Childhood overgrowth

Introduction Childhood overgrowth is one of the symptoms of giant disease and acromegaly. Gigantism is generally an endocrine and metabolic disease caused by persistent excessive secretion of growth hormone (GH). The main cause of GH excessive secretion is somatotropinoma (GH-producing adenoma) or pituitary GH cell proliferation, but tumor or The cause of hyperplasia is unknown. If the growth hormone secretion is insufficient in juvenile, there will be pituitary dwarfism; on the contrary, if the secretion is abnormal, the adolescents are gigantism, and the adult after the onset is acromegaly, a few years ago - The post-onset is giant-acromegaly.

Cause

First, the pituitary: the majority. Including GH cell proliferation or adenoma, GH/PRL cell mixed adenoma, prolactin growth hormone cell adenoma, eosinophilic adenoma and the like.

2. In vitro: Heterologous GH/ and or GHRH secreted tumors (lung, pancreatic cancer, hypothalamic hamartoma, carcinoid, islet cell tumor). Such tumors often fail to be life-threatening in clinical manifestations of excessive GH secretion.

an examination

Related inspection

Whole blood glucose Hb blood routine

an examination:

(1) GH measurement: the basic value is >15ug/L, and the active period is as high as 100ug/L or more (normal <5ug/L).

(2) The growth factor was significantly increased (normal value 75-200 ug/L).

(3) Increased blood sugar, impaired glucose tolerance, glucose inhibition test: oral glucose 100g, before taking sugar and taking sugar 1/2, 1, 2, 3 and 4h, respectively, blood was measured GH. After normal consumption of sugar, GH1h fell below 1ug/L for 2h and fell below 5ug/L. After 4h, it rose to above 5ug/L. The GH of this disease is not inhibited by autologous secretion.

(D) Determination of calcium and phosphorus: a small amount of serum calcium, phosphorus increased, urinary calcium increased, urinary phosphorus decreased. Such as persistent or significant hypercalcemia may be associated with other multiple endocrine neoplasias such as hyperparathyroidism.

(5) X-ray examination: the skull is enlarged, the skull plate is thickened, most of the sella are enlarged, the anterior and posterior nucleus is destroyed, the sinus is enlarged, the occipital trochanter is prominent, the bones of the long bones are proliferated, and the top of the phalanx is plexiform. . CT scans help to identify patients with microadenomas.

Differential diagnosis

Childhood obesity is caused by a variety of factors, and it is divided into two categories: simple obesity and pathological obesity. Among them, simple obesity is most common in childhood, accounting for about 95% of total obesity in children; pathology Sexual obesity, also known as secondary obesity, is secondary to other diseases and accounts for only 5% of childhood obesity. The etiology of simple obesity is still not very clear, and it is generally believed to be related to heredity, eating habits, lifestyle and environment, and neuroendocrine and energy metabolism.

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