Does "Shrek" really exist? ——The scientific knowledge you don't know about pituitary growth hormone adenoma

Author: Wei Yongxu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Reviewer: Zhao Weiguo, Chief Physician and Professor, Ruijin Hospital, Shanghai Jiaotong University School of Medicine

Many people have seen the Hollywood animated film "Shrek the Monsters". In fact, Shrek is not imagined out of thin air. Maurice Tillet, who was born in Russia, is considered to be the prototype of the "monster" in real life.

In 1920, 17-year-old Tillett was diagnosed with acromegaly, a rare disease that caused his bones to grow wildly and his appearance to change drastically. He later became a professional wrestler and was known as the "Monster of the Wrestling Ring." Eventually, at the age of 51, he died of a heart attack. Based on his medical records, people discovered that acromegaly was the cause of his death.

1. What is acromegaly?

Acromegaly is a rare disease caused by an excess of growth hormone, usually due to a pituitary adenoma; it usually occurs after puberty and is characterized by progressive bone growth, enlargement of the hands and feet, thickening of the skin, and roughening of the face.

2. What is growth hormone?

Growth hormone is a peptide hormone secreted by the pituitary gland that can promote the growth of bones, internal organs and the whole body, promote protein synthesis, affect fat and mineral metabolism, and play a key role in human growth and development.

The tumor cells of patients with pituitary growth hormone adenomas secrete excessive growth hormone, which may manifest as "gigantism" before epiphyseal closure (<15 years old) and "acromegaly" after epiphyseal closure in adults.

3. What are the symptoms of adult patients with pituitary growth hormone type?

1. Acromegaly : broad face, thick lips, wider gaps between teeth, higher cheekbones, wide and flat nose bridge, rough skin, larger shoes, socks and gloves, thicker fingers and toes, etc.

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2. Hyperglycemia : More than 1/3 of patients develop insulin resistance, impaired glucose tolerance, and diabetes due to increased secretion of diabetes-related hormones. In the early stage, they manifest as polydipsia and polyphagia, and in the late stage, they develop polydipsia, polyuria, weight loss, and even diabetic coma.

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3. Heart disease : More than 1/3 of patients may experience myocardial cell proliferation, cardiac hypertrophy, valvular insufficiency, and even develop heart failure, which may lead to death in severe cases (such as Tilete).

4. Hyperprolactinemia : Less than 1/3 of patients may have combined hyperprolactinemia, and patients may show symptoms such as amenorrhea, galactorrhea, decreased sexual function, and infertility.

4. How to treat pituitary growth hormone adenoma?

Pituitary growth hormone adenoma is a benign lesion, but some can grow invasively. Excessive hormone secretion is also extremely harmful to the body. Once diagnosed, it is necessary to receive treatment, and surgical resection is the first choice.

1. Surgical treatment : Endoscopic transsphenoidal pituitary tumor resection is suitable for most patients with pituitary adenoma. Its characteristics are small surgical trauma, fast recovery and high cure rate.

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2. Drug treatment : Patients with poor physical condition who cannot tolerate surgery can take oral somatostatin receptor ligand drugs, dopamine receptor agonists, growth hormone receptor antagonists and other drugs. Drug treatment has the disadvantages of long-term medication, high cost and drug resistance.

3. Other treatment methods : Gamma knife treatment may also be considered for patients with difficult-to-resectable tumors, residual tumors after surgery, recurrence, and drug resistance.

In short, "acromegaly" caused by pituitary growth hormone adenoma is extremely harmful to the patient's body. For friends who have the above symptoms, they should go to the hospital for corresponding examination and treatment as soon as possible. Timely and appropriate treatment can enable most patients to obtain satisfactory treatment results.