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Typical changes in the viscerocranium in acromegaly.

A Künzler·M Farmand
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Abstract

31 patients (mean age 52.7 years) suffering from persistent symptoms of a growth hormone-producing pituitary adenoma underwent both clinical and radiological examination at least one year after transnasal extirpation of the tumour. The results of standardized X-ray analysis of the viscerocranium were compared with a group of 21 healthy subjects (mean age 42.1 years): Although several remarkable changes of the facial skeleton were observed, statistically significant changes could be found in the lower jaw only. The ascending ramus as well as the mandibular body were found to be elongated. The main contribution to the elongation was made by the chin prominence and the condyle. Two different growth patterns of the mandible could be determined; neither of them was pathognomonic for acromegaly. Due to overgrowth of the septal cartilage in 7 patients we found a so-called "hanging columella". In 16 patients the mandibular canal was widened and showed marked deviations in its diameter or a funnel-shaped mandibular foramen.

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AcromegalyAdenomaAdultAgedCephalometryChinFaceFacial BonesFemaleHumansMaleMalocclusion, Angle Class IIIMandibleMandibular CondyleMiddle AgedNasal SeptumPituitary NeoplasmsRadiography, PanoramicSkin AgingTemporomandibular JointTomography, X-RayJournal Article

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A Künzler, M Farmand. 1991. Typical changes in the viscerocranium in acromegaly.. https://doi.org/10.1016/s1010-5182(05)80274-4

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PubMed2007

Protein metabolism in acromegaly: differential effects of short- and long-term treatment.

CONTEXT: GH acutely increases body protein by stimulating protein synthesis and reducing protein oxidation. OBJECTIVE: The objective of the study was to determine whether these changes in protein metabolism are sustained in long-term GH excess and reversed by correction. DESIGN: We conducted a cross-sectional study in 16 acromegalic and 18 normal subjects and a longitudinal study in which acromegalic subjects were studied before and after short-term (n=8) or long-term (n=10) treatment. SETTING: The study was conducted at a clinical research center. MAIN OUTCOME MEASURES: Whole-body rates of leucine appearance (leucine Ra; an index of protein breakdown), leucine oxidation, and nonoxidative leucine disposal (NOLD; an index of protein synthesis) estimated using infusion of 1-[13C] leucine were measured. RESULTS: Leucine Ra and NOLD were greater (P<0.01) in acromegalic compared with normal subjects, whereas leucine oxidation did not differ. Leucine oxidation increased significantly (P<0.05) after short-term treatment but returned to baseline after long-term treatment. Both leucine Ra and NOLD decreased significantly (P<0.05) after short- and long-term treatment. Adjustment for body composition did not affect results. CONCLUSIONS: In acromegalic subjects, protein breakdown and synthesis are increased, whereas protein oxidation does not differ from normal subjects. Protein oxidation increases transiently, whereas protein breakdown and synthesis are stably reduced after treatment. Because protein oxidation represents irreversible loss, we conclude that the normal state of protein oxidation found in acromegaly and after long-term treatment represents metabolic adaptation, which maintains protein mass at a steady state after stable changes in GH status.

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