Diagnosis and Treatment
What can be done about these conditions?
Pituitary Dwarfism Diagnosis: (7)
Before being treated, some tests must be done after physical examination of the patients weight, height, and body proportions showing deviation from normal growth curves are completed. These tests include:
Other hormones Below you can see a list of the treatments for deficiencies of certain hormone deficiencies that are risk factors for pituitary dwarfism. You can see that vasopressin does not have a specific treatment, but the others do. Treatment of Pituitary Dwarfism:
Surgical procedures can correct issues such as the following (7):
Limb Lengthening Limb lengthening is a video about Tiffany who completed the limb lengthening procedure by undergoing many limb lengthening procedures. As one could guess it is a very controversial procedure that has both physical and emotional risks. Typically, the maximum height added for the procedure is 4 inches. This is the reccomended amount given by the video below. Tiffany, however, was actually able to gain 14 inches of height! Hormone Therapy
Treatment for growth hormone deficiency is done by injecting a synthetic version of the hormone in the patient to increase their final height. The frequency of this treatment is typically performed daily until the patient reaches a maximum adult height, which is assessed by the average height of their adult family members. This treatment could span from diagnosis of pituitary dwarfism all the way until adulthood. If other hormone deficiencies are expected lifelong treatment could be necessary: Gonadotropin deficiency. For patients deficient in gonadotropins not enough sexual hormones are produced as seen from the flow chart in the diagnosis section. Sexually-related hormones are important in the development of sexual organs or maturation of the patient, but they also aid in other functions like helping men maintain muscle mass. The treatment is replacement therapy for these, so patients will mature properly. (1) Thyrotropin deficiency. A deficiency of the hormone thyrotropins causes hypothyroidism, which is a thyroid disorder where the thyroid gland is underactive. This deficiency causes thyroxine (T4) and triiodothyronine (T3) to be underproduced, since it causes little thyroid-stimulating hormone (TSH) to be produced. TSH acts to release T3, which causes the release of T4. When the levels of TSH are low not much can be released to produce more T3 and T4. Hypothyroidism acts to slow down metabolic processes in the body and growth, therefore, when it is untreated especially during infancy it can cause mental retardation and dwarfism (4). The treatment for this includes replacement therapy with thyroid hormone thyroxine, in the flow chart above levothyroxine is listed, which is the generic drug name one may see at the pharmacy (5). Adrenocorticotropic Hormone (ACTH) deficiency. ACTH deficiency causes little release of cortisol, which is necessary to maintain a healthy blood pressure. Cortisol is also important for:
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Pituitary Gigantism Diagnosis (9):
What do the doctors look for when it comes to pituitary gigantism? They are looking for an elevated blood IGF-1 level. The way to test this is to have the patient take an oral glucose tolerance test (OGTT) in which he or she has to drink 75 grams of glucose solution. In normal people this would cause GH levels to get to be as low as one nanogram per milliliter; however, in those with gigantism no suppression will occur and GH levels may even increase. If the doctors suspect a pituitary tumors an MRI is the best way to obtain a good image of the potential tumor. Above you can see a simple image of the physiology of the GH and how it in turn effects the IGF-1 levels. One can see from here why the test above is done for diagnostic reasons.
Treatment of Pituitary Gigantism (9):
The treatment options for gigantism include:
Why transsphenodal surgery? This surgery is used to surgically remove the selected tumor causing the issue. The success of the surgery is dependent on different factors:
Medical Therapy for Gigantism (9): Medications used:
Radiation Therapy: This treatment is used when the other two treatment types are not sufficient to control the acromegaly--stereotactic radiosurgery is then recommended. Stereotactic radiosurgery:
Learn More!Click on the link below and learn about the effects of gigantism on the body after treatment. At 3:50 in the video they begin speaking about things of this nature.
Through watching this video, we hope you learned about the many negative effects of the condition.
Check out additional research that presents the possibility of the opthalmologic system being effected by acromegaly. The excess GH/IGF-1 has been said in this study to cause corneal changes! (13) http://www.ncbi.nlm.nih.gov/pubmed/24489375
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Prognosis/Outcomes
How can you expect these conditions to progress?
As a general rule for both pituitary dwarfism and gigantism, the sooner the treatment, the more positive the outcomes.
For those with Dwarfism:
Physical: With treatment, children with pituitary dwarfism can gain 4+ inches in the first year and 3+ inches during the next 2 years until the growth gradually decreases. This treatment may not work for all children (8). Emotional: The emotional outcomes of dwarfism can be devastating. It is important to encourage a patient who is suffering from dwarfism to speak with his or her parents about his or her feelings. It is also very important that parents speak with their child about how to respond to children at school who may be teasing them. Bullying must be addressed right away by the parent. Once the child begins school, it is important to make them aware of their resources and ways to seek help such as through a principal or a school guidance counselor (8). Social: The social complications of this disease can be coupled with the emotional effects. The child may not be able to interact well with peers because of the emotional hurt that follows being teased. It is important to make sure they get involved in social activities at a young age so that they can learn the skills and Ways to get more social support is to join the nonprofit organization Little People of America. This organization provides social support, information about the disorders, advocacy opportunities and resources such as companies that sell adaptive personal products and clothing (8). |
For those with Gigantism:
Physical (10): With early treatment, the extreme height caused by growth hormone excess could be lessened. Pituitary surgery is often successful in limiting the excessive GH secretion. Surgery may result in low levels of other pituitary hormones (see effects under "Hormone Therapy" in the treatment section for dwarfism). This can cause an array of issues including:
Emotional: The emotional toll is much the same as for dwarfism. It is important to take the same action for those with pituitary gigantism. Social: While seeking treatment for gigantism, the patient may not be with his or her peers as much, so it is important to get involved in support groups where the patient can develop social skills with children who face the same issues. The child will already be physically different from their peers, so trying to reduce their feelings of social alienation as much as possible is absolutely crucial. |
References (view references and quiz questions tab for the AMA-formatted citations):
(1) http://diseasereference.net/info/hypogonadotropic-hypogonadism/208000.html
(2) http://www.ohsu.edu/xd/health/services/brain/getting-treatment/diagnosis/pituitary-disorders/about/hormone-deficiencies/adrenal-insufficiency.cfm
(3) http://www.organsofthebody.com/pituitary-gland/pituitary-gland-hormones.php
(4) http://www.health.harvard.edu/fhg/updates/Thyroid-deficiency-and-mental-health.shtml
(5) http://www.pituitarysociety.org/public/specific/hypopituitarism/treatment_html.aspx
(6) http://www.mayoclinic.org/diseases-conditions/male-hypogonadism/basics/definition/con-20014235
(7) http://www.mayoclinic.org/diseases-conditions/dwarfism/basics/treatment/con-20032297
(8) http://www.mayoclinic.org/diseases-conditions/dwarfism/basics/coping-support/con-20032297
(9) http://pituitary.ucla.edu/body.cfm?id=83
(10) http://www.nlm.nih.gov/medlineplus/ency/article/001174.htm
(11) http://www.youtube.com/watch?v=s4NsbxIGVHc
(12) http://www.youtube.com/watch?v=Ebhf1qKVA9A
(13) Ozkok A, Hatipoglu E, Tamcelik N, et al. Corneal biomechanical properties of patients with acromegaly. British Journal of Ophthalmology. 2014;98(5):651-657. doi: 10.1136/bjophthalmol-2013-304277.
(1) http://diseasereference.net/info/hypogonadotropic-hypogonadism/208000.html
(2) http://www.ohsu.edu/xd/health/services/brain/getting-treatment/diagnosis/pituitary-disorders/about/hormone-deficiencies/adrenal-insufficiency.cfm
(3) http://www.organsofthebody.com/pituitary-gland/pituitary-gland-hormones.php
(4) http://www.health.harvard.edu/fhg/updates/Thyroid-deficiency-and-mental-health.shtml
(5) http://www.pituitarysociety.org/public/specific/hypopituitarism/treatment_html.aspx
(6) http://www.mayoclinic.org/diseases-conditions/male-hypogonadism/basics/definition/con-20014235
(7) http://www.mayoclinic.org/diseases-conditions/dwarfism/basics/treatment/con-20032297
(8) http://www.mayoclinic.org/diseases-conditions/dwarfism/basics/coping-support/con-20032297
(9) http://pituitary.ucla.edu/body.cfm?id=83
(10) http://www.nlm.nih.gov/medlineplus/ency/article/001174.htm
(11) http://www.youtube.com/watch?v=s4NsbxIGVHc
(12) http://www.youtube.com/watch?v=Ebhf1qKVA9A
(13) Ozkok A, Hatipoglu E, Tamcelik N, et al. Corneal biomechanical properties of patients with acromegaly. British Journal of Ophthalmology. 2014;98(5):651-657. doi: 10.1136/bjophthalmol-2013-304277.