ACROMEGALY: Definition
time.
Acromegaly, a disorder caused by an excess of
GH in adults, results in enlargement of
peripheral body parts and soft tissue, after the
fusion of the epiphyseal plates has occurred
(Hickey & Silverstein, 2019), without an
increase in height with an incidence of between
0.2 and 1.1 cases per 100,000 people
(Lavrentaki, Paluzzi, Wass, et al., 2017).
Although rare, oversecretion of GH in children
before the fusion of epiphyseal growth plates
result in pituitary gigantism; a person may grow
to be 7 or even 8 feet tall.
Acromegaly is a rare disorder of excessive bone
and soft tissue growth due to elevated levels of
growth hormone. In young children, prior the
completed fusion and growth of bones,
excessive growth hormone can cause a similar
condition called gigantism.
Causes
In most cases, acromegaly is caused by over-
secretion of growth hormone (GH) produced
by a benign tumor of the pituitary gland.
In a small number of cases, malignant tumors of
other organs (pancreas, adrenal, lung) may be
the source of excess GH.
Risk Factors
• Hereditary
• Average Age of Diagnosis: 40 – 45
years old.
Symptoms
Symptoms usually develop very slowly over
Acromegaly can cause serious complications
and premature death if not treated.
In children, excess GH production causes
elongation of the bones and associated soft
tissue swelling. If not treated, children with this
disorder can grow ta height of 7-8 feet.
Symptoms and complications in adults may
include the following:
• Abnormally large growth and deformity
of the:
Hands (rings nlonger fit)
Feet (need a bigger size shoe)
Face (protrusion of brow and lower jaw)
Jaw (teeth dnot line up correctly when
the mouth is closed)
Lips
Tongue
• Carpal tunnel syndrome
• Skin changes, such as:
Thickened, oily, and sometimes
darkened skin
Severe acne
Excessive sweating and offensive body
order due tenlargement of the sweat
glands
• Deepening voice due to enlarged
sinuses, vocal cords, and soft tissues of
the throat
• Fatigue and weakness in legs and arms
• Sleep apnea
• Arthritis and other joint problems
especially in the jaw
• Hypothyroidism
• Enlargement of the liver, kidneys,
spleen, heart, and/or other internal
organs, which can lead to:
Diabetes
High blood pressure
Cardiovascular disease
 In women:
• Irregular menstrual cycles
• Galactorrhea (abnormal production of
breast milk) in 50% of cases
In men:
• In about 50% of cases, impotence
Diagnosis
o Blood tests to measure the level of
insulin-like growth factor (IGF-I),
GRHR, and other pituitary hormones.
A glucose tolerance test may also be given to see
if the GH level drops—it will not drop in cases
of acromegaly.
If these tests confirm acromegaly, the following
may be done to locate the tumor that is causing
the disorder:
o Head CT Scan
o MRI Scan
Treatment
Reduce production of GH to normal levels.
Stop and reverse the symptoms caused by over-
secretion of GH.
Correct other endocrine abnormalities (thyroid,
adrenal, sex organs).
Reduce the tumor size.
• Surgery
• Radiosurgery
• Radiation Therapy
Medications
• Cabergoline (Dostinex) – given orally
• Pergolide (Permax) – given orally
• Bromocriptine (Parlodel) – may be
given before surgery to shrink tumor
• Octreotide (Sandostatin) – injection
• Pegvisomant – injection for px not
responding to other forms of treatment
ACROMEGALY SYMPTOMS
A – Arthralgia / Arthritis
B – Blood Pressure Raised
C – Carpal Tunnel Syndrome
D – Diabetes
E – Enlarged Organs
F – Field Defect (Visual)
Nursing Management
PREOPERATIVE. At the time of diagnosis, the
patient requires education and emotional
support. Focus education on the cause of the
disease, the prescribed medical regimen, and
preparation for surgery. Encourage the patient to
interact with family and significant others.
Reassure the patient that treatment reverses
some of the physical deformities. If you note
disabling behavior, refer the patient to
psychiatric resources.
Prepare the patient and family for surgery.
Explain the preoperative diagnostic tests and
examinations. For a patient who is undergoing a
transsphenoidal hypophysectomy or a
transfrontal craniotomy, explain the
postoperative need for nasal packing and a
mustache dressing.
POSTOPERATIVE. Elevate the patient’s head
to facilitate breathing and fluid drainage. Do not
encourage the patient to cough, as this interferes
with the healing of the operative site. Provide
frequent mouth care, and keep the skin dry. To
promote maximum joint mobility, perform or
assist with range-of-motion exercises.
Encourage the patient to ambulate within 1 to 2
days of the surgery. To assure healing of the
incision site, explain the need to avoid activities
that increase intracranial pressure, such as
toothbrushing, coughing, sneezing, nose
blowing, and bending.
Documentation Guidelines
o Physical findings: Respiratory rate and
pattern; nasal drainage: color, amount,
and presence of glucose.
o Neurological status: Level of
consciousness, motor strength,
sensation, and vision.
o Presence of postoperative
complications: Diabetes insipidus,
hypopituitarism, meningitis.
o Psychosocial assessment: Self-esteem,
coping, interpersonal relationships, and
sexual dysfunction
Discharge and Home Healthcare Guidelines
Refer patients with advanced acromegaly who
experience arthritic changes and require assist
devices for ambulation and activities of daily
living to a physical therapist.
ACTIVITY RESTRICTIONS. Instruct the
patient to avoid activities that increase
intracranial pressure for up to 2 months after
surgery. Toothbrushing can be resumed in 2
weeks. Instruct the patient to report increased
nasal drainage. Incisional numbness and altered
olfaction may occur for 4 months after surgery.
MEDICATIONS. If octreotide is prescribed, the
patient will need to be able to demonstrate how
to administer a subcutaneous or intramuscular
injection.
FOLLOW-UP. Patients need to be monitored for
development of cardiac disease, diabetes
mellitus, and gallstones and a recurrence of
symptoms. Advise the patient to wear a medical
identification bracelet.
DWARFISM: Definition
Conversely, insufficient secretion of GH during
childhood can result in generalized limited
growth and pituitary dwarfism.
As a result of a medical or genetic condition, it
is described by the advocacy group Little People
of America (LPA) as adult height of 4 feet 10
inches or below.
The average height of an adult with dwarfism is
4 feet, despite the fact that other groups may
raise the standard for some forms of dwarfism to
5 feet. The majority of illnesses connected to
dwarfism are genetic, while other ailments have
unidentified origins.
• Turner Syndrome is a condition that
only affects girls and women and is
caused when a sex chromosome is
missing or partially absent.
• Achondroplasia is a condition when a
person has one mutant copy of the gene
associated with the disorder and one
normal copy of the gene.
Dwarfism can be divided into two primary
categories: proportional and disproportionate.
Disproportionate dwarfism can either have a
truncated trunk with longer limbs or a
normal-sized torso with shorter arms and
legs. The physical parts are in proportion but
shorter in proportionate dwarfism.
Causes
• Metabolic or hormonal disorders in
infancy or childhood.
• Chromosomal abnormalities
• Pituitary Gland Disorders-which
influence growth and metabolism
• Absorptive problems when the body
can't absorb nutrients adequately
• Kidney disease
• Achondroplasia
 • Turner syndrome
• Genetic Treatment

Dwarfism treatments don't increase stature but

Signs and Symptoms may alleviate problems caused by complications.

o Late development of certain motor
skills, such as sitting up or walking
o Increased susceptibility to ear infections
o Breathing problems
o Weight problems
o A curvature of the spine
o Bowed legs
o Joint stiffness and arthritis
o lower back pain or numbness in the legs
o Crowding of teeth
Surgical procedures that may correct problems
with bones in people with disproportionate
dwarfism.
Some people with dwarfism elect to undergo
limb-lengthening surgery.
Growth hormone deficiency is treated with
injections of a synthetic version of the hormone.

Nursing Management
Tests and Diagnosis
Nurses should be familiar with a child's typical
• Measurement of height, weight, and growth and development as well as the need to
head circumference. regularly check a child's weight and height and
• Many distinct facial and skeletal features keep accurate records.
are associated with each of several
dwarfism disorders. Help with making a diagnosis.
• MRI Scan
• Genetic tests Support the parent and child emotionally.
• Family history
Give health instruction.
• Hormone tests
Give them the chance to voice their thoughts on
Prevention
sexual function and body appearance.
If genetically caused, it is impossible to prevent
Furniture and other necessities, such as beds,
but genetic testing can be performed to screen
chairs, and dresses, should be made to fit
for specific variations that result in the
children's sizes for comfort.
condition.

Appropriate diet or hormonal therapy can treat

dwarfism resulting from malnutrition or a
hormonal abnormality. GH deficiency can be
remedied by injection of HGH in early life.

Complications

A – Arthropathy
C – Cataracts
R – Raised intraocular pressure
D – Disproportionate short stature
R – Retinal Detachment