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Abnormal height that matters

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Doctors may have found an answer to hormonal problems. Structural changes in protein clumps could be the culprit for this abnormality in height.

A fourteen year boy or girl might get a height of  six feet few inches though  his parents are of average height. CLICK & SEE

We call Gigantism  which is a condition that leads to excessive growth — occurs when the pituitary or thyroid gland release excess hormones. But a study published recently in the Journal of Biological Chemistry implies that there may be a remedy — over time — for such hormone disorders. CLICK & SEE

Scientists have known for a while that many critical life processes controlled by the hormones are affected even when their production by glands is normal. This usually happens because the hormones are not released when they are needed.

Hormones regulate processes that are crucial for healthy functioning. Many of these hormones — including insulin, glucagon and the growth hormone — are protein or peptide molecules that are synthesised by the body and stored in cells known as secretory granules in clumps called amyloids. These amyloids are released into the blood stream as and when required by the body. For example, insulin, which plays an important role in sugar metabolism, is released from the pancreatic cells in response to glucose levels in the blood stream. CLICK & SEE

Scientists have now discovered that the problem lies in the structural changes that take place in these amyloids.  “The structure or shape of a protein could be crucial for its efficient storage and secretion. Therefore, in most cases, structure governs the function of a protein,”

The group studied the role played by the structure of a peptide hormone called somatostatin-14 (SST14), which is involved in several functions of the human body, the most well known of which is countering a excessive growth hormone secretion, thus regulating human growth. Other important functions include controlling gastric acid secretion and insulin and glucagon secretion in the pancreas. A deficiency of this hormone can lead to gigantism and pituitary adenoma or non-cancerous tumours in the pituitary gland.

The researchers who carried out studies on a lab rat found that the structure of SST-14, which is stored in an amyloid form, could change in abnormal cases. And this happened when a particular chemical bond (disulphide bond) which kept it stable was disturbed. This caused the protein to take on a different structure, resulting in faster amyloid formations. These amyloids, however, do not release the somatostatin hormone readily.

The scientists, who hope to study this in bigger animals in the future, are now figuring out whether these results are applicable to other hormones too.

It shows that the difference between people who have abnormal growth hormone releases and those who don’t may lie in their somatostatin structure. This may help pharmaceutical companies hone their strategy for attacking this disorder,

Now, if experts can create long-acting somatostatin outside the human body, it can be used to treat dwarfism and pituitary deficient newborns too. Besides, this type of somatostatin can also be used to repair body tissue.”

Sources : The Telegraph (Kolkata, India)

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Ailmemts & Remedies

Cushing’s syndrome

Alternative Names: Itsenko-Cushing syndrome, hyperadrenocorticism or hypercorticism
Definition:
Cushing’s syndrome is a hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone (ACTH) or CRH

You may click to see the pictures

Cushing’s disease refers to one specific cause of the syndrome, a tumor (adenoma) in the pituitary gland that produces large amounts of ACTH, which in turn elevates cortisol. It is the most common cause of Cushing’s syndrome, responsible for 70% of cases.

This pathology was described by Harvey Cushing in 1932.

Cushing’s syndrome is not confined to humans and is also a relatively common condition in domestic dogs and horses.

Treatments for Cushing’s syndrome can return your body’s cortisol production to normal and noticeably improve your symptoms. The earlier treatment begins, the better your chances for recovery.

Symptoms:
SymptomsMost people with Cushing syndrome will have:

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•Upper body obesity (above the waist) and thin arms and legs
•Round, red, full face (moon face)
•Slow growth rate in children

Skin changes that are often seen:
•Acne or skin infections
•Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
•Thin skin with easy bruising

Muscle and bone changes include:
•Backache, which occurs with routine activities
•Bone pain or tenderness
•Collection of fat between the shoulders (buffalo hump)
•Thinning of the bones, which leads to rib and spine fractures
•Weak muscles

Woman with cushing syndrome often have:

•Excess hair growth on the face, neck, chest, abdomen, and thighs
•Menstrual cycle becomes irregular or stops

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Men may have:
•Decreased fertility
•Decreased or no desire for sex
•Impotence

click & see

Other symptoms that may occur with this disease:
*Mental changes, such as depression, anxiety and irritability or changes in behavior
*Fatigue
*Headache
*High blood pressure
*Increased thirst and urination
*Muscle weakness
*Loss of emotional control
*Cognitive difficulties
*New or worsened high blood pressure
*Glucose intolerance that may lead to diabetes
*Headache
*Bone loss, leading to fractures over time

Iatrogenic Cushing’s syndrome (caused by treatment with corticosteroids) is the most common form of Cushing’s syndrome. The incidence of pituitary tumors may be relatively high, as much as one in five people, but only a minute fraction are active and produce excessive hormones.

Adults with the disease may also have symptoms of extreme weight gain, excess hair growth in women, high blood pressure, and skin problems. In addition, they may show:

*muscle and bone weakness
*osteoporosis
*diabetes mellitus
*hypertension
*moodiness, irritability, or depression
*sleep disturbances
*menstrual disorders such as amenorrhea in women and decreased fertility in men
*baldness
*hypercholesterolemia

Cause:
There are several possible causes of Cushing’s syndrome.

Exogenous vs. endogenous Hormones that come from outside the body are called exogenous; hormones that come from within the body are called endogenous.

The most common cause of Cushing’s syndrome is exogenous administration of glucocorticoids prescribed by a health care practitioner to treat other diseases (called iatrogenic Cushing’s syndrome). This can be an effect of steroid treatment of a variety of disorders such as asthma and rheumatoid arthritis, or in immunosuppression after an organ transplant. Administration of synthetic ACTH is also possible, but ACTH is less often prescribed due to cost and lesser utility. Although rare, Cushing’s syndrome can also be due to the use of medroxyprogesterone.

Endogenous Cushing’s syndrome results from some derangement of the body’s own system of secreting cortisol. Normally, ACTH is released from the pituitary gland when necessary to stimulate the release of cortisol from the adrenal glands.

*In pituitary Cushing’s, a benign pituitary adenoma secretes ACTH. This is also known as Cushing’s disease and is responsible for 70% of endogenous Cushing’s syndrome.

*In adrenal Cushing’s, excess cortisol is produced by adrenal gland tumors, hyperplastic adrenal glands, or adrenal glands with nodular adrenal hyperplasia.

*Finally, tumors outside the normal pituitary-adrenal system can produce ACTH that affects the adrenal glands. This final etiology is called ectopic or paraneoplastic Cushing’s syndrome and is seen in diseases like small cell lung cancer.

Pseudo-cushing’s syndrome:
Elevated levels of total cortisol can also be due to estrogen found in oral contraceptive pills that contain a mixture of estrogen and progesterone. Estrogen can cause an increase of cortisol-binding globulin and thereby cause the total cortisol level to be elevated. However, the total free cortisol, which is the active hormone in the body, as measured by a 24 hour urine collection for urinary free cortisol, is normal.

Pathophysiology:
The hypothalamus is in the brain and the pituitary gland sits just below it. The paraventricular nucleus (PVN) of the hypothalamus releases corticotropin-releasing hormone (CRH), which stimulates the pituitary gland to release adrenocorticotropin (ACTH). ACTH travels via the blood to the adrenal gland, where it stimulates the release of cortisol. Cortisol is secreted by the cortex of the adrenal gland from a region called the zona fasciculata in response to ACTH. Elevated levels of cortisol exert negative feedback on the pituitary, which decreases the amount of ACTH released from the pituitary gland. Strictly, Cushing’s syndrome refers to excess cortisol of any etiology. One of the causes of Cushing’s syndrome is a cortisol secreting adenoma in the cortex of the adrenal gland. The adenoma causes cortisol levels in the blood to be very high, and negative feedback on the pituitary from the high cortisol levels causes ACTH levels to be very low. Cushing’s disease refers only to hypercortisolism secondary to excess production of ACTH from a corticotrophic pituitary adenoma. This causes the blood ACTH levels to be elevated along with cortisol from the adrenal gland. The ACTH levels remain high because a tumor causes the pituitary to be unresponsive to negative feedback from high cortisol levels.

Cushing’s Syndrome was also the first autoimmune disease identified in humans.

Diagnosis:-
When Cushing’s syndrome is suspected, either a dexamethasone suppression test (administration of dexamethasone and frequent determination of cortisol and ACTH level), or a 24-hour urinary measurement for cortisol offer equal detection rates. Dexamethasone is a glucocorticoid and simulates the effects of cortisol, including negative feedback on the pituitary gland. When dexamethasone is administered and a blood sample is tested, high cortisol would be indicative of Cushing’s syndrome because there is an ectopic source of cortisol or ACTH (e.g.: adrenal adenoma) that is not inhibited by the dexamethasone. A novel approach, recently cleared by the US FDA, is sampling cortisol in saliva over 24 hours, which may be equally sensitive, as late night levels of salivary cortisol are high in Cushingoid patients. Other pituitary hormone levels may need to be ascertained. Performing a physical examination to determine any visual field defect may be necessary if a pituitary lesion is suspected, which may compress the optic chiasm causing typical bitemporal hemianopia.

When any of these tests are positive, CT scanning of the adrenal gland and MRI of the pituitary gland are performed to detect the presence of any adrenal or pituitary adenomas or incidentalomas (the incidental discovery of harmless lesions). Scintigraphy of the adrenal gland with iodocholesterol scan is occasionally necessary. Very rarely, determining the ACTH levels in various veins in the body by venous catheterization, working towards the pituitary (petrosal sinus sampling) is necessary.

Mnemonic:
C – Central obesity, Cervical fat pads, Collagen fibre weakness, Comedones (acne)
U – Urinary free cortisol and glucose increase
S – Striae, Suppressed immunity
H – Hypercortisolism, Hypertension, Hyperglycemia, Hypercholesterolemia, Hirsutism
I – Iatrogenic (Increased administration of corticosteroids)
N – Noniatrogenic (Neoplasms)
G – Glucose intolerance, Growth retardation

Treatment:-
Most Cushing’s syndrome cases are caused by steroid medications (iatrogenic). Consequently, most patients are effectively treated by carefully tapering off (and eventually stopping) the medication that causes the symptoms.

If an adrenal adenoma is identified it may be removed by surgery. An ACTH-secreting corticotrophic pituitary adenoma should be removed after diagnosis. Regardless of the adenoma’s location, most patients will require steroid replacement postoperatively at least in the interim as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed, replacement with hydrocortisone or prednisolone is imperative.

In those patients not suitable for or unwilling to undergo surgery, several drugs have been found to inhibit cortisol synthesis (e.g. ketoconazole, metyrapone) but they are of limited efficacy.

Removal of the adrenals in the absence of a known tumor is occasionally performed to eliminate the production of excess cortisol. In some occasions, this removes negative feedback from a previously occult pituitary adenoma, which starts growing rapidly and produces extreme levels of ACTH, leading to hyperpigmentation. This clinical situation is known as Nelson’s syndrome.

Lifestyle and home remedies:-

The length of your recovery from Cushing’s syndrome will depend on the severity and cause of your condition. Remember to be patient. You didn’t develop Cushing’s syndrome overnight and your symptoms won’t disappear overnight, either. In the meantime, these tips may help you on your journey back to health.

*Increase activities slowly. You may be in such a hurry to get your old self back that you push yourself too hard too fast, but your weakened muscles need a slower approach. Work up to a reasonable level of exercise or activity that feels comfortable without overdoing it. You’ll improve little by little, and your persistence will be rewarded.

*Eat sensibly. Nutritious, wholesome foods provide a good source of fuel for your recovering body and can help you lose the extra pounds that you gained from Cushing’s syndrome. Make sure you’re getting enough calcium and vitamin D. Taken together, they help your body absorb calcium, which can help strengthen your bones, counteracting the bone density loss that often occurs with Cushing’s syndrome.

*Monitor your mental health. Depression can be a side effect of Cushing’s syndrome, but it can also persist or develop after treatment begins. Don’t ignore your depression or wait it out. Seek help promptly from your doctor or a therapist if you’re depressed, overwhelmed or having difficulty coping during your recovery.

*Gently soothe aches and pains. Hot baths, massages and low-impact exercises, such as water aerobics and tai chi, can help alleviate some of the muscle and joint pain that accompanies Cushing’s syndrome recovery.

*Exercise your brain. If you’re recovering from any cognitive difficulties as a result of Cushing’s syndrome, mental exercises, such as math problems and crossword puzzles, may improve your brain function.

Coping and support:-
Support groups can be valuable in dealing with Cushing’s syndrome and recovery. They bring you together with other people who are coping with the same kinds of challenges, along with their families and friends, and offer a setting in which youe can share common problems.

Ask your doctor about support groups in your community. Your local health department, public library and telephone book and the Internet also may be good sources to find a support group in your area.

Prognosis:
Removing the tumor may lead to full recovery, but there is a chance that the condition will return.

Survival for people with ectopic tumors depends on the tumor type. Untreated, Cushing syndrome can be life-threatening.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Cushing’s_syndrome
http://www.mayoclinic.com/health/cushings-syndrome/DS00470
http://www.nlm.nih.gov/medlineplus/ency/article/000410.htm
http://www.bbc.co.uk/health/physical_health/conditions/cushing1.shtml

Cushing’s Syndrome


http://www.potbellysyndrome.com/documents/083EFB330BDDC27C6EEC8354AFFA139607633EB6.html
http://www.wrongdiagnosis.com/c/cushings_disease/book-diseases-7a.htm

http://www.nature.com/eye/journal/v20/n6/fig_tab/6701956f4.html

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Categories
Ailmemts & Remedies

Acromegaly

Other Names: Somatotroph adenoma; Growth hormone excess; Pituitary giant

Definition:-
Acromegaly is a chronic metabolic disorder in which there is too much growth hormone and the body tissues gradually enlarge.
CLICK TO SEE THE PICTURES
It is a syndrome that results when the pituitary gland produces excess growth hormone (hGH) after epiphyseal plate closure at puberty. A number of disorders may increase the pituitary’s GH output, although most commonly it involves a GH producing tumor called pituitary adenoma, derived from a distinct type of cell (somatotrophs).

Acromegaly most commonly affects adults in middle age,  and can result in severe disfigurement, serious complicating conditions, and premature death if unchecked. Because of its insidious pathogenesis and slow progression, the disease is hard to diagnose in the early stages and is frequently missed for many years, until changes in external features, especially of the face, become noticeable.

Acromegaly is often also associated with gigantism.

CLICK TO SEE THE PICTURES
You may click to see :Netter Medical Images
Symptoms:-
Features that result from high level of GH or expanding tumor include:

*Soft tissue swelling visibly resulting in enlargement of the hands, feet, nose, lips and ears, and a general thickening of the skin. In particular the appearance of the hands can indicate to a knowledgeable person that a stranger may be developing acromegaly; there are documented instances of physicians warning strangers that they had acromegaly.

*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

*Generalized expansion of the skull at the fontanelle

*Pronounced brow protrusion, often with ocular distension

*Pronounced lower jaw protrusion with attendant macroglossia (enlargement of the tongue) and teeth gapping

*Hypertrichosis, hyperpigmentation, and hyperhidrosis may occur in these patients

Observations:

•Body odor
•Carpal tunnel syndrome
•Decreased muscle strength (weakness)
•Easy fatigue
•Enlarged bones of the face
•Enlarged feet
•Enlarged hands
•Enlarged glands in the skin (sebaceous glands)
•Enlarged jaw (prognathism) and tongue
•Excessive height (when excess growth hormone production begins in childhood)
•Excessive sweating
•Headache
•Hoarseness
•Joint pain
•Limited joint movement
•Sleep apnea
•Swelling of the bony areas around a joint
•Thickening of the skin, skin tags
•Widely spaced teeth
•Widened fingers or toes due to skin overgrowth with swelling, redness, and pain

Other symptoms that may occur with this disease:
•Excess hair growth in females...click & see
•Weight gain (unintentional)……click & see

Causes:-

Pituitary adenoma
In over 90 percent of acromegaly patients, the overproduction of growth hormones is caused by a benign tumor of the pituitary gland, called an adenoma. The pituitary gland, which is located just below the brain, controls the production and release of several different hormones, including growth hormone.

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These tumors produce excess growth hormones and, as they expand, compress surrounding brain tissues, such as the optic nerves. This expansion causes the headaches and visual disturbances that often accompany acromegaly. In addition, compression of the surrounding normal pituitary tissue can alter production of other hormones, leading to changes in menstruation and breast discharge in women and impotence in men because of reduced testosterone production.

There is a marked variation in rates of GH production and the aggressiveness of the tumor. Some adenomas grow slowly and symptoms of growth hormone excess are often not noticed for many years. Other adenomas grow rapidly and invade surrounding brain areas or the sinuses, which are located near the pituitary. In general, younger patients tend to have more aggressive tumors.

Most pituitary tumors arise spontaneously and are not genetically inherited. Many pituitary tumors arise from a genetic alteration in a single pituitary cell which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but is acquired during life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells; it permanently switches on the signal that tells the cell to divide and secrete growth hormones. The events within the cell that cause disordered pituitary cell growth and growth hormone oversecretion currently are the subject of intensive research.

Other tumors
In a few patients, acromegaly is caused not by pituitary tumors but by tumors of the pancreas, lungs, and adrenal glands. These tumors also lead to an excess of GH, either because they produce GH themselves or, more frequently, because they produce GHRH (Growth Hormone Releasing Hormone), the hormone that stimulates the pituitary to make GH. In these patients, the excess GHRH can be measured in the blood and establishes that the cause of the acromegaly is not due to a pituitary defect. When these non-pituitary tumors are surgically removed, GH levels fall and the symptoms of acromegaly improve.

In patients with GHRH-producing, non-pituitary tumors, the pituitary still may be enlarged and may be mistaken for a tumor. Therefore, it is important that physicians carefully analyze all “pituitary tumors” removed from patients with acromegaly in order not to overlook the possibility that a tumor elsewhere in the body is causing the disorder.

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. As an affected child becomes an adult, many of the adult problems can gradually develop. The distinction between gigantism (occurring in children) and acromegaly (occurring in adults) can be made by the occurrence of the adenoma in relation to the closure of the epiphyses. If elevated growth hormone levels occur before the closure of the epiphyses (i.e. in prepubertal children), then gigantism ensues. If it occurs after the closure of the epiphyses (i.e., in adults) then acromegaly ensues.

Diagnosis:
If acromegaly is suspected, medical imaging and medical laboratory investigations are generally used together to confirm or rule out the presence of this condition.

*IGF1 provides the most sensitive and useful lab test for the diagnosis of acromegaly. A single value of the Growth hormone (GH) is not useful in view of its pulsatality (levels in the blood vary greatly even in healthy individuals). GH levels taken 2 hours after a 75 or 100 gram glucose tolerance test are helpful in the diagnosis: GH levels are suppressed below 1 ?g/L in normal people, and levels higher than this cutoff are confirmatory of acromegaly.

*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 (thyroid stimulating hormone), gonadotropic hormones (FSH,LH), ACTH (adrenocorticotropic hormone), prolactin.

Exams and Tests
*High growth hormone level
*High insulin-like growth factor 1 (IGF-1) level
*Spine x-ray shows abnormal bone growth
*Echocardiogram may show an enlarged heart, leaky mitral valve, or leaky aortic valve
*An MRI of the brain focusing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumor.

This disease may also change the results of the following tests:

*Fasting plasma glucose
*Glucose tolerance test

Treatment:
The goals of treatment are to reduce GH production to normal levels, to relieve the pressure that the growing pituitary tumor exerts on the surrounding brain areas, to preserve normal pituitary function, and to reverse or ameliorate the symptoms of acromegaly. Currently, treatment options include surgical removal of the tumor, drug therapy, and radiation therapy of the pituitary.

Once the diagnosis has been confirmed by blood tests and scans, treatment can be provided. This may include a combination of surgery to remove the tumour, radiotherapy to destroy any tumour cells and drugs to suppress the production of GH.

Surgery is a rapid and effective treatment, of which there are two alternative methods. The first method, a procedure known as Endonasal Transphenoidal surgery, involves the surgeon reaching the pituitary through an incision in the nasal cavity wall. The wall is reached by passing through the nostrils with microsurgical instruments. The second method is Transsphenoidal 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. Endonasal Transphenoidal surgery is a less invasive procedure with a shorter recovery time than the older method of Transphenoidal surgery, and the likelihood of removing the entire tumor is greater with reduced side-effects. Consequently, Endonasal Transphenoidal surgery is often used as a first option, with Transphenoidal and other treatments, such as, medicinal therapy or radiostatic neurosurgery being used to reduce the remaining adverse effects of the remaining tumor.

These procedures normally relieve the pressure on the surrounding brain regions and lead to a lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days. Surgery is most successful in patients with blood GH levels below 40 ng/ml before the operation and with pituitary tumors no larger than 10 mm in diameter. Success depends on the skill and experience of the surgeon. The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and IGF-1 levels. Ideally, GH should be less than 2 ng/ml after an oral glucose load. A review of GH levels in 1,360 patients worldwide immediately after surgery revealed that 60 percent had random GH levels below 5 ng/ml. Complications of surgery may include cerebrospinal fluid leaks, meningitis, or damage to the surrounding normal pituitary tissue, requiring lifelong pituitary hormone replacement.

Even when surgery is successful and hormone levels return to normal, patients must be carefully monitored for years for possible recurrence. More commonly, hormone levels may improve, but not return completely to normal. These patients may then require additional treatment, usually with medications.

The primary current medical treatment of acromegaly is to use somatostatin analogues — octreotide (Sandostatin) or lanreotide (Somatuline). These somatostatin analogues are synthetic forms of a brain hormone, somatostatin, which stops GH production. The long-acting forms of these drugs must be injected every 2 to 4 weeks for effective treatment. Most patients with acromegaly respond to this medication. In many patients, GH levels fall within one hour and headaches improve within minutes after the injection. Several studies have shown that octreotide and lanreotide are effective for long-term treatment. Octreotide and lanreotide have also been used successfully to treat patients with acromegaly caused by non-pituitary tumors.

Somatostatin analogues are also sometimes used to shrink large tumors before surgery.

Because octreotide inhibits gastrointestinal and pancreatic function, long-term use causes digestive problems such as loose stools, nausea, and gas in one third of patients. In addition, approximately 25 percent of patients develop gallstones, which are usually asymptomatic. In rare cases, octreotide treatment can cause diabetes. On the other hand, scientists have found that in some acromegaly patients who already have diabetes, octreotide can reduce the need for insulin and improve blood sugar control.

For those who are unresponsive to somatostatin analogues, or for whom they are otherwise contraindicated, it is possible to treat using one of the dopamine agonists, Bromocriptine (Parlodel) or Cabergoline. These have the advantage of being tablets rather than injections, and cost considerably less. These drugs can also be used as an adjunct to somatostatin analogue therapy. They are most effective in those whose pituitary tumours cosecrete prolactin. Side effects of these dopamine agonists include gastrointestinal upset, nausea, vomiting, light-headedness when standing, and nasal congestion. These side effects can be reduced or eliminated if medication is started at a very low dose at bedtime, taken with food, and gradually increased to the full therapeutic dose. However, bromocriptine lowers GH and IGF-1 levels and reduces tumor size in fewer than half of patients with acromegaly. Some patients report improvement in their symptoms although their GH and IGF-1 levels still are elevated.

The latest development in the medical treatment of acromegaly is the use of growth hormone receptor antagonists. The only available member of this family is pegvisomant (Somavert). By blocking the action of the endogenous growth hormone molecules, this compound is able to control disease activity of acromegaly in virtually all patients. Pegvisomant has to be administered subcutaneously by daily injections. Combinations of long-acting somatostatin analogues and weekly injections of pegvisomant seem to be equally effective as daily injections of pegvisomant.

Radiation therapy has been used both as a primary treatment and combined with surgery or drugs. It is usually reserved for patients who have tumor remaining after surgery. These patients often also receive medication to lower GH levels. Radiation therapy is given in divided doses over four to six weeks. This treatment lowers GH levels by about 50 percent over 2 to 5 years. Patients monitored for more than 5 years show significant further improvement. Radiation therapy causes a gradual loss of production of other pituitary hormones with time. Loss of vision and brain injury, which have been reported, are very rare complications of radiation treatments.

No single treatment is effective for all patients. Treatment should be individualized depending on patient characteristics, such as age and tumor size. If the tumor has not yet invaded surrounding brain tissues, removal of the pituitary adenoma by an experienced neurosurgeon is usually the first choice. After surgery, a patient must be monitored for a long time for increasing GH levels. If surgery does not normalize hormone levels or a relapse occurs, a doctor will usually begin additional drug therapy. The current first choice is generally octreotide or lanreotide. However, bromocriptine or cabergoline are much cheaper and easier to administer. With both types of medication, long-term therapy is necessary because their withdrawal can lead to rising GH levels and tumor re-expansion. Radiation therapy is generally used for patients whose tumors are not completely removed by surgery; for patients who are not good candidates for surgery because of other health problems; and for patients who do not respond adequately to surgery and medication.

The following medications may be used to treat acromegaly:

*Octreotide (Sandostatin) or bromocriptine (Parlodel) may control growth hormone release in some people.
*Pegvisomant (Somavert) directly blocks the effects of growth hormone, and has been shown to improve symptoms of acromegaly.

These medications may be used before surgery, or when surgery is not possible.

After treatment, periodic evaluation is necessary to ensure that the pituitary gland is working normally. Yearly evaluations are recommended.

Possible Complications:-
*Arthritis
*Cardiovascular disease
*Carpal tunnel syndrome
*Colonic polyps
*Glucose intolerance or diabetes
*High blood pressure
*Hypopituitarism
*Sleep apnea
*Spinal cord compression
*Uterine fibroids
*Vision abnormalities
*Severe headache
*Enlarged heart
*Hypertension
*Diabetes mellitus
*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.

Prognosis :
Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon.

Without treatment the symptoms will get worse, and the risk of cardiovascular disease increases.

Prevention:
There are no methods to prevent the condition, but early treatment may prevent complications of the disease from getting worse.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000321.htm
http://www.bbc.co.uk/health/physical_health/conditions/acromegaly1.shtml
http://en.wikipedia.org/wiki/Acromegaly

http://www.sd-neurosurgeon.com/diseases/pit_tumors.html

http://www.elp.manchester.ac.uk/pub_projects/2002/MNBY9APB/THEPITUITARYCLINICAL.htm

http://commons.wikimedia.org/wiki/File:Endocrine_growth_regulation.svg

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Categories
Ailmemts & Remedies

Growth Disorders

Overview:
Growth is one of the complex and amasing facts of life that most people take for granted, but it can be a cause for concern for parents who have a child who’s shorter than others of the same age and doesn’t appear to be growing any taller.

Children of the same age vary greatly in height due to factors such as diet, genetics, and ethnic background. In most cases, tall or short stature is not abnormal and is due to a family tendency to be taller or shorter than average or to reach final height later than usual. Tall or short stature is a cause for concern only if the child’s height is well outside the average range for his or her age. Abnormally short or tall stature may be caused by a number of disorders.

What are the types?
Normal growth depends on a nutritionally adequate diet and good general health and is controlled by specific hormones. disruption of any of these three important factors may lead to a growth disorder that results in a child having abnormally short or tall stature.
short stature:
A child may be shorter than normal if his or her diet is inadequate. a chronic illness, such as cystic fibrosis or severe asthma, may also result in poor growth. crohn’s disease, a type of inflammatory bowel disease, is another example of a chronic illness that may lead to short stature. babies who have intrauterine growth retardation may reach a shorter than average height i later life.

Sometimes, short stature is caused by insufficient production of the hormones that are necessary for normal growth. in some children, the pituitary gland does not produce enough growth hormone. insufficient production of thyroid hormones is another cause of poor growth.

short stature is also a characteristic feature of tuner syndrome, a genetic disorder that only affects girls. in addition, short stature may occur as a result of a skeletal abnormality such as achondroplasia, an inherited disorder in which the bones of the legs and arms are shorter than normal.

Tall stature:
children may be temporarily taller than others of the same age and sex if puberty occurs early. however, in such children, the final height is usually normal. in very rare cases, exaggerated growth caused by the overproduction of growth hormone results in excessive height known as gigantism. the overproduction may be due to pituitary gland tumor. boys with the chromosome disorder klinefelter syndrome may also grow taller than normal at puberty.

Causes of delayed growth:
There are a large number of medical, genetic and external factors that can delay or inhibit normal growth. These include conditions such as Growth Hormone Deficiency (GHD) in children, Turner’s syndrome, Down’s syndrome, achondroplasia (defective growth of cartilage cells in the bones of the limbs) and various malfunctions of the endocrine system.

Chronic diseases and illnesses can also have a detrimental effect on growth including Inflammatory Bowel Disease IBD, chronic renal insufficiency and heart disease, as too can factors such as malnutrition, drug and alcohol abuse, neglect, chronic stress and lack of exercise. However, in many cases the cause of delayed or restricted growth is not known.

Many children are smaller than average during childhood yet end up reaching a normal adult height. But for some, a more normal adult height will not be achieved without treatment with supplemental human growth hormone (hGH). These include children with GHD and Turner’s syndrome.
A more common growth disorder is growth hormone deficiency (GHD). This is the condition of having too little GH. There are several possible explanations for its occurrence:

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A child can be born with GHD.
The condition also may arise because of damage to the hypothalamus or pituitary gland as a child or adult because of a tumor, an infection, or radiation to the brain — usually for the treatment of a tumor.
A deficiency in GH may also have an undefined cause. (In this case, it is said to be of idiopathic origin.)
Pituitary disorders, such as GH excess or GHD, are evaluated and treated by endocrinologists — medical specialists in hormone-related conditions. Because the diagnosis and treatment of such disorders require special expertise, primary care physicians who suspect patients have GH abnormalities should refer them to an endocrinologist.

One out of 2,500 to 5,000 children is born with a deficient growth hormone production resulting in impaired physical development, and another one in 2,000 to 2,500 girls are born with the genetic defect Turner’s syndrome. Both disorders may result in decreased final height, which may be improved by supplemental somatropin.

Growth Hormone Deficiency (GHD):-

In children
A child with an inadequate production of growth hormone (reduced or non-existent) may have a normal height and weight at birth, but the child’s physical development following birth is severely impaired.

The under-secretion of human growth hormone during childhood and puberty slows bone growth and teeth development, and also causes the growing plates of the long bones to close before normal height is reached. In addition, other organs of the body fail to grow and the body proportions remain childlike.

Without treatment the child with GHD risks the development of a range of complications, as well as having a short stature.

Turner’s syndrome
Turner’s syndrome is a common genetic defect that affects girls and women and occurs in about one out of every 2,000 to 2,500 female births.

In Turner’s syndrome all or part of one of the two X-chromosomes is missing, but the reason why this happens is not known. This defect can cause a number of physical and medical problems and in some cases creates educational and behavioural concerns.

Characteristics of Turner’s syndrome
As the extent of the defect to the chromosome varies, every case of Turner’s syndrome is individual and each affected girl may have only a few of the possible characteristics that can be associated with the syndrome.

Short stature is a common characteristic of Turner’s syndrome resulting in a decreased final adult height and is generally accompanied by a failure of the ovaries and infertility.

Growth failure in Turner’s syndrome
The reasons for the growth retardation in Turner’s syndrome are not entirely understood, but patients are generally not deficient in growth hormone. The pituitary gland produces adequate amounts but the long bones do not respond.

The growth plates appear to be resistant to the action of the body’s GH, yet the hormone functions normally in controlling metabolism and organ development. By treating with supplemental hGH the resistance can be overcome, creating growth in the long bones. Female hormones may need to be given as well.

Being a genetic problem the affected individual will be faced with the consequences of the syndrome all her life, but can expect to lead a healthy life with appropriate care and treatment.

Growth Hormone Excess:
Excess growth hormone (GH) in children (gigantism) is extremely rare, occurring in fewer than 100 children in the United States.

Excess GH in adults (acromegaly) most commonly occurs in middle-aged men and women. Approximately 60 out of every million Americans have acromegaly.

Very infrequently, GH excess may run in families, or be one manifestation of a number of rare syndromes.

Frequent Sign & Symptoms:

The signs and symptoms depends upon the type of growth disorder. A child with a growth problem needs to be evaluated by a health care provider to determine the underlying health issues involved.

How is it diagnosed?
Your child’s height will be measured during routine checkups. if his or her height is consistently either lower or higher than the normal range, he or she will need to be measured frequently. If growth rates continue to be normal, tests may be performed to check hormone levels and to look for underlying disorders, such as genetic abnormality. in some cases, maturity of a child’s bones may be assesses by taking x-rays of the hand and wrist.

What is the treatment?
Treatment for growth disorders is most successful if started well before puberty when bones still have the potential for normal growth. short stature caused by an inadequate diet usually improves if the diet is modified while the child is still growing. If the growth disorder is a chronic illness, careful control of the illness can sometimes result in normal growth. growth hormone deficiency is usually treated by replacement of growth hormone. hypothyroidism is treated by replacing thyroid hormone.

Abnormal early puberty may be treated using drugs to halt the advancement gland tumor may be treated by removal of the tumor.

Treated early, most children with a growth disorder reach a relatively normal height, but, if treatment is delayed until puberty, normal height is more difficult to achieve. Abnormal stature may cause a child to be self-conscious and unhappy, and he or she may need support such as counseling.

Growth Hormone Excess: Treatment Options
Because excess GH — acting alone or together with excess IGF-1 — produces adverse health effects, reducing the levels to normal is desirable. Surgery, medication and/or irradiation of the pituitary gland may be appropriate to achieve these goals.

Growth Disorders Lifestyle and Prevention:
For children:
Because growth hormone is taken for years, it is good for parents of children with GHD to be aware of some safety precautions:

Carefully follow the directions for taking GH
Tell all doctors who care for your child that he or she is taking growth hormone
Make sure your child takes any other prescription drugs exactly as prescribed
Contact your child’s doctor immediately if you have any questions about treatment or signs or symptoms which suggest a complication of GH treatment.
In addition, encourage your child to have a healthy lifestyle. Eating a variety of healthy foods will help your child to grow and respond to growth hormone treatment. Be sure that your child gets regular exercise and plenty of sleep, too.

For adults:

Adults receiving GH treatment should also eat a balanced diet, get regular exercise, and plenty of sleep.

Some adults find their lives are much better after taking GH alone. Others may find they still need some help, particularly with the psychological symptoms of GHD. You may need medication to control anxiety or lift your mood.

Counseling may be helpful too. Some forms of therapy, such as cognitive-behavior therapy, can allow you to correct negative thoughts you may be having. You also may want to join a support group with other adults who have GHD. Talking to others who have been through the same thing can be healing.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.charak.com/DiseasePage.asp?thx=1&id=344
http://www.ferring.com/en/therapeutic/endo/About+Growth+Disorders/
http://www.hormone.org/Growth/overview.cfm

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Ailmemts & Remedies

Amenorrhea

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There are two types of amenorrhea, primary and secondary. Primary amenorrhea is the term used to describe menstruation that as not started at all by age 16. once menstruation has started at puberty, it is normal for it to stop during pregnancy, for a few months following childbirth, while breast-feeding, after ceasing to take oral contraceptive pills, and permanently at menopause. If menstrual periods stop at any other time for at least 3 continuous months, the condition is known as secondary amenorrhea.

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What are the causes?
Amenorrhea is often caused by disturbance in the female sex hormones, which may be brought on by factors such as stress or depression. Excessive exercise and extreme or sudden weight loss may also lead to such hormonal disturbances and are common causes of amenorrhea in athletes, gymnasts, and ballot dancers. Hormonal changes may lead to primary or secondary amenorrhea, depending on when they occur.

Primary amenorrhea is a characteristic feature of delayed puberty, and may be caused by a chromosomal abnormality. The failure of menstrual periods to start at puberty may also be due to a condition in which the hymen (the thin membrane over the vagina) has no opening, and menstrual blood cannot leave the body. in rare cases, the uterus is absent from birth, and therefore no menstruation can occur.

Secondary amenorrhea may be due to a pituitary gland disorder, such as pituitary tumor, or it may be due to a premature menopause, in which menstrual periods cease before age 35. Other possible causes are disorders of the ovaries, such as polycystic ovary syndrome, and treatments such as chemotherapy and radiation therapy, that can result in damage to the ovaries.

What might be done?
Treatment is not needed if amenorrhea occurs for a few months after stopping oral contraceptives or during pregnancy or breast-feeding. Enstruation usually resumes within a few months of giving birth if you are not breast-feeding or within a month of stopping breast-feeding. If you are near menopause, amenorrhea will be permanent.

Amenorrhea that occurs at any other time should be investigated. Your doctor will examine you and may do a pregnancy test. You may also need to have blood tests to measure hormone levels, ultrasound scanning of the ovaries and uterus, and ct scanning of the pituitary gland.

treatment of the underlying disorder induces menstruation in most cases. if the cause cannot be treated, hormonal treatment may be used to start menstruation. amenorrhea due to weight loss, stress, or excessive exercise should clear up once the problem is overcome.

Recommended Ayurvedic Therapy: Virechan , Basti

Click to learn more about Amenorrhea……(1).……(2).……(3)…….(4)

Homeopathic treatment of Amenorrhea ………………………………..(1).(2)…..(3)

Herbal Home Remedy of Amenorrhea ………………………….(1).……..(2)

Parsley is the most beneficial herb for the treatment of Amenorrhea

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources: http://www.charak.com/DiseasePage.asp?thx=1&id=278