THE TUMOURS COSECRETING THE HORMONE

THE TUMOURS COSECRETING THE HORMONE OF GROWTH: THE ACROMEGALIA Hypersecretion is bound usually to a tumour of a pituitary body which approximately at 20 of patients contains eosinophilic, and at the others - chromophobic granules. However by means of a submicroscopy in a combination to special methods cytochemical and colourings manage to be found out STG-CONTAINING secretory ultram granules almost in all chromophobic tumours [155]. Presence or absence filled in cells of a tumour does not correlate secretory granules with level in plasma, and reflects a parity between ability of a cell to store a hormone, on the one hand, and to synthesise and cosecrete it is with another. Absence of secretory granules specifies, however, on rather smaller tumours that is in turn reflected in rate of its growth. Really, eosinophilic adenomas usually have the smaller sizes, grow more slowly and frame possibility of long development of signs and symptoms of hypersecretion whereas chromophobic tumours often find out faster growth and are accompanied by symptoms of expansion of tumoral mass at smaller expression of signs of hypersecretion . Signs and symptoms Classical implications StG-sekretnrujushchih of tumours are caused by one or more of following three factors: tumour expansion, insufficiency hormones and hypersecretion .
The clinical signs defined by first two factors, already were surveyed, their frequency at patients with StG-sekretirujushchimi tumours in the past was rather appreciable. With the advent of possibility of earlier diagnostics these signs meet rather less often. Signs and symptoms of hypersecretion usually appear after 20-30 years of a life and develop slowly. Before all as shown signs edemas and a hypertrophy of the soft tissues, extending on extremities and the person ( 7-14) serve. The photos received with 10-20- by an interval, often testify to progressing changes of appearance of the patient. Changes of extremities are most expressed in the field of brushes and feet: fingers become , and the augmentation of volume of soft tissues leads to necessity constantly to enlarge the size of rings, gloves and footwear. The skin also becomes buy pyridium online rasping, and expression of dermal cords amplifies. The generalised hirsutism can develop and amplify pigmentation. 1/4 patients have dermal fibrous nodules and sometimes it becomes perceptible acanthosis nigricans. The secretion of sebaceous glands causing fat content of a skin and formation of cysts, and also tongue often amplifies. At patients with the most active acromegalia the raised sweating serving by a sensitive clinical indicator of activity of process is shown. Osteal changes develop more slowly and include a thickening of a cortical layer of bones, formation of osteal outgrowths and thorns in the field of trailer phalanxes. The hypertrophic arthropathy accompanied by a thickening and eventually by a degeneration of articulate cartilages, and a hypertrophy of ligaments cause occurrence of the symptoms varying from an easy arthralgia to a deforming arthritis, conducting to physical inability. The mandible that leads to a prognathism and appreciable the bottom incisors is considerably enlarged. Besides, intervals between a teeth are often enlarged. Osteal edges of a skull and often expand frontal, malar and nasal bones. Osteal sinuses, as a rule, are enlarged in size, that together with a hypertrophy of vocal chords leads to deep voice occurrence. The hypertrophy of mucosas causes sometimes an occlusion of acoustical pipes and development of a serous inflammation of a middle ear. If hypersecretion begins in the childhood before merge of epiphyseal plates the growth augmentation usually happens proportional that leads to a true gigantism. Owing to frequent development of a hypogonadism closing of epiphyseal clefts is late, and term of possible growth is extended. Growth of the most known the giant (giant Alton) reached 3 m. to the Thicket it is necessary to observe patients with the admixed lines of a gigantism and an acromegalia that reflects conservation of a hypersecretion of a hormone of growth at mature age. On modern data, StG-sekretirujushchie tumours make 20 of all adenomas of a pituitary body diagnosed in the childhood [156]. Often it becomes perceptible peripheric , caused by a combination: 1 - prelums of nerves owing to growth of surrounding ligaments and a fibrous tissue, that affects a median nerve (a carpal tunnel syndrome) more often and is more rare - on spinal nervous roots and cauda equina; 2 - demyelinations of axons of peripheric nerves in connection with a proliferation perineural and elements that leads to possibility to palpate nerves [157].