말단비대증 (acromegaly)

ETIOLOGY OF HYPERSOMATOTROPISM

-Excess growth hormone secretion is associated with pituitary and extrapituitary tumors
-Pure somatotropinomas contain either densely(slow growing) or sparsely (rapid growing) staining cytoplasmic growth hormone granule ( 60% )
-Bimorphous adenoma, two mature somatotroph and lactotroph cell type ? GH & prolactin secretion
-Monomorphous mammosomatotroph cell adenomas arise from a mature cell that secretes growth hormone and prolactin
-...
-Growth hormone-secreting carcinomas with definite proof of distant metastasis are extremely rare

CLINICAL FEATURES OF ACROMEGALY
-attributed to high serum levels of growth hormone,IGF-1, both
-Central features of an expanding pituitary mass are common, especially with macroadenoma. Headache is often severe, and chiasmal compression leads to visual impairment
-lateral extension can cuase diplopia or facial pain owing to compression of cranial nerve
-Skeletal overgrowth owing to periosteal new bone formation in response to IGF-1 : mandibular overgrowth with prognathism, widening of the maxilla, tooth separation, jaw malocclusion, overbite, frontal bossing, nasal bone hypertrophy, enlargement of paranasal sinuses


Surgery
―For well defined somatotroph cell adenomas, the preferred approach is selective transsphenoidal surgical resection

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