ResearchTop 26 Research Articles...

["swesshfsrsssr..se. +kbCKaKST~~}T~~(CsCBCC(CIB(CB(#CIB(CY(CK(BK1CKsBCaB#CCCIB(((IB(BbBIBk(C[.S}T~~}T~~","Acromegaly."," This results from excess growth hormone. Usually this involves a brain lesion. Athletes using growth hormone injections develop signs of acromegaly.","An ancient disease,"," acromegaly has been studied for over 100 years. Acromegaly is fascinating. After many years of confusion, I had my IGF-1 tested and discovered I had acromegaly.","Symptoms."," I checked a medical book, Textbook of Oral Pathology. It states that acromegaly occurs most often in men in their thirties. Acromegaly causes characteristic features (page 671). ","Note: ","Acromegaly is sometimes self-diagnosed, as its features are so distinct and unusual (and noticeable by patients).","It is more common in males and occurs most frequently in third decade. Bone overgrowth and thickening of the soft tissue causes a characteristic coarsening of facial features termed acromegaly.","Textbook of Oral Pathology","Symptoms."," In addition to the thickening of facial features\u2014which can be detected most effectively by a computer algorithm\u2014symptoms affect the hands and the feet of the person. ","Hand and feet become large, with clubbing of the toes and fingers due to enlargement of the tufts of the terminal phalanges.... The terminal phalanges of the hands and [feet] become large and the ribs also increase in size.","Textbook of Oral Pathology","ins","class","adsbygoogle","data-ad-client","ca-pub-4712093147740724","data-ad-slot","9180592904","data-ad-format","auto","ins","class","adsbygoogle","data-ad-client","ca-pub-4712093147740724","data-ad-slot","9180592904","data-ad-format","auto","Brain lesion symptoms."," Remember that acromegaly is most often caused by a lesion in the brain\u2014often a pituitary adenoma. The remainder of the symptoms are actually caused by this lesion. ","So: ","Acromegaly itself\u2014the growth hormone excess\u2014does not cause temporal headaches.","Finger clubbing."," From the above medical textbook, acromegaly is associated with an \"enlargement of the tufts of the terminal phalanges.\" ","Note: ","This is called finger clubbing or digital clubbing. Many other medical conditions cause a similar condition.","Finger Clubbing ","digital-clubbing-causes","Note: ","The most common cause of finger clubbing is pulmonary disease. This includes lung cancer.","And: ","Digital clubbing is an important clue to the diagnosis of acromegaly\u2014and many other medical conditions.","Strength."," Acromegaly causes an increase in lean body mass. This is muscle tissue. One study looked into this change. Mice with excess growth hormone were found to have larger muscles. ","But: ","These larger muscles were not proportionally stronger than the mice with smaller muscles\u2014which did not have excess growth hormone.","Growth hormone (GH) is used by athletes like bodybuilders to increase muscle strength and weight gain. On the other hand, chronic hypersecretion of GH in active acromegaly may result in outwardly hypertrophied but functionally weaker muscles.","Effects of growth hormone on grip strength ","https://www.ncbi.nlm.nih.gov/pubmed/8548060","Big and weak muscles."," The end result of the acromegaly simulated in these mice was big and weak muscle development. And muscle weight did not proportionally increase. ","Note: ","The weight gain was lean body mass but not muscle tissue. Strength would not increase with no additional muscle mass.","Muscles, Large and Weak ","muscles-weak","Note, athletes."," This study does not support the use of growth hormone for athletes. It does support the use of growth hormone for bodybuilders who are not concerned with strength.","Diabetes."," Diabetes is associated with acromegaly\u2014and also the abuse of growth hormone. One interesting report tells of a young bodybuilder who abused anabolic steroid injections. ","Also: ","The man injected growth hormone\u2014a product intended for cows. The man developed diabetes after the abuse of these treatments.","We report a case of a young bodybuilder with no significant past medical history who was diagnosed with... diabetes associated with supraphysiologic self-injections of the bovine growth hormone, trenbolone acetate, combined with testosterone.","New onset diabetes growth hormone ","https://www.ncbi.nlm.nih.gov/pubmed/21558143","Note, diabetes."," It is unclear whether this man's diabetic condition was merely precipitated by the drugs\u2014he was likely to get diabetes already\u2014or if they caused it. ","Info: ","Diabetes is common\u2014most cases are not caused by acromegaly or steroid use.","Diabetes prevalence:","\n\n8.3% of the United States population","Skin."," What are the skin changes that occur with acromegaly or excess growth hormone? One study in Brazil determined all the skin changes in 15 people who have acromegaly. ","Note: ","The study found skin abnormalities in all patients. So this is a clear sign of acromegaly.","We also observed the occasional presence of melasma, psoriasis, hidradenitis suppurativa, sebaceous hyperplasia, Civatte poikiloderma, xanthelasma and vascular lesions like cherry angiomas and facial telangiectasia....","Dermatologic disorders in acromegaly","Acne."," Acromegaly also may cause an increase in acne. This study found less acne than expected among the patients. Acromegaly causes oily skin\u2014and this is expected to result in some acne. ","Acne, Anabolic Steroids ","acne-steroids","Acne was evidenced in our cases in a percentage very similar to other studies, although in a prevalence below the expected due to the high frequency of oily skin among the patients.","Dermatologic disorders in acromegaly","Skin, disorders not found."," Some disorders of the skin were not found. These problems are also known to occur in people who have acromegaly. ","Note: ","These problems do not occur in all cases. They may occur in only a minority of cases of acromegaly.","However, we did not see blue nevi, cutis verticis gyrata, mucocutaneous mixomas or psammomatous melanotic schwannomas.","Dermatologic disorders in acromegaly","CVG."," Cutis verticis gyrata is a condition that affects the scalp. Thick ridges appear on the scalp, usually going from the front to the back. ","Cutis Verticis Gyrata, CVG ","cutis-verticis-gyrata","Also: ","Acromegaly is one condition of many that cause cutis verticis gyrata. It can also cause frontal bossing.","Frontal bossing."," This is an increase in the forehead bone. It can change the shape of your face. It makes the eyes seem more \"deep set.\" It can be a normal feature. ","Frontal Bossing ","frontal-bossing","Computer diagnosis."," A fascinating new development in acromegaly diagnosis is from computer science. A person's face often shows signs of acromegaly. ","Computer: ","A study has found that it can be detected 86% of the time by a computer.","Physicians: ","Physicians can only detect acromegaly 26% of the time. Please note that this is an average score.","Note: ","The most adept physician actually detected acromegaly 90% of the time\u2014slightly better than the algorithm.","The accuracy of the computer model was 86%; the average of the 10 physicians was 26%. The worst individual physician, 16%, the best, 90%.","Early diagnosis of acromegaly: computers vs clinicians ","https://www.ncbi.nlm.nih.gov/pubmed/21521289","Perhaps this study"," mostly shows that physicians are often bad at detecting acromegaly\u2014not that the computer is particularly good. The best physician did better than the algorithm.","Ancient."," Acromegaly is an ancient condition. It has existed as long as modern humans have existed. One study did an examination of a skeleton from the seventh century\u20141400 years ago.","The skeleton"," of the unfortunate Greek had clear signs of acromegaly\u2014and also the presence of a brain lesion\u2014a macroadenoma. Remember that acromegaly is often caused by pituitary adenomas. ","All anatomical signs of acromegaly were present on this skull. More importantly, enlargement of the sella turcica clearly indicated the development of a macroadenoma, at the origin of the disease.","A case of acromegaly: Greece, 7th century AD ","https://www.ncbi.nlm.nih.gov/pubmed/21868602","Pachydermoperiostosis."," Many of the features of acromegaly are shared in pachydermoperiostosis. This condition is often hereditary, meaning it runs in families. It mostly affects men. ","Pachydermoperiostosis ","pachydermoperiostosis","TMJ."," Problems with the temporomandibular joint result in facial pain. In patients with acromegaly, some joint degeneration is common\u2014it occurs in about half of patients. ","Jaw Pain ","jaw","In all, 43% of the patients with acromegaly had hearing loss, and 20% had had an episode of otitis in at least one ear.... Auditory imaging showed that 50% of the patients had temporomandibular joint degeneration (TMJD).","Evaluation of hearing in acromegaly ","https://www.ncbi.nlm.nih.gov/pubmed/21883347","Story."," My body had begun to change in small but perceptible ways. And when I visited by primary care physician, my doctor was alarmed. She told me that my heart rate was going too fast.","Also,"," I had skin symptoms. I had an urgent appointment with an endocrinologist on the other side of that coastal city. I remember that time, waiting and wonder what might be wrong. ","So: ","At this point the endocrinologist had me do a urine test\u2014for a possible excess of adrenal hormones.","Summary."," Acromegaly has many signs\u2014it affects every part of the body in some way. Growth hormone abuse carries the same symptoms. Acromegaly affects the size of the fingers and feet.","It affects"," the strength and bulk of the muscles. It affects the rate of diabetes diagnosis. It changes the skin of the body in unusual ways. 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)","url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAL4AAABDCAAAAAAHE+CGAAACHElEQVR4Xu3XMYskIRAF4Pv/P+llZmZGJh2ZGBgYdCAIIu+oamXnGNgLFlkG6iWlVUPzCe0M8wcfnd/mG58fGuP/J8Y3vvGNb3zjG9/4xje+8Y1vfOMb3/jtciGNVspgkYwhpbKVp1LbMt71a7RnjWut/Umy6lJLPcm/IXEBaISkNSmRBZq5PrHHyGSAJJJcvYsSrLhORki0xJN8D8BHJz4VxzES4Cubh+RmBrTPBEnghKaSm+kokXnKTk9TvWxYHXw9yRfI4HRA000hGxC3DJkBbvc184Z2KLmAoIfkM2962rWJvGV0mh8qaynjnR8BP7XsPoCapS6+g78BpH/4YR0M3SPyKD9D4lIn3/kyLEDZfW2kAFcW/wYyHeA2P8iJ9VnDAQHoZ/ksDpr8zscNwAN991GCNq7NT0BpAY+yQeNuaopsEo/yZ2utXnqCuvn35oOPh198Ma2yL74mL37J+ybo0M2z/Ab4yRkegVd4Aq7Fj0K7XvgNkr74HfAxRgB+8dt8vr24Lg+P8+FzwgPM6+1FJUcAmjBRxZUmC5CGE+tIADp7AvKY+vbcQ+YowvdX4fOA0I/zHTRukHOt/aRi0GU3Xn62ygUg6SwyaqdBU6il+WezHhCP86/bC6bLdqgoDi4+PeD5yq8A6nf87oEwD/Lf09t4ucuDP0vv9nfF+N/F+MY3vvGNb3zjG9/4xje+8Y1vfOMb/3Nj/F/OXwYZPOX27tJnAAAAAElFTkSuQmCC)"]