There are appreciable disagreements

There are appreciable disagreements of, whether the acromegalia is primary the disease caused by development of an independent tumour, or it has subthalamic (or other central-nervous) a parentage bound to supersecretion StG-rilizing of pyridium the factor (or, probably, with secretion depression ) ( 7-15). In favour of a subthalamic parentage of disease the following testifies: 1 - at the majority sick of an acromegalia secretion is not independent, and the insulinic hypoglycaemia and an arginine reacts to the stimulus mediated by a hypothalamus, such, as a glucose. It means, that , despite the tumoral degeneration, keep ability to react to the signals arriving from a hypothalamus; 2 - the tumours of a hypothalamus accompanied by hypersecretion and an acromegalia, testify to possible participation in process StG-rilizing of the factor; 3- to plasma sick the activity shown in experiences in vitro [171 173] is present an acromegalia StG-rilizing; 4 - the acromegalia caused StG-sekretirujushchimi by tumours, disappears after excision bronchial carcinoid or tumours which contain StG-rilizing the factor [169-170]. Thus, hypersecretion and even a pituitary body tumour can develop in reply to long stimulation StG-rilizing by the factor; 5 - besides, reactions to inhibition by a glucose and stimulation by insulin at check after excision StG-sekretirujushchih of adenomas usually remain broken even if initial level is in limits of norm [174]; b-at last, secretion at an acromegalia changes under influence agents (a-adrenergic antagonists and b-adrenergic agonists) [175] which as consider, operate within .
All these arguments testify to a subthalamic parentage of hypersecretion , but do not exclude formation possibility eventually an independent tumour of a pituitary body. Data about initially genesis StG-sekretirujushchih of tumours are based on two observations: 1 - in some cases after a full oncotomy there came normalisation not only level , but also its secretory reactions to the signals mediated by nervous system [176]; 2 - histological research of a tissue , surrounding a tumour, does not find out hyperplasia signs [177]. Discrepancy of data does not allow to come now to the certain conclusion. However it is quite possible, that exists two subgroups of the acromegalia, one of which has subthalamic, and another - a parentage. To part these two groups it is possible, possibly, by means of detailed inspection of the patient to an oncotomy and during the various periods after its excision though for the definitive answer specific methods of definition in blood StG-rilizing of the factor and a subthalamic parentage buy ultram tramadol can be demanded. Treatment There are three kinds of treatment of an acromegalia: surgical, an irradiation and medicinal (pharmacological) therapy. As well as at patients with nonfunctioning tumours of a pituitary body, it is necessary to consider consequences of diffusion of tumoral mass in a skull, necessity of conservation of residual function of a pituitary body and replaceable therapy at deficiency of hormones. Hypersecretion a tumour does not change the bases for treatment tumours. In the given section efficiency of various kinds of treatment mainly concerning normalisation of level and a softening of clinical semiology of its hypersecretion is discussed. Treatment problems consist in correction of metabolic disturbances, liquidation whenever possible changes of soft tissues and a suspension of increase of osteomuscular complications. Can be noted and some regress of osteal changes, but it meets rather seldom. It was informed, that depression of level favorably influences preexisting cardiovascular diseases, though and not at all patients. Now acromegalia treatment does not depend on that, it subthalamic or has a parentage. However prior to the beginning of the treatment referred on a pituitary body, it is necessary to survey carefully development possibility tumours ( or from pancreas islets) which excision can liquidate hypersecretion . Surgical intervention Surgical excision StG-sekretirujushchih of tumours by means of transsphenoidal or face-to-face access is a fast and effective method of treatment of an acromegalia. Indications and contraindications to operation, including the dangers interfaced to it, do not differ from those at nonfunctioning tumours, behind that exception, that if the acromegalia diagnosis is established, the surgical intervention is justified even at the minimum radiological data. The efficiency of operation varying in different groups of patients, reaches 92 if its criterion to consider depression of maintenance in plasma to norm [177]. [146, 178-180] it is possible to explain some discrepancies of this indicator differences in understanding different authors of the term "normalisation" of level (for example, initial level 10 ng/ml either 5 ng/ml, or its level after reception of a glucose 5 ng/ml).