Excessive secretion of growth hormone

Introduction Giant disease and acromegaly are caused by excessive secretion of growth hormone in the anterior pituitary. For example, after the onset of puberty, when the epiphysis has been fused, it is manifested as extremity; if the onset is before puberty, the epiphysis has not yet merged. , it is manifested as giant disease; if the onset is in adolescence, and continues to develop after adulthood, it is manifested as acromegaly. In the vast majority of cases of excessive secretion of pituitary growth hormone, there are pituitary adenomas that secrete growth hormone, and a few are hyperplasia or adenocarcinoma.

Cause

The cause of pituitary secretion of growth hormone tumors is not well understood. It may be related to hypothalamic dysfunction. The hypothalamus secretes growth hormone releasing hormone and growth hormone inhibitory hormone. When hypothalamic dysfunction occurs, such as excessive growth hormone releasing hormone or When the growth hormone inhibitory hormone is too little or absent, the pituitary growth hormone cells can be stimulated by long-term and excessive excitement to form adenoma or hyperplasia. In addition, some patients may have a family history.

an examination

Related inspection

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1 biochemical determination: pituitary auxin can increase the reabsorption of phosphorus by renal tubules, so that urinary phosphorus, fecal phosphorus excretion is reduced, so that blood phosphorus is increased, pituitary growth hormone affects glucose metabolism, which raises blood sugar and stimulates insulin secretion, pituitary growth hormone secretion When there is too much, there may be impaired glucose tolerance or diabetes, and the blood sugar will increase after fasting and after meals.

2 Determination of pituitary growth hormone and target gland hormone: The blood growth hormone level was significantly increased by radioimmunoassay, and the fasting value was >5mg/ml. If there is corresponding target gland dysfunction, the blood gonad, thyroid and adrenal gland can be measured separately. Corticosteroids are judged.

3 pituitary function test - growth hormone inhibition test: because high blood sugar can inhibit the release of growth hormone, so you can do glucose growth hormone inhibition test to determine the presence or absence of growth hormone secretion. After normal oral administration of 100g glucose, blood growth hormone can be inhibited to less than 3mg/ml, while growth hormone in patients with giant disease and acromegaly is not inhibited or increased.

4 morphological examination: can be done on the lateral side of the skull, the saddle tomography and other routine X-ray examination and saddle CT or nuclear magnetic resonance imaging to determine the presence or absence of pituitary tumors and tumor size, location and compression.

5 visual field of vision and fundus examination: can be found in the development of pituitary tumors on the saddle, and sometimes it may be early symptoms of the lesion.

If the patient has the above-mentioned typical signs and clinical manifestations, and the determination of hormones, hormone-regulated blood biochemical levels, localization examination, etc., it is not difficult to diagnose giant disease or acromegaly.

Differential diagnosis

Excessive secretion of salt corticosteroids: mineralocorticoids, mainly acting on sodium, potassium, chloride and water metabolism, it is known as mineralocorticoid. Among these hormones are aldosterone and deoxycorticosterone, among which aldosterone is the strongest. Mineralocorticoids have the effect of preserving sodium and potassium, promoting the reabsorption of sodium by the renal tubules and the effect of potassium release, thereby maintaining the proper concentration of sodium and potassium in the plasma. When the adrenal cortex hyperfunction (such as Cushing's syndrome), 11-deoxycorticosterone secretion, due to retention of sodium and water in the body beyond the limits of edema, increased blood volume, elevated blood pressure, high blood sugar, hypokalemia Wait. Conversely, if the adrenal cortical function is insufficient, the metabolism of sugar and minerals is disordered, causing a bronze disease, or "Addison's disease", which shows muscle weakness, decreased blood pressure, skin pigmentation and hypoglycemia, blood. Symptoms such as decreased sodium and increased potassium, while blood loses water and concentrates, and are life-threatening in severe cases.

Excessive secretion of glucocorticoids: If a person has excessive secretion of glucocorticoids or long-term use of cortisone hormones, it can cause centripetal obesity, face like full moon, muscle atrophy, high blood sugar, high blood pressure, abdomen and thighs. The skin has purple streaks called Cushing syndrome.

Too much androgen: The male hormone in the body has a fixed amount. If it exceeds this amount, it is called female androgen. Female androgen high is easy to cause women to not ovulate, less menstruation or even amenorrhea, thus making women infertile.

Increased secretion of vasopressin (ADH): vasopressin (also known as vasopressin) is a 9-peptide hormone secreted by the neurons of the suprachiasmatic and paraventricular nucleus of the hypothalamus, which reaches the neurohypophysis after the hypothalamic-pituitary bundle Released. Its main function is to improve the permeability of the distal convoluted tubules and collecting tubes to water and promote the absorption of water. It is a key regulating hormone for urine concentration and dilution. In addition, the hormone enhances the permeability of the inner medullary collecting duct to urea. Severe vomiting or diarrhea, etc., when the body loses water, the plasma osmotic pressure rises, which may cause an increase in the secretion of antidiuretic hormone.

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