GROWTH HORMONES

ACROMEGALY, GIGANTISM, AND

GROWTH HORMONE DEFICIENCY

Dr. Diyah Saraswati, SpPD

Pituitary gland and Hypothalamus serve to link the nervous
system other glands and metabolic functions.

2003-2004
2003-2004
2003-2004
• Acts on the liver, stimulating it to
release several polypeptide
hormones.
• Stimulates amino acid uptake and
protein synthesis in target cells.
• Ultimately stimulates cell growth
(cell size and number), especially in
muscle and bone.
• Also stimulates fat breakdown.
 GH
Levels
awake sleep

strenuous
exercise
 GH ABNORMALITIES
THE DEFINITION

• It refers to the conditions when level of GH is

found to be higher or lower than normal body
requirements
• GH is important for children to grow or adults to
have a comfortable life
 TYPES EXCESS AND DEFICIENCY

• GH may be secreted in excess or there can be deficiency

of GH with different clinical manifestations
• GH abnormalities can occur both in children and adults
• Excess of GH causes Gigantism in children and
Acromegaly in adults
• Deficiency of GH causes Dwarfism in children – Rare in
adults
 GIGANTISM
• Abnormal large growth due to an excess
of growth hormone during childhood
• Gigantism in children and adolescents
occurs when epiphysis are not fused
• Causes = benign tumor of the pituitary
gland, diseases (Carney complex,
McCune-Albright syndrome,
Neurofibromatosis)
 Gigantism
hypersecretion of GH

Bao Xishun, a 7ft 8.95 in

herdsman from Inner Mongolia
 Symptoms
• Delayed puberty
• Double vision
• Increased sweating
• Headache
• Irregular periods
• Large hands and feet
• Thick fingers and toes
A. Clinical Photograph B. Frontal Radiograph
 Treatments
• Surgery to remove tumor
• Somatostatin analogs = reduce growth
hormone release
• Dopamine agonists = reduce hormone
release, generally less effective
• Pegvisomant = blocks the effect of growth
hormone
• Radiation therapy
 ACROMEGALY

• Acromegaly results from excessive secretion of

growth hormone in adults with fused epiphysis
• It is usually the result of benign pituitary
adenoma in middle aged individuals
• Excessive secretion of GH leads to excessive
generation of IGF-1 - the mediator of the
effects of GH
Acromegaly –↑ in bone thickness and soft tissues
Acromegaly - Wide sole of foot
Acromegaly – Large skull. lower jaw, nose and
Bulging Forehead
 DIFFERENCE BETWEEN
ACROMEGALY AND GIGANTISM
TITLE ACROMEGALY
The nature Excess of GH in adults when
epiphysis are closed
Major action Increase in the size of short
and flat bones especially
extremities
Size of skull and lower Prominent skull, fore head,
jaw and overgrowth of lower jaw
Size of the viscera Enlarged liver and heart
Muscle mass Increase in muscle mass
Metabolic role Promotion of proteogenesis,
lipolysis, and hyperglycemia
Hypogonadism Absent
GIGANTISM
Excess of GH in children
when epiphysis are
ununited
Overgrowth of the
longbones of the limbs
especially lower limb
Overgrowth of long bones
especially lower limb
No relative increase in
size
Increase in bone mass
Promotion of GIT
absorbtion of Ca,
proteogenesis, lipolysis,
and hyperglycemia
Present usually
 DEFICIENCY OF
GROWTH HORMONES

• The manifestations of GH deficiency depends

upon:
 The age of the of onset of the disorder or
 The cause whether it is heritable or
acquired disease
• GH deficiency results Dwarfism in children, GH
deficiency is rare in adults
 DWARFISM

• Deficiency of GH in children produces a

condition called Dwarfism
• GH is secreted less than the body
requirements
• Dwarfism is commonly associated with
Panhypopituitrism. It is a total failure of
Pituitary in children
 SPECIAL FEATURES

• All the physical body parts like size of hands

and feet develop in appropriate proportion to
each other but the rate of development is
greatly reduced
• The affected child appears to be younger
than his actual age. A child at the age of 10
years may have body development of a child
aged 4 -5 – years
 SPECIAL FEATURES

• A dwarf individual may not pass through

puberty as he never secretes sufficient
quantity of Gonadotropins
• GH in these children may be sufficient but
there will be deficiency of IGF-1 – an active
metabolite of GH 1
DWARFISM IN CHILDREN
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