phenylephrine-hydrochloride and Acromegaly

The authors present the clinical of a male patient aged 45 years whose main complaints were loud snoring and excessive daytime sleepiness. Polysomnographic study revealed a sleep obstructive apnea syndrome with an apnea/hypopnea index of 86.5. After being treated with nasal continuous positive air pressure, (12 cm H2O), the apneas ended and sleep architecture was corrected. Physical examination also indicated the presence of an acromegaly, and therefore, the patient was subjected to endocrinological and cerebral imagiological studies; the diagnosis confirmed it as a predisposing factor to the sleep breathing disorder. A brief literature review about the incidence of sleep apnea syndrome in acromegaly is also made; the authors conclude that there is still the need for a systematic screening of sleep breathing disorders in acromegalic patients in order to optimise the treatment and prognosis of this disorders.

Topics: Acromegaly; Chronic Disease; Humans; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes

Topics: Acromegaly; Adenoma; Animals; History, 19th Century; History, 20th Century; Humans; Hypophysectomy; Nose; Pituitary Neoplasms; Surgical Flaps

Facial abnormality is the most significant feature in acromegaly patients. However, it is unclear whether and how patient facial appearance improves after treatment. This study aimed to identify 3D facial changes in acromegaly patients after surgical treatment.. This study included 30 acromegaly patients who underwent resection of a pituitary GH adenoma. The location and extent of facial changes were identified by comparing baseline and 2-year follow-up 3D images of the face. Relationships between facial changes and GH and IGF-1 were evaluated with simple or multivariable linear regression models.. Significant soft tissue improvements were observed in acromegaly patients with complete remission, especially in the nose and lip region. Significant reductions in nasal width (3.46 mm, P < 0.001), tip protrusion (1.18 mm, P = 0.003), face curve length (3.89 mm, P = 0.004) and vermilion area (1.42 cm3, P = 0.001) were observed at the 2-year follow-up. Further, changes in nasal width were associated with decreases in GH (β = 4.440, P = 0.017), the GH nadir (β = 4.393, P = 0.011) and IGF-1 (β = 5.263, P = 0.002). The associations were maintained after adjusting for confounders.. Acromegaly patients achieved considerable facial improvements after surgical treatment. The change in nose width was associated with GH and IGF-1 decrease. Better control of patient hormone levels after surgery improves patient facial recovery.

Topics: Acromegaly; Adenoma; Adolescent; Adult; Aged; China; Cohort Studies; Face; Female; Follow-Up Studies; Human Growth Hormone; Humans; Insulin-Like Growth Factor I; Male; Middle Aged; Nose; Pituitary Neoplasms; Prognosis; Remission Induction; Treatment Outcome; Young Adult

Topics: Acromegaly; Cross-Sectional Studies; Discriminant Analysis; Early Diagnosis; Face; Female; Humans; Imaging, Three-Dimensional; Machine Learning; Male; Mandible; Nose

To investigate the role of endoscopic endonasal transsphenoidal surgery and the pseudocapsule in the treatment of growth hormone adenomas.. The study included 43 patients (age range, 21-64 years) with growth hormone adenomas treated with an endoscopic endonasal approach. We compared the tumor characteristics and surgical outcomes of cases with (group A, 21 cases, from November 2013 to January 2015) and without (group B, 22 cases, from October 2011 to October 2013) extra-pseudocapsule resection.. The preoperative demographics, tumor characteristics, and surgical complications were not significantly different between groups A and B. Postoperative remission without adjuvant therapy was achieved in 18 of 21 cases (85.7%) in group A, which was significantly greater than that observed in group B (12 of 22 cases [54.4%]). In group A, the pseudocapsules were verified by endoscopy and histopathology. The pseudocapsule was removed en bloc with the whole adenoma in only 5 cases (23.8%). For the remaining 16 patients (76.2%), following extra-pseudocapsule dissection, incomplete pseudocapsule removals with intracapsule procedures were achieved.. The combination of extra-pseudocapsule resection and endoscopy led to a high rate of gross total tumor resection and endocrinologicl remission in acromegalic patients compared with the group with intracapsular resection. Extra-pseudocapsule resection resulted in no additional postoperative complications.

Topics: Acromegaly; Adenoma; Adult; Female; Follow-Up Studies; Human Growth Hormone; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroendoscopy; Nose; Pituitary Neoplasms; Postoperative Complications; Sphenoid Bone; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

To assess the sagittal soft tissue morphology of patients with acromegaly in comparison with a healthy control group.. Twenty-seven patients with acromegaly (11 male, 16 female; mean age 47.3 ± 11.5 years) and 30 healthy subjects (15 male, 15 female; mean age 42.2 ± 17.4 years) were included in the study. Linear and angular measurements were made on lateral cephalograms to evaluate soft tissue and skeletal characteristics. The intergroup comparisons were analysed with the Student's t-test.. Facial convexity (p < 0.01) and the nasolabial angle (p < 0.001) were reduced in patients with acromegaly, whereas nose prominence (p < 0.01), upper lip sulcus depth (p < 0.01), upper lip thickness (p < 0.01), basic upper lip thickness (p < 0.01), lower lip protrusion (p < 0.05), mentolabial sulcus depth (p < 0.05) and soft tissue chin thickness (p < 0.001) were increased. Anterior cranial base length (p < 0.05), the supraorbital ridge (p < 0.01), the length of the maxilla and mandible (p < 0.001, p < 0.01, respectively) were significantly increased, and mandibular prognathism was an acromegalic feature (p < 0.05).. Acromegalic coarsening and thickening of the craniofacial soft tissues was identified from lateral cephalograms, which may therefore contribute to early diagnosis when evaluated together with other changes caused by the disease.

Topics: Acromegaly; Adult; Cephalometry; Chin; Face; Facial Bones; Female; Humans; Lip; Male; Mandible; Maxilla; Middle Aged; Nasal Bone; Nose; Orbit; Prognathism; Skull Base; Vertical Dimension

A fifty years old woman hailing from Purbadhala of Netrokona district complaining of gradual enlargement of hands, feet, nose and other acral parts of the body for about last eight years. She noticed coarsening of the skin and gradual protrusion of her lower jaw. She complained of headache, vertigo, frequent passage of urine, increased thirst, weight loss and fatiguability. She was found hypertensive having blood pressure 200/110 mm of Hg. Her appearance was coarse with rough skin. There were enlargement of hands, feet, nose, lower jaw with prognathism and enlargement of other acral parts. Investigations revealed high plasma glucose level, both fasting and 2 hrs. after glucose, high level of growth hormone, failure of suppression of growth hormone during OGTT. Thyroid function tests of the patient were found normal with increased heel pad size and enlarged sella turcica in all diameters. She was diagnosed as a case of acromegaly due to growth hormone hypersecretion.

Topics: Acromegaly; Blood Glucose; Female; Foot; Hand; Humans; Hypertension; Middle Aged; Nose; Prognathism; Radiography; Skin; Skull

Topics: Acromegaly; Adult; Female; Humans; Nose

Topics: Acromegaly; Adenoma, Chromophobe; Adolescent; Adult; Aged; Child; Cushing Syndrome; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Pituitary Neoplasms; Postoperative Complications; Tomography, X-Ray Computed; Vision, Ocular

Since 1960 we have performed stereotactic transsphenoidal cryohypophysectomy in 70 patients with pituitary adenomas, 42 women and 28 men, aged 11-59 years. The dominant clinical syndrome was acromegaly in 50 patients, galactorrhea in 9, amenorrhea in 5, adiposogenital dystrophy in 4 and gigantism with mild endocrine symptomatology in 2 patients. In 67 patients the histological structure of the tumor was established by biopsy (50 patients with eosinophil adenoma, 10 with mixed-type adenoma, 4 with chromophobe adenoma and 3 with basophil adenoma). Somatotropic hormone, human growth hormone, prolactin, ACTH and 17-ketosteroid levels indicated active/inactive adenomas. In 42 cases the adenoma was only intrasellar, which was confirmed by contrast X-ray investigations, CT scanning, angiography and ophthalmological investigation. Transnasal stereotactic cryohypophysectomy was performed in all 70 cases using a stereotactic apparatus especially designed for operations on the pituitary. All patients (except 2) tolerated the operation well. No complications occurred. Vision deteriorated after operation in 1 patient. Thrombosis of the left middle cerebral artery developed in another patient. All the other patients noted improvement directly after operation - rapid diminution of signs of acromegaly and rapid restoration of normal values in hormonal tests. Six patients with continuing growth of the tumor underwent a second operation 1.5-6 years after the first operation. We conclude from our own clinical experience and information from the literature that transnasal stereotactic cryodestruction is highly effective and relatively safe in the management of pituitary adenoma.

Topics: Acromegaly; Adenoma; Adolescent; Adult; Child; Cryosurgery; Female; Humans; Hypophysectomy; Male; Middle Aged; Nose; Pituitary Neoplasms; Stereotaxic Techniques; Treatment Outcome

The skeletal deformities associated with acromegaly are not reversed by correction of abnormal growth hormone dynamic. We describe a patient with acromegaly in whom facial reconstruction was undertaken after successful removal of a pituitary adenoma.

Topics: Acromegaly; Adult; Bone Transplantation; Facial Bones; Growth Hormone; Humans; Male; Mandible; Maxilla; Nose; Osteotomy; Pituitary Neoplasms; Surgery, Plastic; Tongue

Topics: Acromegaly; Humans; Nose; Nose Diseases