Archive | May 2020

QUOTE FOR THE WEEKEND:

“Gigantism is a serious condition that is nearly always caused by an adenoma, a tumor of the pituitary gland. Gigantism occurs in patients who had excessive growth hormone in childhood. The pituitary tumor cells secrete too much growth hormone (GH), leading to many changes in the body.  Gigantism usually presents in childhood or young adulthood. If a pituitary tumor that secretes growth hormone develops after the bone growth plates fuse, the result is acromegaly.”

UCLA Health Ed.

Gigantism, also knows as Acroemegaly.

 

Gigantism is described as accelerated growth during childhood from the production of excess growth hormone. By definition, gigantism must occur during childhood before the growth plates in the long bones of the body (for example, the femur or humerus) have closed. In adults, the condition is called acromegaly.

Gigantism is most often caused by a benign tumor on the pituitary gland called a pituitary adenoma. However, it can also be caused by the following disorders:

  • Neurofibromatosis
  • McCune-Albright syndrome (MAS)
  • Carney complex
  • Multiple endocrine neoplasia type 1

Sign and Symptoms of Gigantism:

  • Abnormally tall stature
  • Abnormal growth of the face, hands and feet
  • Thickened facial features
  • Irregular menstrual cycle
  • Excessive perspiration with slight activity
  • Delayed puberty
  • Double vision
  • Deafness
  • Headache

How Gigantism is Diagnosed:

Magnetic resonance imaging (MRI) is used to determine the size and location of your child’s tumor if it is suspected that the disease is caused by a pituitary adenoma.

Furthermore, several blood tests can provide a diagnosis. High levels of prolactin or increased amounts of insulin growth factor-1 (IGF-1) can suggest acromegaly, as can high levels of growth hormone in the blood after oral administration of a large dose of glucose. Low levels of cortisol, thyroid hormone, testosterone (in boys), and estradiol (in girls) can also suggest involvement of the pituitary gland.

Treatment for Gigantism:

Surgery

Surgery is the best form of treatment and cures 80 percent of the cases of gigantism. Your child’s surgeon will gain access to your child’s pituitary gland using the transsphenoidal approach—so named because the route crosses, or transects, the sphenoid bone. This bone is located behind your child’s nose, mostly within their skull.

Using precise surgical instruments, the surgeon will make an incision through your child’s nasal cavity to create an opening in the sphenoid bone. Once the surgeon gains access to your child’s sphenoid sinus (the air-filled area behind the sphenoid bone), further incisions will be made until a hole is created in the sella turcica—the bone that cradles and protects the pituitary gland.

After your child’s pituitary gland is in the operative field, removal of the tumor can proceed. Your child’s surgeon will use high magnification to readily distinguish normal pituitary tissue from the tumor.

Once the tumor has been removed, your child’s surgeon will clean the tumor cavity and seal it.

At Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center, our surgeons specialize in two types of surgery for adenomas:

  • Microsurgery uses a powerful operating microscope to help your child’s surgeon distinguish between tiny structures in and around the pituitary gland.
  • Endoscopic surgery uses small tubes and a tiny camera to help your child’s surgeon remove the tumor in small pieces.

Most patients are able to return home the day after their surgery for removal of a pituitary adenoma, and nasal packing is seldom required.

Pharmacological Treatment and Hormone Therapy

Treatment with a prescription medication is possible if surgery does not cure your child’s gigantism or if surgery is not recommended. Medicines are also sometimes prescribed before surgery to improve the likelihood of a good outcome.

  • Octreotide or lanreotide are synthetic forms of the hormone somatostatin and stop the release of growth hormone. They are often effective for the long-term control of gigantism, but they can only be administered by injection every two to four weeks. If your child’s tumor is particularly large, these drugs may be administered before surgery. Due to the side effects of these drugs and their expense, surgery to achieve a long-term cure is preferable.
  • Bromocriptine and cabergoline are from a class of drugs called dopamine agonists. They can lower IGF-1 and growth hormone levels in about half of the people treated with them (although your symptoms could improve even if your IGF-1 and growth hormone levels do not decrease). Although not as effective as the synthetic hormones octreotide and lanreotide, they are less expensive and more convenient to administer, because no injection is required. They can be combined with octreotide in children with no adverse effects on long-term health.
  • Pegvisomant is a recently developed drug that blocks the action of growth hormone in your body, thereby lowering IGF-1 levels. It must be administered by subcutaneous (beneath the skin) injection daily. It is another option if your child does not respond to surgery or other medications, or if your child cannot tolerate these treatments for other reasons.

Gamma Knife

Gamma Knife radiosurgery is a highly advanced form of radiotherapy that is used to achieve similar results to the traditional surgical techniques described above. However, with Gamma Knife it can take several years for growth hormone and levels to return to normal, rather than days or weeks as with traditional surgery. It is typically a treatment of last resort in patients with gigantism.

The ‘knife’ in this surgery is actually made up of many small beams of radiation focused on a single point. Each individual beam too weak enough to damage healthy tissue, but at the point where the beams converge they deliver a dose of radiation that is lethal to the tumor.

Gamma Knife is an outpatient procedure, does not involve any incisions, and requires only brief sedation under general anesthetic.

However, there are additional considerations for pediatric Gamma Knife surgery. These are best discussed with your child’s neurosurgeon.

 

QUOTE FOR FRIDAY:

34.2 million people, or 10.5% of the U.S. population, have diabetes. An estimated 26.8 million people – or 10.2% of the population – had diagnosed diabetes. Approximately 7.3 million people have diabetes but have not yet been diagnosed (2018).

Diabetes Research Institute Foundation

QUOTE FOR THE WEEKEND:

“Gigantism is a serious condition that is nearly always caused by an adenoma, a tumor of the pituitary gland. Gigantism occurs in patients who had excessive growth hormone in childhood. The pituitary tumor cells secrete too much growth hormone (GH), leading to many changes in the body.  Gigantism usually presents in childhood or young adulthood. If a pituitary tumor that secretes growth hormone develops after the bone growth plates fuse, the result is acromegaly.”

UCLA Health Ed.

QUOTE FOR THURSDAY:

“Insulin is a hormone made by the pancreas that allows your body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use. Insulin helps keeps your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia).”

EndocrineWeb (endocrineweb.com)

Simply Understanding Insulin and how people can get Diabetes!

Insulin is a hormone made by the pancreas that allows your body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use. Insulin helps keeps your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia).  How it works; when the glucose gets in your body after digestion starting from eating or even if your not eating by mouth but through IV with Dextrose in it (a form of sugar) or just on a feeding tube via a nasogastric tube or gastric tube (PEG) with Dextrose or some form of sugar in it will put glucose in your blood.  When you eat or drink, much of your food is broken down into a simple sugar called “glucose.”   All 3 routes of getting nutrition can cause your glucose count in the bloodstream to go up, if some form of sugar is in the nutrition supply you get in your body for the cells in our bloodstream.  Now glucose is food to our cells but the food has to get into the cells.  For glucose to pass into our cells it needs a hormone to allow the glucose to pass in the cell to be the food for the cell.  This is where Insulin comes into play!  Insulin is released by the pancrease and put in our bloodstream to do one of its MAIN functions to allow glucose in the cell.  For without insulin what happens is the glucose just will pile up outside of the blood cells and in time cause what we call Diabetes.  Without glucose going into our cells through insulin allowing it to pass in the cells we would not have energy that helps us in doing our activities of daily living.

So in review, the amount of glucose in your bloodstream is tightly regulated by the hormone insulin. Insulin is always being released in small amounts by the pancreas but especially after eating and when digestion takes place releasing the broken down sugar to “glucose” being released into our blood. When the amount of glucose in your blood rises to a certain level, the pancreas will release more insulin to push more glucose into the cells.

Diabetes mellitus (sometimes called “sugar diabetes“) is a condition that occurs when the body can’t use glucose (a type of sugar) normally. Glucose is the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas that it releases into the blood- stream when glucose level goes up allowing for it to be utilized by our body in allowing the glucose to transfer over the cell membranes into the cells as the main source of energy-a major form of nutrition for out cells to do its functions especially transfer oxygen throughout the body to keep our tissues healthy and alive.  Without oxygen we would have tissue and cell starvation.  Think in a diabetic when blood flow gets thick due to high glucose levels in the bloodstream making it difficult for the blood to move throughout our body to oxygenate our tissues the first place the body compensates to allow oxygenated blood by our cells to get to our vital organs like heart, lungs, brain and not areas far away from the body like feet.  That is why you commonly hear of amputations of lower legs with uncontrolled or badly controlled diabetics (arms amputated is very, very rare due to diabetes, more its due to trauma.

People with diabetes either don’t make insulin or their body’s cells are resistant to insulin, leading to high levels of sugar circulating in the blood, called simply high blood sugar. By definition, diabetes is having a blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an overnight fast (not eating anything).

So ending line without Insulin no glucose, a energy nutrition for our cells. we would not get glucose inside the cells. This as a ending result would cause cellular starvation of energy resulting into death in time (much sooner than other people without this problem) unless they take their insulin!

Another function of insulin is after our body uses all the glucose it needs at that time it needs to be stored somewhere.  Insulin helps control blood glucose levels by signaling the liver and muscle and fat cells to take in glucose from the blood.  To get the glucose level in therapeutic range for the body in time.

The 2 major groups of Diabetes occurs if someone has a problem with this role function of insulin resulting in one of the following:

Type 1 Diabetes occurs because the insulin-producing cells of the pancreas (called beta cells) are destroyed by the immune system. People with type 1 diabetes produce no insulin and must use insulin injections to control their blood sugar.  This is most commonly seen in people under age 20 but may occur at any age.

Type 2 Diabetes is the most common form of diabetes, affecting almost 18 million Americans. While most of these cases can be prevented, it remains for adults the leading cause of diabetes-related complications such as blindness, non-traumatic amputations, and chronic kidney failure requiring dialysis. Type 2 diabetes usually occurs in people over age 40 who are overweight, but can occur in people who are not overweight as well.Sometimes referred to as “adult-onset diabetes,” type 2 diabetes has started to appear more often in children because of the rise in obesity in young people.

Sometimes referred to as “adult-onset diabetes,” type 2 diabetes has started to appear more often in children because of the rise in obesity in young people.

Some people can manage their type 2 diabetes by controlling their weight, watching their diet, and exercising regularly. Others may also need to take a pill that helps their body use insulin better, or take insulin injections.

Often, doctors are able to detect the likelihood of type 2 diabetes before the condition actually occurs. Commonly referred to as pre-diabetes, this condition occurs when a person’s blood sugar levels are higher than normal, but not high enough for a diagnosis of type 2 diabetes.

Know this diabetes can be hereditary as well.

Maybe you might want to get your glucose checked by your M.D. and make sure your insulin is functioning well for the side effects of uncontrolled diabetes are detrimental and could shorten your life!

 

QUOTE FOR WEDNESDAY

“An enzyme is a biological catalyst and is almost always a protein. It speeds up the rate of a specific chemical reaction in the cell. The enzyme is not destroyed during the reaction and is used over and over. A cell contains thousands of different types of enzyme molecules, each specific to a particular chemical reaction.”
 
National Human Genome Research Institute

QUOTE FOR TUESDAY:

“Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious.”

CDC (cdc.org)

COVID-19 and where we are at; including other pandemics in history!

Global coronavirus epidemic outbreak concept – 3D illustration

Coronavirus Cases:

5,532,110

Deaths:

347,243

Recovered:

2,319,216

Now Let Us Look At 1918-1919 H1N1 Swyne Flu statistics

CDC states: “The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.”

So H1N1 affected 500 million people  1/3 of the world at that time.

H1N1 by 1918 killed 50 million deaths.

Covid-19 is not even close in numbers.  No comparison and there was a lock down 6 weeks in the US for H1N1 1918 to 1919. 

The 100-year anniversary of the 1918 pandemic and the 10-year anniversary of the 2009 H1N1 pandemic are milestones that provide an opportunity to reflect on the groundbreaking work that led to the discovery, sequencing and reconstruction of the 1918 pandemic flu virus. This collaborative effort advanced understanding of the deadliest flu pandemic in modern history and has helped the global public health community prepare for contemporary pandemics, such as 2009 H1N1, as well as future pandemic threats. ”

By the numbers of both pandemics this is shown to be true (Covid -19 compared to our deadliest pandemic 1918-1919 Swine Flu=The Spanish Flu doesn’t even come close in numbers of how many affected and killed).

Covid over 500,000 affected and H1N1  over 5,000,000. See the difference and we will get through this.

H1N1 in 2009-2010:

“From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.”.
Ending line, history does repeat itself and there have been pandemics worse, similar, or less but significant in count to be called a pandemic.
We needed to lock down but now we are ready to reopen.   God willing it stays that way and by history pandemics the research on Covid-19 will get better in treating and being prepared for this.  Also, our economy will get better in time.

QUOTE FOR THE WEEKEND:

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance where for others it could be a lot worse.

MAYO CLINIC