Hyperpituitarism is the excessive production of growth hormone, which continues to be produced well.
Hyperpituitarism also called acromegaly and gigantism. Hypersecretion of pituitary hormones secondary to macroadenomas can interfere with other pituitary hormone functions, resulting in target organ hormone deficiencies. Acromegaly occurs after epiphyseal closure, causing bone thickening and transverse growth and visceromegaly. This form of hyperpituitarism occurs equally among men and women, usually between the ages of 30 and 50. In most patients, the source of excessive growth hormone (GH) or human growth hormone secretion is a GH-producing adenoma of the anterior pituitary gland, usually macroadenoma (eosinophilic or mixed-cell). Since pituitary tumors (usually benign) are the most common cause of this condition, other areas controlled by the pituitary are often affected, such as Prolactin and thyroid hormones.
Hyperpituitarism causes are hyperplasias and carcinomas of the adenohypophysis, secretion by non-pituitary tumours and certain hypothalamic disorders and carcinoid tumors.
Prolonged effects of excessive GH secretion include:
- carpal tunnel syndrome
- heart enlargement
- heart failure
Acromegaly develops slowly. In many people, the changes are so slow that they are not noticed for years.
- an enlarged jaw
- thickened tongue
- enlarged and weakened hands
- coarsened facial features
- oily or leathery skin
- prominent supraorbital ridge
Gigantism develops abruptly, producing some of the same skeletal abnormalities seen in acromegaly.
Gigantism affects infants and children, causing them to grow to as much as three times the normal height for their age. As they may eventually reach a height of more than 8′ (2.4 m).
Hypogonadism, leading to pubertal arrest, pubertal failure, or pubertal delay.
- a highly arched palate
- muscular hypotonia
- slanting eyes
Nonfunctioning pituitary adenomas are rare in children, accounting for only 3-6% of all adenomas in 2 large series, while they comprise 30% of adenomas.
Treatment can consist of:
- pituitary microsurgery to remove tumor
- pituitary radiation if surgery fails
- gamma knife radiation treatment (a special type of focused radiation)
- bromocriptine (helps decrease growth hormone in some patients)
- octreotide (partially shrinks pituitary tumors)
Adjunctive treatment may include bromocriptine, which inhibits GH synthesis, and octreotide acetate, a long-acting analogue of somatostatin that suppresses GH secretion in at least two-thirds of patients with acromegaly. Medical therapy for Cushing disease is adjunctive only. The goal is to inhibit the enzymes responsible for cortisol synthesis with adrenal enzyme inhibitors, such as metyrapone.
Treatment for Hyperpituitarism
- Treatment can consist of pituitary microsurgery to remove tumor.
- Adjunctive treatment may include bromocriptine, which inhibits GH synthesis, and octreotide acetate, a long-acting analogue of somatostatin that suppresses GH secretion in at least two-thirds of patients with acromegaly.
- GRA is treated with small doses of glucocorticosteroids (i.e., hydrocortisone, prednisone).
- Dietary sodium restriction and administration of medication may control the symptoms without surgery.
- ACE inhibitors and angiotensin receptor blockers (ARBs) are also potential treatment options.
- A low-salt diet, though helpful in achieving blood pressure control in this condition.
- Blood pressure elevation needs to be controlled and monitored by frequent blood pressure measurements.