Acromegaly

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.

Acromegaly Causes

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.

Acromegaly symptoms

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.

• Weight gain
  
• Swollen and painful joints that restrict movement
  
• Spaces appearing between teeth
  
• Hoarse voice
  
• Fatigue
  
• Headache
  
• Inability to sleep
  
• Muscle weakness
  
• Excessive sweating
  
• Body odor due to enlargement of sweat glands
  
• Enlarged sebaceous glands that make skin oily
  
• Severe acne
  
• Severe snoring
  
• Impaired vision
  
• Menstrual cycle irregularities in women
  
• Abnormal breast milk production in women
  
• Erectile dysfunction in men
  
• Increased chest size
  
• Non-cancerous thickened skin and skin tags.

Acromegaly diagnosis

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.

Acromegaly Treatment

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.

Hirsutism

Hirsutism is a condition where a woman has male-pattern hair growth. It results in excessive coarse dark hair where women don't generally have hair, such as the face, chest and back. It can happen due to high androgen levels or increased skin sensitivity to androgens caused due to certain medical conditions. Else it could be traced to ethnicity and genes.

Excessively high androgen levels are most often the cause for Hirsutism. Some signs of virilization might be noticed along with Hirsutism such as acne, balding, deepening voice, enlarged clitoris and reduced breast size. Other causes include:

• PCOS- Polycystic Ovarian Syndrome
  
  
• Cushing's Syndrome H- or Hypercortisolism as it is known owing to the high levels of cortisol in the body.
  
  
• Tumor
  
  
• Acromegaly - A hormonal disorder that results from excessive secretion of growth hormone.
  
  
• Congenital adrenal hyperplasia
  

Tackling Hirsutism

Anti-androgens are often prescribed to block the androgen effect thereby reducing the excessive hair growth. The effect is slow as the hair takes about 6 months to get thinner and less noticeable. Oral contraceptives, Finasteride, Spironolactone and Cyproterone are commonly prescribed anti-androgens.

Women resort to waxing and shaving to get rid of unwanted hair. Depilatories and eflornithine cream are also self-care options. Laser treatment or IPL (Intense Pulsed Treatment) are undertaken to destroy the hair root permanently. They are done over several sittings and must be done under qualified practitioners.

Breast Density

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:

patient age
breast density
tumor size
location
mammographic appearance

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

• High breast density is common among younger women and varies based on the age and weight of the woman.
  
  
• Pre-menopausal women tend to have dense breasts.
  
  
• Healthy women are more likely to have dense breast when compared to obese women.
  
  
• Lactation
  
  
• Mastitis
  
  
• Medication like menopausal hormone therapy or other medications that contain hormones may affect the breast density of a woman. These medications tend to increase the breast density of the woman.
  

Factors lowering breast density

• Breast density of a woman lowers as she gets older.
  
  
• Weight gain
  
  
• Acromegaly
  
  
• Vitamin D and calcium intake in pre-menopausal women
  

Women with high breast density

• Discuss after mammogram with their health care provider. In case the woman belongs to a high risk group classified based on gene mutation study or family history, then she should get an MRI done.
  
  
• Adapt a healthy lifestyle.
  
  
• Quit smoking
  
  
• Exercise regularly
  
  
• Limit alcohol consumption
  
  
• Eat a nutritious diet.
  
  
• Should undergo Breast Self Examination regularly.
  
  
• Get a doctor to examine the breasts every year.
  
  
• A digital mammogram every year from the age of 40.
  
  
• MRI and other imaging studies as per doctor recommendation