Acromegaly is a hormonal disorder that usually affects middle aged adults. Acromegaly is the result of excessive production of Growth Hormone (GH) from the pituitary gland. In children it can result in Gigantism - unusual bone growth and consequent unusual height. Acromegaly is characterized by enlarged hands, feet and face (lips, tongue and nose). Acromegaly can affect heart and bones also.
The hands and feet are over sized when the body makes elevated amounts of growth hormone due to a benign tumor in the pituitary gland located at the base of the brain. The elevated levels cause an excess of bone and tissue growth.
The most noticeable symptom is an over-sized finger necessitating the ring if worn, to be removed. Hitherto fitting shoe may seem unfitting due to an increased shoe width. Noticeable change in the face is a swollen/larger/broader lip, tongue and nose. Other symptoms may include one or a combination of the following.
The physical changes occur gradually and are often not recognized immediately. There are instances when individuals recognize symptoms after comparing old photographs. Awareness is the key to seeking medical attention. If any of the symptoms persists for more than few weeks, seek medical attention. An early diagnosis can avert severe health complications.
Doctors proceed to laboratory tests after discussing medical history followed by physical examination. Blood tests are done to confirm diagnosis. To assess the size and location of the tumor, magnetic resonance imaging (MRI) of the brain or a Computerized Tomography (CT scan) is required.
Instead of checking random levels of hormones which vary minute to minute, doctors recommend testing for protein called insulin like growth factor 1 or IGF-1 which indicate the presence of abnormal body growth.
Another definitive diagnosis method is the growth hormone suppression test. Blood levels of growth hormone before and after drinking a preparation of glucose is measured. If the test shows high GH level, it confirms Acromegaly.
Medications, surgery and radiation are suggested depending on the age and health condition of the individual. The aim is to restrict the excessive production of hormones and improve problems caused by the condition. Doctors prescribe medicines for treatment after surgery or in cases where surgery cannot be performed. Surgery is performed to remove the tumor if it is not too large. In cases where medicines and surgery do not treat the condition, radiotherapy (stereotactic radio surgery or conventional radio therapy) that eventually leads to reduction in growth hormones is recommended.
Breast density compares the amount of fat in the breast to the amount of tissue present. It is a measure used to describe mammogram images and is not a measure of how the breast feels (breast size and firmness). Breast tissue is made up of milk gland, milk ducts and supportive tissues (dense breast tissue) and fatty tissue (non- dense breast tissue).
Higher breast density indicates that the breast and connective tissue are denser when compared to the fat present in the breast. Lower breast density indicates more fat when compared to breast and connective tissue.
BIRADS or BI-RADS means Breast Imaging Reporting and Data System - a standard established by the American College of Radiology. This helps place findings from mammogram screenings into well-defined categories:
BI-RADS type 1: fatty; breast is almost entirely fat. Glandular tissue is less than 25%.
BI-RADS type 2: scattered fibroglandular; breast has scattered areas of fibroglandular density.
BI-RADS type 3: heterogeneously dense; breast tissue is heterogeneously dense.
BI-RADS type 4: dense; breast tissue is extremely dense. The breast contains greater than 75% glandular and fibrous tissue.
Dense breasts may be common and may not always pose a health issue. However women with high breast density are more prone to breast cancer when compared to women with low breast density. It is unclear as to why dense breasts may be more cancer prone. In a few cases women with low breast density are prone to develop breast cancer due to aging or menopause. 2/3 of pre-menopausal and 1/4 of post menopausal women (40%) have dense breast tissue.
A mammogram helps in identifying the density of breast. Women with dense breasts have more dense tissue than fatty tissue. Dense breasts look white or grey. Thus for women with dense breasts it may be difficult to identify cancer using a mammogram as both the dense breast tissue and cancer look grey or white in color in the image. Whereas for women with more fatty breasts it is easy to identify cancer as fatty tissues look black cancer look grey or white in color.
The 'success' rate of Mammogram detecting incidence of cancer depends on several factors:
In younger women with denser breasts, mammography is less sensitive than in older women with fatty breasts where mammography can detect at least 90% of malignancies. Smaller tumors especially those without calcifications are more difficult to detect especially in dense breasts. Diagnostic mammography is associated with higher sensitivity but lower specificity as compared to screening mammography.
Factors that affect breast density
Factors increasing breast density
Factors lowering breast density
Women with high breast density
Bibliography / Reference
Collection of Pages - Last revised Date: July 20, 2018