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Leave a comment Posted on March 10, 2016 Hormones

Acromegaly – what are the signs, symptoms , causes and treatments of Acromegaly?

Growth hormone complications

Acromegaly is a condition in which the body produces too much growth hormone, leading to the excess growth of body tissues over time.

Typical features include:

abnormally large hands and feet
large, prominent facial features
an enlarged tongue
abnormally tall height (if it occurs before puberty)

Growth hormone is produced and released by the pituitary gland, a pea-sized gland just below the brain.

When growth hormone is released into the blood, it stimulates the liver to produce another hormone – insulin-like growth factor 1 (IGF-1) – which causes growth of muscle, bones and cartilage throughout the body.

This process is essential for growth and repair of body tissues.

What happens in people with acromegaly?

Acromegaly is caused by excessive production of growth hormone.

This usually occurs as the result of a benign (non-cancerous) brain tumour in the pituitary gland called an adenoma, but rare cases have been linked to tumours elsewhere in the body, such as in the lungs and pancreas.

Although acromegaly does very occasionally run in families, most adenomas are not inherited – they usually develop spontaneously as a result of a genetic change within a cell of the pituitary gland. This genetic change switches on a signal that tells cells in the pituitary gland to divide and secrete growth hormone.

The tumour almost never spreads to other parts of the body, but it may grow to more than 1cm in size and compress the surrounding nerves and normal pituitary tissue, which can affect the production of other hormones, such as thyroid hormones released from the thyroid gland.

Who is affected

It’s not clear exactly how many people are affected by acromegaly, although it’s been estimated that around 4 to 13 in every 100,000 people may have the condition.

This means there is likely to be between 2,500 and 8,300 people in the UK with the condition.

Acromegaly can affect people of any age, but it is rare in children. The average age at which people are diagnosed is around 40-45.

Problems caused by acromegaly

Acromegaly can cause a wide range of symptoms that tend to develop slowly over time.

Typical symptoms include:

joint pain
large hands and feet
carpal tunnel syndrome (compression of the nerve in the wrist, causing numbness and weakness of the hands)
thick, coarse, oily skin
skin tags
enlarged lips, tongue and nose
a protruding jaw and brow
widely spaced teeth
deepening of the voice due to enlarged sinuses and vocal cords
obstructive sleep apnoea (breaks in breathing during sleep due to obstruction of the airway)
excessive sweating
fatigue and weakness
headaches
impaired vision
loss of sex drive
in women, abnormal periods
in men, erectile dysfunction
in children and teenagers, excessive height (gigantism)

Some of the above symptoms are the result of the tumour compressing nearby tissues – for example, headaches and vision problems may occur if the tumour squashes nearby nerves.

If you think you have acromegaly, see your GP straight away. Acromegaly can usually be successfully treated with brain surgery and medication, but early diagnosis and treatment is important to prevent the symptoms getting worse and to reduce your chance of getting complications.

Possible complications

If acromegaly is left untreated, you may be at risk of the following health problems:

type 2 diabetes
high blood pressure (hypertension)
cardiovascular disease
cardiomyopathy (a disease of the heart muscle)
arthritis as a result of overgrowth of bone and cartilage
bowel polyps, which can potentially turn into bowel cancer if left untreated

Left untreated, these complications can become serious and fatal.

Diagnosing acromegaly

Blood tests

If your doctor suspects acromegaly from your symptoms, they will order blood tests to measure your levels of human growth hormone.

Levels of growth hormone naturally vary from minute to minute as it is released from the pituitary gland in spurts. Therefore to accurately diagnose acromegaly, growth hormone needs to be measured under conditions that normally suppress growth hormone secretion.

To ensure an accurate result, you may be referred to a hospital doctor for a glucose tolerance test. This involves testing your blood after drinking a solution or drink containing the sugar glucose.

In most people, drinking the glucose solution will suppress the release of growth hormone, but in people with acromegaly, the level of growth hormone in the blood will remain elevated.

Your doctor will also measure your level of IGF-1, which should increase with the level of growth hormone. An elevated IGF-1 level almost always indicates acromegaly.

Brain scans

You may then have a magnetic resonance imaging (MRI) scan of your brain to locate and define the size of the pituitary gland tumour causing your acromegaly. A computerised tomography (CT) scan can be carried out if you are unable to have an MRI scan.

Treating acromegaly

Treatment aims to:

reduce excess growth hormone to normal levels
relieve the pressure the tumour is exerting on the surrounding structures
treat any hormone deficiencies
improve the symptoms of acromegaly

This is usually achieved through surgical removal of the tumour and medication.

Brain surgery

In most cases, surgery is recommended to remove the adenoma from your pituitary gland. This is effective in most people, although sometimes the tumour is too large to be removed completely.

Under a general anaesthetic, the surgeon will make an incision inside your nose or behind your upper lip to access the gland. An endoscope (a long, thin, flexible tube that has a light source and a video camera at one end) and surgical instruments are then passed through the incisions to remove the tumour.

Removing the tumour promptly relieves the pressure on the surrounding structures and leads to a rapid lowering of growth hormone levels. Facial appearance and swelling often improve within a few days.

Possible complications of surgery include damage to the healthy parts of the pituitary gland, leakage of cerebrospinal fluid (which surrounds and protects the brain), and meningitis, though this is rare. Your surgeon will discuss these risks with you and answer any questions you have.

Radiotherapy

If surgery is not possible, or surgery and medication do not cure the condition, radiotherapy aimed at the adenoma may be an option.

This can eventually lead to a reduction in growth hormone levels, although it may not have a noticeable effect for several years and you may need to take medication in the meantime.

There are two main types of radiotherapy for acromegaly:

Stereotactic radiosurgery – where a high-dose beam of radiation is precisely aimed at the tumour, requiring you to wear a rigid head frame to keep your head still. This can sometimes be done in a single session.
Conventional radiotherapy – where the tumour is targeted with external beams. This can potentially damage the surrounding pituitary gland and brain tissue, so small doses of radiation are given over four to six weeks, giving normal tissue time to heal in between treatments.

Stereotactic radiosurgery is generally preferred to conventional radiotherapy because it minimises the risk of damage to nearby healthy tissue, although it is not always widely available.

Radiotherapy can have a number of side effects. For example, the treatment will often cause a gradual decline in the production of other hormones from your pituitary gland, so you’ll usually need to take hormone replacement therapy for the rest of your life. There’s also a risk it will impair fertility. Speak to your doctor about the risks involved.

Bowel cancer screening

There is some evidence acromegaly may increase your risk of bowel cancer, so guidelines recommend having a colonoscopy when you are diagnosed with the condition, and regular colonoscopy screening from the age of 40.

A colonoscopy is an examination of your entire large bowel using a type of endoscope called a colonoscope that is inserted into your bottom. See bowel cancer tests for more information about what a colonoscopy involves.

Outlook

Treatment is often effective at stopping the excessive production of growth hormone and improving problems caused by the condition. Treatment can also increase life expectancy to around that of someone without acromegaly.

Some treatments can take a long time to have a noticeable effect and you may need to take medication for a long period of time.

After treatment, you’ll need regular follow-up appointments with your specialist for the rest of your life. These will be used to monitor your pituitary function, check you are on the correct hormone replacement treatment, and to ensure the condition does not return.

Without treatment, acromegaly can cause long-term problems and may reduce life expectancy by a number of years.

[Original article on NHS Choices website]

Leave a comment Posted on March 7, 2016March 7, 2016 Diet

Consumers often receive out-of-date diet and health advice – do you agree?

Out of date advice?

Experts representing public health nutrition, preventive medicine, and consumer behaviour call for better health information.

European consumer research* conducted by the Institute for Scientific Information on Coffee (ISIC) to better understand beliefs, behaviours, and knowledge regarding coffee and a healthy diet, suggests consumers are confused about the potential health benefits of coffee, in part because the information they are receiving is not always in line with the latest science.

Moderate consumption of coffee at 3-5 cups per day has been associated with a range of desirable physiological effects such as improved alertness[1] and a reduced risk of type 2 diabetes[2,3], cardiovascular disease[4,5] and cognitive decline[6,7]. It can be consumed as part of a healthy balanced lifestyle, providing fluid and small amounts of some nutrients, such as potassium, magnesium and niacin. Pregnant and breastfeeding women are also advised by EFSA that caffeine intakes of up to 200mg (2 cups of coffee) per day are considered safe for the foetus/infant[8].

To further explore the consumer research findings, ISIC invited three eminent experts representing public health nutrition, preventive medicine, and consumer behaviour to review and discuss the latest scientific research on coffee and health, consumers’ knowledge and attitudes, and the role of healthcare professionals in disseminating healthy diet advice.

Conclusions from the roundtable:

· Many consumers are not aware of the potential health effects of coffee, with 49% believing it may cause health problems.

· Consumers often obtain out-of-date information on coffee and health from the internet and media sources (such as magazines and TV) but also from healthcare professionals e.g. 56% of the survey respondents who believed that “drinking coffee increases the risk of heart disease” heard this either online, in a newspaper/magazine, or on TV and 16% heard this from a doctor, nurse, or dietician.

· Consumers may not always distinguish between coffee and caffeine, viewing it purely as a stimulant, missing out on coffee’s specific components and potential physiological benefits.

Key Recommendations

· HCPs need up-to-date accurate, science-based information that healthcare professionals can discuss and share with their patients.

· Informing patients about the latest science on coffee could result in behavioural change as consumers begin to appreciate its role within a healthy diet.

· More education is needed to help the general public identify reliable/unreliable information from media/online sources.

The experts were:

· Prof Chris Seal: Professor of Food and Human Nutrition, and Chair of Board of Studies, Food & Human Nutrition BSc at Newcastle University, UK.

· Prof Lluís Serra-Majem: Director of the Research Institute of Biomedical and Health Sciences, Las Palmas de Gran Canaria University, Spain

· Dr Agnès Giboreau: Research Director, Institut Paul Bocuse, France

Professor Lluís Serra-Majem commented: “We are increasingly seeing consumers obtain health information from the internet and media sources rather than from qualified healthcare professionals. We need to improve access to information for all parties, as in my experience healthcare professionals sometimes impart their own opinions to patients, even if this is only based on personal experience, not scientific fact.”

Professor Chris Seal continued: “Whilst key dietary messages such as ‘consume five portions of fruit and vegetables a day’ and ‘eat less fat, salt and sugar’ are well known, many remain unaware of the potential health benefits of coffee. Helping people to understand how regular daily consumption of 3-5 cups of coffee might reduce their risk of certain diseases and long-term health conditions could prompt behaviour change.”

Dr. Agnès Giboreau said: “Coffee is often drunk to accompany or conclude a meal therefore it’s important that consumers understand the value of what they’re drinking as well as eating. Personal habits, such as the way someone takes their coffee, are often based on experiences and cultural backgrounds, and so changing behaviour must be consistent with culture, beliefs and typical habits.”

There was unanimous agreement amongst the expert panel that healthcare professionals, including dietitians, nutritionists and clinicians, are the best source of reliable, scientifically-grounded information on healthy lifestyles for consumers. They are also best placed to advise consumers on where to find reliable information on coffee and a healthy diet. Healthcare professionals could also encourage consumers to analyse the credibility and validity of health information they read or see in the media. It was agreed that this group of professionals should be supported with regularly-updated educational material to ensure that the advice they give is accurate.

* 4119 respondents across 10 European countries were surveyed by ISIC through an independent research company in November 2015.

To read the roundtable report, ‘The good things in life: coffee as part of a healthy diet and lifestyle’ click here.

References

1. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) (2011) Scientific Opinion on the substantiation of health claims related to caffeine and increased fat oxidation leading to a reduction in body fat mass (ID 735, 1484), increased energy expenditure leading to a reduction in body weight (ID 1487), increased alertness (ID 736, 1101, 1187, 1485, 1491, 2063, 2103) and increased attention (ID 736, 1485, 1491, 2375) pursuant to Article 13(1) of Regulation (EC) No 1924/20061. EFSA Journal;9(4):2054

2. Huxley R. et al. (2009) Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus. Arch Intern Med, 169:2053-63.

3. Zhang Y. et al. (2011) Coffee consumption and the incidence of type 2 diabetes in men and women with normal glucose tolerance: The Strong Heart Study. Nutr Metab Cardiovasc Dis. 21(6):418-23.

4. European Heart Network, ‘European Cardiovascular Disease Statistics 2012’ Available at: http://www.ehnheart.org/cvd-statistics.html

5. Ding M. et al (2014) Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies. Circulation. 129(6):643-59

6. Santos C. et al. (2010) Caffeine intake and dementia: systematic review and meta-analysis. J Alzheimers Dis, 20(1):187-204

7. Palacios N. et al. (2012) Caffeine and Risk of Parkinson’s Disease in a Large Cohort of Men and Women. Movement Disorders, 1;27(10):1276-82

8. EFSA (2015) Scientific Opinion on the Safety of Caffeine, EFSA Journal, 13(5):410

Leave a comment Posted on March 1, 2016March 1, 2016 Invisible Illness

Strategies for dealing with fear and anxiety caused by a chronic medical condition.

I came across this fascinating infographic just now and felt I should share it with your all.

While it as written for people with multiple sclerosis but it is very suitable for other conditions such as diabetes, rheumatoid arthritis and fibromyalgia.

Do feel free to share with anyone you feel may be interested.

From Visually.

Leave a comment Posted on February 28, 2016February 26, 2016 Fatigue

Fatigue – 10 medical reasons for feeling tired

Fatigue

Any serious illness, especially painful ones, can make you tired. But some quite minor illnesses can also leave you feeling washed out. Here are 10 health conditions that are known to cause fatigue.

1. Coeliac disease

This is a type of food intolerance, where your body reacts badly when you eat gluten – a substance found in bread, cakes and cereals. One in 100 people in the UK are affected, but research suggests that up to 90% of them don’t know they have the condition, according to patient group Coeliac UK. Other symptoms of coeliac disease, apart from tiredness, are diarrhoea, anaemia and weight loss. Your GP can check if you have coeliac disease through a blood test.

2. Anaemia

One of the most common medical reasons for feeling constantly run down is iron deficiency anaemia. It affects around one in 20 men and post-menopausal women, but may be even more common in women who are still having periods.

Typically, you’ll feel you can’t be bothered to do anything, your muscles will feel heavy and you’ll get tired very quickly. Women with heavy periods and pregnant women are especially prone to anaemia.

Read more about iron deficiency anaemia.

3. Chronic fatigue syndrome

Chronic fatigue syndrome (also called myalgic encephalomyelitis or ME) is a severe and disabling tiredness that goes on for at least six months. There are usually other symptoms, such as a sore throat, muscle or joint pain and headache.

Read more about chronic fatigue syndrome.

4. Sleep apnoea

Sleep apnoea is a condition where your throat narrows or closes during sleep and repeatedly interrupts your breathing. This results in bad snoring and a drop in your blood’s oxygen levels. The difficulty in breathing means that you wake up often in the night, and feel exhausted the next day.

It’s most common in overweight, middle-aged men. Drinking alcohol and smoking makes it worse.

5. Underactive thyroid

An underactive thyroid gland means that you have too little thyroid hormone (thyroxine) in your body. This makes you feel tired. You’re also likely to put on weight and have aching muscles. It’s most common in women, and it happens more often as you get older.

Your GP can diagnose an underactive thyroid by taking a blood test.

Read more about having an underactive thyroid.

6. Diabetes

One of the main symptoms of diabetes, a long-term condition caused by too much sugar in the blood, is feeling very tired. The other key symptoms are feeling very thirsty, going to the toilet a lot and weight loss. Your GP can diagnose diabetes with a blood test.

Read more about diabetes and find out how to make smart sugar swaps.

Find your local diabetes support services.

7. Glandular fever

Glandular fever is a common viral infection that causes fatigue, along with fever, sore throat and swollen glands. Most cases happen in teenagers and young adults. Symptoms usually clear up within four to six weeks, but the fatigue can linger for several more months.

8. Depression

As well as making you feel very sad, depression can also make you feel drained of energy. It can stop you falling asleep or cause you to wake up early in the morning, which makes you feel more tired during the day.

9. Restless legs

This is when you get uncomfortable sensations in your legs, which keep you awake at night. You might have an overwhelming urge to keep moving your legs, a deep ache in your legs, or your legs might jerk spontaneously through the night. Whatever your symptoms, your sleep will be disrupted and of poor quality, so you’ll feel very tired throughout the day.

10. Anxiety

Feeling anxious is sometimes perfectly normal. However, some people have constant, uncontrollable feelings of anxiety, which are so strong they affect their daily life. Doctors call this generalised anxiety disorder (GAD). It affects around around one in 20 people in the UK. As well as feeling worried and irritable, people with GAD often feel tired.

Acanthosis nigricans – what are the signs and why we need to be aware of it?

Acanthosis nigricans

It’s not a condition in itself, but can be a sign of an underlying health problem. These underlying conditions aren’t usually serious, although occasionally acanthosis nigricans can be sign of cancer.

Signs and symptoms

Dark, velvety patches. If you have acanthosis nigricans, you’ll have thickened, brownish-grey or black patches of skin.

The patches will be dry and rough, feeling similar to velvet. They may also be itchy.

These patches may occur anywhere, but are usually seen around the neck, in the armpit, around the groin and sometimes in other skin folds. Occasionally, the skin over the joints of the fingers and toes may be affected, as well as the lips, palms of the hands and soles of the feet.

The patches usually develop slowly over time. Patches that grow and spread quickly are more likely to be associated with cancer. In these cases, the mouth, tongue, throat, nose and windpipe may also be affected.

Tiny growths on the skin

You may also have lots of tiny finger-like growths from the patches. This is known as papillomatosis.

There may also be skin tags around the affected area. These are small flesh-coloured or pigmented growths that hang off the skin and look a bit like warts.

When to see your GP

Acanthosis nigricans is usually harmless, but as it can be a sign of something serious it’s a good idea to see your GP if you think you have it. They may suspect acanthosis nigricans just by looking at your skin.

If the cause isn’t clear, you may have blood tests to check your blood sugar or hormone levels, and you might need additional tests such as an endoscopy or X-ray.

What causes acanthosis nigricans?

Acanthosis nigricans sometimes occurs in people who are otherwise in good health, particularly dark-skinned people of African descent.

However, in most cases it’s a sign of an underlying problem or condition such as obesity, diabetes or abnormal hormone levels. Some of the main causes of acanthosis nigricans are outlined below.

Obesity

Acanthosis nigricans is usually the result of obesity. This is known as obesity-associated acanthosis nigricans.

It occurs because obesity can cause insulin resistance (when the body is unable to properly use the hormone insulin), which may lead to high levels of insulin in the blood, affecting the skin cells.

Insulin resistance can also cause type 2 diabetes, so acanthosis nigricans can be an early sign that you have diabetes or are at risk of developing the condition.

Syndromes and hormone problems

Acanthosis nigricans is sometimes associated with an underlying syndrome or hormone problem, such as:

polycystic ovary syndrome – a condition that affects how a woman’s ovaries work, which can cause excessive body hair, irregular periods, infertility, acne and weight gain
Cushing’s syndrome – symptoms such as weight gain, bruising and stretch marks caused by very high levels of the hormone cortisol in the body
acromegaly – where the body produces too much growth hormone, leading to the excess growth of body tissues over time
underactive thyroid (hypothyroidism) – where your thyroid gland does not produce enough hormones, causing symptoms such as tiredness and weight gain

This type of acanthosis nigricans is known as syndromic acanthosis nigricans.

Genes

In rare cases, acanthosis nigricans can be caused by a faulty gene inherited directly from your parents. This is known as familial or benign genetic acanthosis nigricans.

This type is usually passed on in an autosomal dominant pattern, which means it can be passed on if only one of your parents carries the faulty gene.

Cancer

If the dark skin patches come on suddenly and spread quickly, it may be a sign you have cancer (usually stomach cancer). This is known as malignant acanthosis nigricans.

This is a rare condition that tends to affect middle-aged or elderly people, regardless of their weight or ethnic background.

The patches are more severe and the mouth, tongue and lips may also be affected. The skin may also become irritated and itchy.

How acanthosis nigricans is treated

Treatment for acanthosis nigricans aims to correct the underlying cause of your symptoms. This will usually cure the acanthosis nigricans or significantly improve the appearance of your skin.

Treatments that may be recommended include:

losing weight, making changes to your diet and taking medication to reduce the level of insulin in your blood
taking treatments to correct your hormone levels – read about treating Cushing’s syndrome, treating polycystic ovary syndrome and treating an underactive thyroid
surgery, chemotherapy, or radiotherapy for cancer

There’s no specific treatment to get rid of the patches, but a dermatologist (skin specialist) may be able to recommend treatments such as creams or tablets that may help improve the look of your skin.

Outlook

Most cases of acanthosis nigricans are harmless and not a sign of anything serious. The skin patches often fade with time as the underlying condition is treated.

If you have inherited acanthosis nigricans from your parents, your patches may gradually get bigger before staying the same or eventually fading on their own.

Only in cases where there is underlying cancer is the situation very serious. If the tumour is successfully treated, the condition may disappear, but unfortunately the types of cancer that cause acanthosis nigricans tend to spread quickly and a cure is often not possible.

[Original article on NHS Choices website]