32-year-old Ms. Li should be a beautiful age, but was told by several friends that her face has changed a lot, obviously not as beautiful as before, Ms. Li herself also feels that in recent years, not only have her hands and feet become bigger, her voice has become thicker, but even her lips have become thicker, and her nose is much bigger than before.
Ms. Li accompanied by her family to the neurosurgery department of the hospital for a systematic examination, and finally diagnosed that Ms. Li had a tumor in her skull, namely growth hormone (GH) pituitary adenoma.
Popular science knowledge. 1.What are the clinical manifestations of growth hormone (GH) pituitary adenoma?
Patients with GH pituitary adenoma mainly present with changes in appearance and limbs, such as ugly face, large nose and thick lips, rough thickening, excessive sweating and excessive secretion of sebaceous glands, and enlargement of hands and feet
In the late stage, there are more elongated heads, protruding eyebrow arches, oblique forehead lengthening, protruding jaws, tooth sparseness and crossbite, occipital tuberosity enlargement and posterior protrusion, forehead and scalp and multiple folds, barrel chest and hunchback.
2.Diagnosis of GH pituitary adenoma.
1.Clinical manifestations of acromegaly, facial changes;
2.Laboratory tests: Serum GH level measurement: The level of serum GH fluctuates greatly over 1 day and can be 001～2.Fluctuating between 82 nmol L, serum GH levels in normal people can be suppressed by hyperglycemia.
However, the serum GH level of patients with active GH pituitary adenoma continues to increase and is not suppressed by hyperglycemia. Therefore, whether the patient's condition is under control or ** depends not only on fasting or random serum GH levels, but mainly on whether serum GH levels are suppressed to normal after glucose loading.
Determination of serum IGF-1 level: The role of serum GH is mainly mediated by IGF-1, and the correlation between serum IGF-1 level and disease activity is more closely related to the patient's disease activity than that of serum GH, so the serum IGF-1 level can more sensitively reflect the patient's condition than the GH level.
3.Imaging: MRI and CT scans can see the size of the pituitary adenoma and its relationship to adjacent tissues. For the observation of microadenoma, high-resolution thin stratification, enhanced scanning, and dynamic enhanced MRI scanning can improve the detection rate. These techniques can be used to determine whether the adenoma is growing aggressively and whether it compresses and affects the optic chiasm.
3.GH pituitary adenoma**.
Surgery: Surgical resection of the tumor is the preferred method for most GH pituitary adenomas
It mainly includes craniotomy transfrontal pituitary tumor resection and microscopic or endoscopic transnasal pituitary tumor resection
Successful surgery can immediately reduce serum GH levels and relieve tumor compression.
Drugs**: Drugs include somatostatin analogues (SSAs), dopamine agonists, and GH receptor antagonists. SSA is the first choice among the current drugs**, which can reduce tumor volume, control serum GH and IGF-1 levels, and improve clinical symptoms in some patients.
Radiation**: Radiation** is most commonly used as an adjunct to postoperative remission and residual tumors**, and can be treated with radiation therapy for patients with high serum GH after surgery and patients who cannot be operated**.
Stereotactic radiosurgery** (e.g. Gamma Knife) is currently the most recognized form of radiology**. 12 months after Gamma Knife**, the patient's serum GH level returned to normal to 40%. Healthy Wintering Program