
A tumor as a cause of pituitary dwarfism can
cause brain compression and serious complications
before the development of idiocy. Hypothyroidism may occur.
Teenagers with GN are indefatigable in trying to grow up, but when
self-medication with anabolic steroids leads to disastrous
results: bone growth zones are completely closed.

Diagnostics
The criterion for dwarfism is a lag of 2-3 from the average population growth
sigma (approximately 20% or more for the corresponding age).
Boys below 130 cm are considered dwarfs, girls below 120 cm. Delay
differentiation and ossification of the skeleton gives a lag from the calendar
up to 10 years of age!
Attention should be paid to family history (cases of short stature and
delayed sexual development in the family), at the previous appointment
hormonal and other drugs.
The diagnosis is based on identifying a decrease in the secretion of growth hormone and somatomedins
blood.
Determine the basal level and circadian rhythm of their production, response to
thyroid hormone and insulin.

Disease outcomes and prognosis
The prognosis of pituitary dwarfism is determined by
primary pathology. In late illness and
in hereditary forms it is better. The sick live
long, until old age. Possible severe psychosis
suicides are extremely rare. Timely treatment
accelerates physical development. Possible development
gallstone disease. When administering drugs
GH may cause lipoatrophy and subcutaneous
infiltrates. Unique cases of pituitary
dwarfism with offspring.

Treatment
The diet should be rich in proteins, vitamins, calcium, iodine,
zinc
The main thing in the treatment of pituitary dwarfism is sparing the bone growth zones.
Only true pituitary dwarfism responds to therapy.
The indication for its use is not just growth retardation, but
somatotropic insufficiency.
Practice of treating pituitary dwarfism with cadaveric human growth hormone
prohibited (risk of Creutzfeldt-Jakob disease, “mad cow disease”)
Recombinant human GH and its analogues are used
(somatogen, genotropin, seisen, norditropin).
When treatment is started early, the effect is much higher. GH therapy should
imitate the rhythm of its secretion.

Treatment
A subcutaneous method of administration using a pen syringe is recommended. Places
It is advisable to change injections. More frequent administration of GH is more effective
(daily single injections at night, before bedtime). In late puberty
the dose should be increased. To maintain libido, sexual potency and external
sexual characteristics, lifelong use of sex steroids is desirable. For GN
Retabolil can be used. Before the use of anabolic steroids is prohibited
gonadotropins and sex hormones (threat of closing bone growth zones). In boys
15-16 years old chorionic amniotic fluid is used to stimulate Leydig cells
gonadotropin, and in girls to simulate menstruation - estrogens. According to indications
prescribe thyroid hormones (levothyroxine) under the control of T3, T4 and TSH in
blood.
The criterion for stopping GH treatment is achieving growth that is optimal for
of this population.

Prevention
It is important to prevent infections in pregnant women and avoid injuries
head of a newborn in the intra-, peri- and postnatal periods.
Children need normal living conditions, nutritious food,
affection, healthy environment in the family and at school. Timely
sanitation of foci of latent infection.

Clinical examination
Dispensary group - D-3. Taking into account adolescents with pituitary
Nanism is never removed. Visit an endocrinologist every 2-3 months, and with maintenance therapy - once every 6 months.
Patients are periodically examined by an ophthalmologist, neurologist and
a psychologist, and according to indications - a neurosurgeon.

Gigantism is associated with dysfunction of the pituitary gland. Pathologically high growth, frequent fainting, intellectual difficulties and sexual dysfunction are all consequences of gigantism. There are several types of the disease, but 2 main groups can be distinguished:

Diseases that began in childhood.
Pathologies that started in adulthood.

They have one thing in common - increased tissue division under the influence of an abnormally large amount of the hormone produced by the pituitary gland - somatotropin. Children have “growth zones” in the joint area. This is the cartilage of the tubular bone, where active cell division occurs. Therefore, a child can grow up to 2 meters during adolescence.

Note. In adults, these zones are normally absent. At the end of puberty, they are closed by bone tissue, and human growth stops.

There are various pathologies of closure of “growth zones”:

The immunity of the receptors of these zones to sex hormones, under the influence of which the adolescent’s body is formed. As a result, the child’s limbs and all internal organs continue to grow, and sexual development is delayed.
Although the “growth zones” were closed, the production of the hormone increased incredibly. The result will be the development of acromegaly or partial gigantism. Hormones stimulate tissue cell division where there is cartilage tissue.

Note. This does not apply to families where a high body height is genetically determined. In these cases, development occurs proportionally, harmoniously and stops in due time. Such tall people can have offspring, which cannot be said about patients with gigantism.

Often, with a fairly high stature, such people have a small head, curved X-shaped legs, and there is also an absence of secondary sexual characteristics (hair growth does not occur, skeletal features of the male or female type are not formed).

After a brain injury, acromegaly, a type of gigantism, can occur. At the same time, the face, ears, and nose grow. The feet and hands can become incredibly enlarged. The tongue increases in volume and prevents you from chewing food normally and pronouncing words clearly. This condition is caused by a pituitary adenoma and is treated with surgery.

Existing types of gigantism

Endocrinology distinguishes the following types of this disease.

Causes of pathology

In 90% of cases, the cause of gigantism is a pituitary adenoma. The remaining 10% is divided among themselves by the following reasons:

Compression of the pituitary gland by a brain tumor, as a result of which increased production of somatotropin begins.
Metastases of tumors from internal organs go to the brain.
An infection leading to inflammation in the pituitary gland. This is a common complication after influenza or encephalitis.

Recommendation. It is necessary to treat infectious diseases so that there are no consequences. Complications after suffering from influenza or encephalitis lead to an inflammatory process in the pituitary gland. This can give impetus to the onset of the disease.

Symptoms of gigantism

Based on the consequences of exposure to the body, the following groups of symptoms can be distinguished:

Pathological proliferation of bone tissue:

Limb lengthening.
Hyperdevelopment of hands and feet.
The bones of the face enlarge, the appearance becomes rougher.
The lower jaw expands, and gaps appear between the teeth.
The nose is enlarged and deformed.

Acromegaly is expressed by a massive, protruding chin. The brow ridges are enlarged and protrude forward. Prominent cheekbones. Unusually tall. All this together is a reason to undergo diagnostic tests for the condition of the pituitary gland.

Hypertrophy of internal organs:

Cardiomegaly.
Enlarged liver.
Enlarged intestines.
Enlargement of the vocal cords (change in voice).

Compression syndrome:

Constant headaches.
Pain behind the eyes and in the brow ridges.

Note. According to the neurology reference book, every third person has one or another disorder in the functioning of the pituitary gland.

Endocrine diseases:

Increased sweating.
Acceleration of metabolism.
Increased heart rate.
Irritability.

Sexual dysfunction:

Stopping menstruation.
Decreased potency and libido.

Mental disorders.

Neurological disorders.

Methods for diagnosing gigantism

To confirm the diagnosis, there are various samples and tests that determine the level of somatomedins. Biochemical tests show the level of total protein and glucose in the blood. Hormone tests are often prescribed, since all body systems are not working correctly.

One of the most important methods is ophthalmoscopy. Radiological methods are also used.

Existing treatments for gigantism

Treatment for gigantism is designed to reduce the amount of growth hormone. If there are already concomitant diseases, remedies are added to correct them.

Drug therapy

Somatostatin (“Octreotide”). A synthetic hormone that inhibits growth.
Bromocriptine (Parlodel). Stimulates the production of dopamine, which inhibits the synthesis of growth hormone.

Radiation radiotherapy

X-ray therapy. Suppressing tumor growth and reducing the production of somatotropin.
Treatment with irradiation of a directed neutron beam.

Surgical treatment

Preventive measures

Modern medicine attaches great importance to the timely detection of various pathologies. Therefore, constant monitoring of the child’s development will significantly reduce the incidence of gigantism in children. It is important to detect the onset of the disease in time and adhere to the following tips:

Immediately seek help from a doctor.
Timely treatment of influenza.
Avoid head injury.
Keep hormone levels under control.
Follow-up with an endocrinologist and ophthalmologist.

Modern endocrinology has learned to identify early pathologies. Effective treatment methods have been developed. If you follow all the doctors' instructions, your quality of life will improve.