Acromegaly and gigantism can also be referred to as hyperpituitarism and the most common cause is prolonged hypersecretion of growth hormone (GH), usually by a hormone-secreting pituitary tumour. The conditions are only occasionally due to excess growth hormone releasing hormone (GHRH) secreted by the hypothalamus. As the tumour increases in size, compression of nearby structures may lead to: hyposecretion of other pituitary hormones of both the anterior and posterior lobes damage to the optic nerves, causing visual disturbances.
The effects of excess GH include:
> excessive growth of bones
> enlargement of internal organs
> formation of excess connective tissue
> enlargement of the heart and raised blood pressure
> reduced glucose tolerance and a predisposition to diabetes mellitus.
Growth hormone stimulates skeletal and soft tissue growth. Growth hormone (GH) excess therefore produces gigantism in children and acromegaly in adults.
Gigantism occur before fusion of the diaphysis and an individual increases in height
reaching 7-8 feet.
Acromegaly occur after fusion of the diaphysis with the epiphysis and there is enlargement of the acral parts
Both are caused due to a pituitary tumor in almost all cases
Clinical presentation growth hormone hypersecretion.
- Changes in appearance (physical)
- Visual field defects or headaches
- Dermatological problem ie coarsening of the face, broad thick nose, prominent eye brows and spade like hands
- Elongation and widening of the mandible
- Sleep apneas
- Soft tissue swelling i.e lips, tongue, heal pad…
- NB: other signs of Acromegaly
- Weight gain
- Pain / tingling in hands
- Deep voice
- Muscular weakness
- Joint pains
- Hypopituitarism also can occur
> It is confirmed by finding high basal levels of growth hormone
> CT-scan to rule out pituitary adenoma
These could be used together with injection octreotide that slow down the production of growth hormones
Radiation therapy : This suppress the growing tumour
Surgical intervention : This involves surgical removal of the tumour
Nursing Management of Acromegaly
PREOPERATIVE. At the time of diagnosis, the patient requires education and emotional support. Focus education on the cause of the disease, the prescribed medical regimen, and preparation for surgery. Encourage the patient to interact with family and significant others. Reassure the patient that treatment reverses some of the physical deformities. If you note disabling behavior, refer the patient to psychiatric resources.
Prepare the patient and family for surgery. Explain the preoperative diagnostic tests and examinations. For a patient who is undergoing a transsphenoidal hypophysectomy or a transfrontal craniotomy, explain the postoperative need for nasal packing and a mustache dressing.
POSTOPERATIVE. Elevate the patient’s head to facilitate breathing and fluid drainage. Do not encourage the patient to cough, as this interferes with the healing of the operative site. Provide frequent mouth care, and keep the skin dry. To promote maximum joint mobility, perform or assist with range-of-motion exercises. Encourage the patient to ambulate within 1 to 2 days of the surgery. To assure healing of the incision site, explain the need to avoid activities that increase intracranial pressure, such as toothbrushing, coughing, sneezing, nose blowing, and bending.
Discharge and Home Healthcare Guidelines Referrals
Refer patients with advanced acromegaly who experience arthritic changes and require assist devices for ambulation and activities of daily living to a physical therapist.
ACTIVITY RESTRICTIONS. Instruct the patient to avoid activities that increase intracranial pressure for up to 2 months after surgery. Toothbrushing can be resumed in 2 weeks. Instruct the patient to report increased nasal drainage. Incisional numbness and altered olfaction may occur for 4 months after surgery.
MEDICATIONS. If octreotide is prescribed, the patient will need to be able to demonstrate how to administer a subcutaneous or intramuscular injection.
FOLLOW-UP. Patients need to be monitored for development of cardiac disease, diabetes mellitus, and gallstones and a recurrence of symptoms. Advise the patient to wear a medical identification bracelet.
- Sterility in females and importance in males
- Poor learning ability
- Lack of sexual development
- Poor concentration
- Heart disease
- Diabetes mellitus
- Enlargement of internal organs like heart, liver
- Polyp formation