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Growth Hormone Producing Adenomas: Acromegaly

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Advanced Practice in Endocrinology Nursing

Abstract

Acromegaly is a rare disorder characterized by overproduction of growth hormone (GH) predominantly by a pituitary adenoma. Clinical features associated with acromegaly are a result of chronic excess GH and insulin-like growth factor-I (IGF-1) effects on tissue, bone, and other organs.

The disease is associated with increased mortality, chiefly from cardiovascular disease, but morbidity from associated comorbidities is also increased. Adequate control of growth hormone excess is paramount to controlling comorbidities.

The diagnosis is made by the biochemical confirmation of elevated GH and IGF-1 levels, the presence of clinical features, and evidence of a pituitary tumor based on MRI imaging. Transsphenoidal surgery, medical therapies, and radiation therapy are all options for disease control. Patients with acromegaly require long-term health surveillance, despite the fact that they may have normal GH and IGF-1 levels. Patients are monitored lifelong for disease recurrence, management of comorbidities and treatments to improve quality of life.

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Abbreviations

BMI:

Body Mass Index

CHD:

Congestive heart disease

CSF:

Cerebrospinal fluid

CVD:

Cardiovascular disease

DI:

Diabetes insipidus

GH:

Growth hormone

GHRH:

Growth hormone releasing hormone

IGF-1:

Insulin-like growth factor-1

OGTT:

Oral glucose tolerance test

OSA:

Obstructive sleep apnea

SIADH:

Syndrome of inappropriate antidiuretic hormone

SRIF:

Somatostatin

SSA:

Somatostatin analogue

SSRA:

Somatostatin receptor analogue

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Key Reading

  1. Chanson P, Salenave S. Acromegaly. Orphanet J Rare Dis. 2008;3(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Melmed S, Casanueva F, Cavagnini F, Chanson P, et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol. 2005;153(6):737–40.

    Article  CAS  PubMed  Google Scholar 

  3. Melmed S, Kleinberg DL, Bonert V, Fleseriu M. Acromegaly: assessing the disorder and navigating therapeutic options for treatment. Endocr Pract. 2014;20(Suppl 1):7–17; quiz 8–20

    Article  PubMed  Google Scholar 

  4. Plunkett C, Barkan A. The care continuum in acromegaly: how patients, nurses, and physicians can collaborate for successful treatment experiences. Patient Prefer Adherence. 2015;9:1093.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgement

The author acknowledges Shlomo Melmed MB, ChB, FRCP, MACP who is the Professor Cedars-Sinai Medical Center, Dean of the Medical Faculty and Executive Vice President, Chief Academic Officer, Director, Cedars-Sinai Research Institute, Los Angeles, CA, USA.Special thanks also to Muriël Marks–de Korver, WAPO Executive Director, the World Alliance of Pituitary Organizations (WAPO) (http://www.wapo.org) for her contribution to this chapter with case studies, patient resources, and information on the Patient Advocacy Group

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Authors and Affiliations

  1. Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA

    Karen J. P. Liebert

  2. Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Daphne T. Adelman

  3. Department of Endocrinology, Ghent University Hospital, Ghent, Belgium

    Elisabeth Rutten

  4. Northwest Pituitary Center, Oregon Health and Sciences University, Portland, OR, USA

    Christine Yedinak

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  1. Karen J. P. Liebert
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  2. Daphne T. Adelman
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  3. Elisabeth Rutten
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  4. Christine Yedinak
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Corresponding author

Correspondence to Karen J. P. Liebert .

Editor information

Editors and Affiliations

  1. School of Health Sciences, City, University of London, London, UK

    Sofia Llahana

  2. Department of Oncology, Skåne University Hospital, Lund, Sweden

    Cecilia Follin

  3. Northwest Pituitary Center Oregon Health and Sciences University, Portland, OR, USA

    Christine Yedinak

  4. Churchill Hospital, University of Oxford, Oxford, UK

    Ashley Grossman

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Liebert, K.J.P., Adelman, D.T., Rutten, E., Yedinak, C. (2019). Growth Hormone Producing Adenomas: Acromegaly. In: Llahana, S., Follin, C., Yedinak, C., Grossman, A. (eds) Advanced Practice in Endocrinology Nursing. Springer, Cham. https://doi.org/10.1007/978-3-319-99817-6_20

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