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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- In order to prevent wounds from occurring, healthcare providers recommend that individuals: take care when using sharp objects such as knives, scissors, saws, and trimmers; wear shoes or boots on the feet; use helmets when riding a bicycle; use helmets, kneepads, wrist protectors, and elbow pads when using in-line skates or skateboards; and avoid picking up broken pieces of glass and handling razor blades.
- If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, healthcare providers recommend that the individual be checked for pressure sores every day. Also, look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps: change position at least every two hours to relieve pressure; use items that can help reduce pressure such as pillows, sheepskin, foam padding, and powders from medical supply stores; eat healthy, well-balanced meals; exercise daily, including range-of-motion exercises for immobile patients; and keep skin clean and dry. Incontinent people need to take extra steps to limit moisture.
- Individuals with diabetes should check their feet daily for blisters, sores, or other wounds in order to prevent serious infection and possibly amputation.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
- General: The adrenal glands are located just above each of the two kidneys. These glands secrete cortisol, also called hydrocortisone. Cortisol, often called the stress hormone, regulates the body's response to stress. It regulates proper glucose metabolism, blood pressure, and insulin release for blood sugar maintenance. It is also involved in the inflammatory response.
- The adrenal glands also secrete aldosterone, which belongs to a class of hormones called mineralocorticoids. This hormone helps the kidneys retain sodium and expel potassium. As a result, the hormone helps regulate blood pressure and the water and salt balance in the body.
- Addison's disease: Addison's disease, also called adrenal insufficiency or hypocortisolism, is a rare hormonal disorder that is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and occasional darkening of the skin.
- Addison's disease develops when the adrenal glands do not produce enough cortisol. Some patients with the disease may also have low levels of aldosterone. When aldosterone production falls too low, the kidneys are unable to regulate the salt and water balance, subsequently causing blood volume and blood pressure to drop.
- Addison's disease can be caused by a primary adrenal insufficiency. This type of deficiency occurs when the outer layer of the adrenal glands (called the adrenal cortex) is damaged and does not produce enough cortisol. Adrenal insufficiency occurs when at least 90% of the adrenal cortex has been destroyed. Several conditions, including autoimmunity, polyendocrine deficiency syndrome, and tuberculosis infection, may lead to primary adrenal insufficiency.
- Secondary adrenal insufficiency occurs when the adrenal glands are healthy, but factors outside of the adrenal glands cause them to produce less cortisol. The most common cause of secondary adrenal insufficiency occurs when patients who are taking cortisol-like drugs (corticosteroids) suddenly stop taking the medication. These drugs, which can be inhaled, taken by mouth, or injected into a vein, suppress the hypothalamic corticotropin releasing hormone (CRH) and adrenocorticotropic hormone (ACTH). CRH stimulates the release of ACTH, which then stimulates the adrenal glands to release cortisol hormones. Prolonged suppression of the adrenal glands may lead to shrinkage (atrophy), and it may take several weeks or months for the patient to recover to full function after the drug is discontinued. Therefore, patients should slowly taper off mediations under the supervision of their healthcare providers.
- Secondary adrenal insufficiency may also occur if the pituitary gland does not produce adequate amounts of ACTH, the chemical that signals the adrenal glands to release cortisol. Consequently, individuals who have low levels of ACTH will also have low levels of cortisol, even if the adrenal glands are healthy.
- Symptoms of Addison's disease typically develop slowly, often over several months. Physical stress, such as injury, infection, or illness, may cause symptoms to appear suddenly. Common symptoms include muscle weakness and fatigue, decreased appetite (which may cause weight loss), darkening of the skin, low blood pressure, fainting, cravings for salt, low blood sugar levels, irritability, depression, diarrhea, nausea, and vomiting.
- Patients who have untreated Addison's disease may experience Addisonian crisis, also known as acute adrenal failure. This typically occurs in response to physical stress, such as an injury, infection, or illness. Addisonian crisis is a serious condition that can be life threatening. Symptoms of Addisonian crisis may include lower back pain, abdominal pain, leg pain, low blood pressure, loss of consciousness, and severe vomiting and diarrhea that may lead to dehydration.
- Addison's disease is diagnosed after the adrenocorticotropic hormone (ACTH) test is performed. This test measures the level of cortisol in the blood and urine before and 30-60 minutes after an injection of tetracosactide (man-made ACTH). Individuals who do not have adrenal insufficiency will begin producing cortisol in response to the injection. Patients with Addison's disease will produce minimal or no cortisol in response to the injection.
- If the patient tests positive to the ACTH test, a corticotropin releasing hormone (CRH) stimulation test is conducted to determine the cause of adrenal insufficiency. The patient's cortisol levels are measured in the urine and blood before the test. Then, a man-made CRH is injected into the patient's vein. Cortisol levels in the blood and urine are then measured 30, 60, 90, and 120 minutes after the injection. Patients with primary adrenal insufficiency have high levels of ACTH but do not produce cortisol. Patients with secondary adrenal insufficiency have will have very low cortisol levels in response to the injection and absent or delayed ACTH responses. Absent ACTH responses indicate that the pituitary gland is causing the disease. A delayed ACTH response indicates that the hypothalamus (part of the brain that controls the release of hormones from the pituitary gland) is the cause.
- Since patients with Addison's disease do not produce enough hormones, treatment may include one or more hormones to replace the deficiency. Corticosteroids, such as hydrocortisone (Cortef® or Hydrocortone®), prednisone, cortisone, and dexamethasone (Decadron®, Baldex®, or Dexone®), are used to replace cortisol. Mineralocorticoids, such as fludrocortisone (Florinef®), are used to replace aldosterone.
- Addisonian crisis (acute adrenal failure) is a life-threatening condition that requires immediate medical care. Treatment generally includes intravenous injections of hydrocortisone, saline solution, or sugar (dextrose).
- Cushing's syndrome: Cushing's syndrome, or hypercortisolism, is a condition that is characterized by a fatty hump between the shoulders (buffalo hump), a rounded face (moon face), and pink or purple stretch marks on the skin.
- The condition is caused by long-term exposure to high levels of cortisol, a hormone that reduces inflammation (swelling) in the body.
- Excessive cortisol levels may be caused by factors outside of the body (exogenous), such as medications. It may also be caused by factors inside the body (endogenous).
- Cushing's syndrome is most often caused by high doses of cortisol-like medications (corticosteroids), which are often prescribed to treat chronic inflammation. Cushing's syndrome may also develop if the adrenal glands make too much cortisol or if the pituitary gland releases too much adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to release cortisol. When excessive secretions of ACTH cause the condition, it is called Cushing's disease. Tumors may also cause these glands to produce too many hormones.
- Common symptoms of Cushing's syndrome include weight gain (especially around the midsection and upper back), buffalo hump (fatty hump between the shoulders), fatigue, muscle weakness, rounded face (often called moon face), facial flushing, thin and fragile skin that bruises easily, depression, anxiety, irritability, hirsutism (thicker or more visible body and facial hair), irregular or absent menstrual periods in females, erectile dysfunction in males, high blood pressure, acne, and pink or purple stretch marks on the skin of the abdomen, thighs, breasts, and arms.
- Cushing's syndrome may be fatal if left untreated. Severe symptoms may include high blood pressure, bone loss, kidney stones, infections, and sometimes, diabetes.
- Urine, blood, and saliva tests are conducted to determine if the patient has elevated levels of cortisol in the body. Patients who have excessive cortisol levels will then undergo body scans that produce pictures of the internal organs to determine if a tumor inside the body is causing the condition. If the patient is taking corticosteroids, it is usually suspected that the medication is causing the condition. These tests may also help the healthcare provider rule out other medical conditions with similar symptoms.
- Treatments for Cushing's syndrome are designed to lower the level of cortisol in the body. Treatment options vary, depending on the cause of the syndrome. Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
- Patients may be advised to reduce or discontinue corticosteroid use if the condition is drug-induced. Many conditions that are treated with corticosteroids can also be treated with non-corticosteroid drugs. This allows the patient to either reduce or eliminate the use of corticosteroids altogether. However, patients should not stop taking medications until they consult their healthcare providers.
- If a tumor is causing the condition, treatment may include surgery and/or radiation therapy.
- In some instances, patients with Cushing's syndrome never experience a resumption of normal adrenal function and lifelong hormone replacement therapy is necessary. Medications that are commonly used to control excessive production of cortisol include ketoconazole (Nizoral®), mitotane (Lysodren®), and metyrapone (Metopirone®).
Gonads (testes and ovaries)
- General: The gonads (testes or ovaries) help the body maintain normal physiological function. They secrete hormones that are essential for reproductive function, development of secondary sexual characteristics, body composition, and mood.
- The male gonads (testes) produce testosterone, while the female gonads (ovaries) secrete estrogen and progesterone.
- Hypogonadism: Hypogonadism is a hormonal disorder that occurs when the gonads are underactive. Hypogonadism disorders are more common among males than females.
- Primary hypogonadism occurs when the gonads are directly affected. Common causes of primary hypogonadism in males include Klinefelter's syndrome, undescended testicles, mumps orchitis, hemochromatosis, testicle injury, or cancer treatment. Common causes of primary hypogonadism in females include cancer treatment and injury to the ovaries.
- Secondary hypogonadism occurs when other parts of the body, such as the hypothalamus or pituitary gland, are causing the gonads to be underactive. Common causes of secondary hypogonadism in males and females include Kallman syndrome, medications called opiates, inflammatory diseases (such as sarcoidosis), and obesity.
- If the body does not produce enough testosterone during fetal development, the growth of sex organs may be impaired. Male children born with hypogonadism may have female genitals, ambiguous genitals that are neither male nor female, or underdeveloped male genitals. If hypogonadism occurs during puberty, the male may experience decreased development of muscle mass, impaired growth of body hair, impaired growth of genitals, excessive growth of the arms and legs in proportion to the trunk of the body, development of breast tissue, and lack of deepening of the voice. Males who develop hypogonadism during adulthood may experience erectile dysfunction, infertility, decreased body hair growth, increased body fat, decreased testicle size, decreased muscle mass, development of breast tissue, and osteoporosis (hollow, brittle bones).
- Female children with hypogonadism may not menstruate or develop breasts. They are typically short in stature. Females who develop hypogonadism after puberty may experience a loss of menstruation, decreased libido, hot flashes, and loss of body hair.
- Hypogonadism is diagnosed when a patient experiences symptoms that are characteristic of the disorder and has low levels of sex hormones in the blood. Males will have low levels of testosterone, while females will have low levels of estrogen and progesterone. Additional tests may be performed to determine the underlying cause.
- Patients with hypogonadism typically receive hormone replacement therapy (HRT). Males with hypogonadism typically receive testosterone injections. This treatment has been shown to stimulate puberty and restore fertility in patients. Females may take estrogen pills by mouth, injection, or skin patch. Females usually take progesterone as well because it helps prevent the overgrowth of the uterine lining and uterine cancer.
- Menopause/Andropause: Males and females experience a natural decrease in their sex hormones with age.
- As females age, they are less likely to become pregnant because the ovaries no longer release estrogen. This gradual decline in fertility usually starts very subtly in the late 20s to age 35. Once a female goes through menopause, she is no longer able to become pregnant. Most females go through menopause when they are 40 years old or older. Common symptoms of menopause include hot flashes, irritability, vaginal dryness, mood swings, anxiety, difficulty concentrating, loss of sex drive, weight gain, depression, and tender breasts. After menopause, women have an increased risk of developing osteoporosis, a condition which causes the bones to become hollow and brittle. This is because the lower levels of estrogen in the body accelerate bone loss.
- As males age, they tend to experience a decrease in their sex hormone, which is called testosterone. This process is called andropause. Most males go through andropause when they are between the ages of 40 and 55 years old. Common symptoms of andropause include fatigue, depression, hot flashes, night sweats, infertility, decreased sex drive, and erectile dysfunction. Erectile dysfunction, also called impotence, occurs when a male is unable to achieve or maintain an erection. After andropause, men have an increased risk of developing osteoporosis.
- If it is suspected that a patient is going through menopause, a blood sample may be taken to measure the amount of follicle stimulating hormone (FSH). Patients who have high levels of the hormone (50 international units of FSH per liter of blood or more) have undergone menopause.
- If it is suspected that a male patient is going through andropause, a blood sample may be taken to measure the amount of testosterone in the blood. Males who have undergone andropause will have low levels of testosterone in their blood.
- Patients experiencing menopause may benefit from hormone therapy with estrogen to help alleviate symptoms. However, according to research, patients who receive estrogen have an increased risk of stroke. Patients should consult their healthcare providers to determine the potential health benefits and risks associated with hormone therapy.
- Hormone therapy is not used to treat andropause. However, males who experience erectile dysfunction as a complication of andropause may receive treatment. Several drugs, including sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®) have been used treat males who experience erectile dysfunction as a result of aging. These drugs are taken by mouth a few hours before sexual activity. These drugs should not be taken more than once every 24 hours. In general, side effects may include headache, upset stomach, diarrhea, dizziness, flushing, or stuffy nose. Serious side effects may include sudden severe loss of vision, blurred vision, changes in color vision, painful erection, priaprism (prolonged erection lasting longer than four hours), fainting, chest pain, difficulty breathing, hoarseness, itching or burning during urination, and rash. Patients should seek immediate medical treatment if any of these serious side effects develop.
- General: The pancreas is an elongated organ located behind the stomach. The pancreas secretes hormones, called insulin and glucagon, which regulate the amount of sugar (glucose) in the blood.
- Hyperglycemia: Hyperglycemia is a hormonal disorder that occurs when there is too much sugar in the blood. Blood sugar increases when there is not enough insulin in the blood, or if the body cannot properly use insulin.
- If left untreated, hyperglycemia may cause serious health problems, including ketoacidosis, which occurs when toxic waste products (ketones) build up in the blood. Ketoacidosis is a life-threatening condition that requires immediate medical treatment.
- Hyperglycemia is caused by diabetes. Diabetes occurs when patients are not able to produce insulin or are unable to use insulin properly to process sugar. All patients with diabetes develop hyperglycemia from time to time. Diabetics may develop hyperglycemia if they eat too much, do not exercise enough, or forget to take their medications. It may also occur if patients are exposed to physical stress (such as cold temperatures or infections) or emotional stress.
- Symptoms of hyperglycemia typically include frequent urination, and increased thirst. Symptoms of ketoacidosis include shortness of breath, breath that smells fruity, nausea, vomiting, and dry mouth. Patients who experience these symptoms should seek immediate medical treatment.
- Diabetics can determine whether or not they have hyperglycemia by checking their blood sugar levels. If patients have more than 240 milligrams of sugar per deciliter of blood, they should seek medical treatment because they are at risk of developing ketoacidosis.
- Patients who have hyperglycemia can take steps to lower their blood sugar levels. Exercise may help decrease blood sugar levels. However, exercise should be avoided if ketoacidosis is suspected. Exercise during ketoacidosis may actually increase blood sugar levels.
- Patients should take their diabetic medications if the condition occurred because a dose of medication was missed.
- Patients who have symptoms of ketoacidosis should seek immediate medical treatment. Patients typically receive intravenous insulin therapy. Patients also require fluid and electrolyte replacement. After treatment, patients will meet with their healthcare providers to determine what triggered the episode and how to prevent it from occurring in the future.
- Hypoglycemia: Hypoglycemia (low blood sugar) is a hormonal disorder that occurs when there is too much insulin in the blood.
- Hypoglycemia occurs most often in diabetics. If diabetics take too much insulin or other medications used to treat their condition, hypoglycemia may develop.
- Many other conditions may lead to low blood sugar levels in patients who do not have diabetes. For instance, some types of cancer, critical illnesses (such as kidney, heart, or liver failure), and some medications may lead to hypoglycemia. Patients who drink excessive amounts of alcohol without food may develop hypoglycemia. Patients with anorexia nervosa or patients who do not eat enough food may develop hypoglycemia. Tumors of the pancreas may stimulate the pancreas to release too much insulin, which may then lead to hypoglycemia.
- Common symptoms include confusion, abnormal behavior, impaired vision (such as blurred or double vision), irregular heartbeat, tremors, anxiety, sweating, and hunger. In rare cases, patients may develop seizures or lose consciousness.
- Healthcare providers use a method called Whipple's triad to diagnose hypoglycemia. First, healthcare providers will evaluate the patient's signs and symptoms during a physical examination. In some cases, a healthcare provider may have the patient fast for 24 hours before the exam. Next, the healthcare provider will take a sample of the patient's blood to determine how much sugar is present. The last step needed to confirm a diagnosis is evaluating the patient's symptoms after blood sugar levels are raised. Patients with hypoglycemia will experience no symptoms once their blood sugar levels are increased.
- Treatment of hypoglycemia involves short-term steps to increase the patient's blood sugar level. It also involves long-term steps to identify and treat the underlying cause of hypoglycemia.
- Patients with hypoglycemia will first receive treatment to reduce symptoms. Patients may receive glucose tablets or eat foods high in sugar (such as candy) to increase blood sugar levels. In severe cases, patients may require intravenous glucose or an injection of the glucagon hormone.
- Once initial symptoms are treated, healthcare providers will work with the patient to determine the underlying cause of symptoms. Treating the underlying cause reduces the chances of hypoglycemia occurring in the future. If a tumor in the pancreas is causing symptoms, patients may need to have it surgically removed. If a medication is causing the condition, an alternative drug or dose may be recommended.
- General: The thyroid gland, located in the neck, produces two hormones, called thyroxine and triiodothyronine. These hormones control growth and the rate at which the body uses energy (metabolism).
- Hyperthyroidism: Hyperthyroidism occurs when the thyroid gland produces too much thyroxine. As a result, the patient's metabolism increases dramatically, causing sudden weight loss and irregular heartbeat.
- Most patients fully recover from hyperthyroidism with lifelong treatment. However, if left untreated, the condition may be life threatening. Complications may include heart problems, brittle bones, and thyrotoxic crisis (also known as "thyroid storm"). Thyrotoxic crisis occurs when symptoms suddenly become extreme, causing fever, increased heartbeat, and sometimes delirium.
- The most common cause of hyperthyroidism is Grave's disease. Grave's disease is an autoimmune disorder because it occurs when the immune system mistakenly attacks the thyroid gland, stimulating the gland to produce more hormones.
- Non-cancerous tumors (abnormal growths) on the thyroid gland may also lead to hyperthyroidism. Some tumors may produce excess thyroid hormone and cause the gland to become enlarged.
- Hyperthyroidism may also occur if the thyroid gland becomes inflamed. When the gland is swollen, stored thyroid hormone may leak into the bloodstream. Researchers do not know what causes the gland to swell in some patients.
- Common symptoms of hyperthyroidism include sudden and unexplained weight loss, increased or irregular heartbeat, nervousness, irritability, tremors (especially in the hands), increased sweating, abnormal menstruation, increased sensitivity to warmth, more frequent bowel movements, enlarged thyroid gland (goiter), fatigue, difficulty sleeping, and muscle weakness. Some patients may be unable to close the eyelid (eyelid retraction). Some patients may also experience lid-lag. This occurs when the eyelids do not move down when the patient's eye looks downward.
- A blood test is the standard diagnostic test for hyperthyroidism. Patients with the condition will have high levels of thyroxine and low or nonexistent levels of thyroid stimulating hormone (TSH) in the blood.
- There are several treatments available for hyperthyroidism. Patients typically take radioactive iodine by mouth. The thyroid gland absorbs this medication, which stimulates the gland to shrink. Symptoms usually start to improve within three to six months of treatment. However, many patients develop hypothyroidism as a result of radioactive iodine treatment. If hypothyroidism develops, patients need to take thyroxine (Euthyrox®, Levothroid®, Levoxyl®, Synthroid®, or Unithroid®) for life.
- Patients may also medications, such as propylthiouracil or methimazole (Tapazole®), which reduce the amount of hormones released by the thyroid. Symptoms usually start to improve within six to 12 weeks of treatment. These medications do not cure hyperthyroidism. They are taken to manage symptoms until the underlying cause is treated. Patients generally take these drugs for one year or longer.
- Surgery is also an option for some patients. During the procedure, most of the gland is removed. As a result, the remaining thyroid gland produces very limited amounts of thyroid hormones. Patients will need to take a man-made version of the thyroid hormone, called levothyroxine (Euthyrox®, Levothroid®, Levoxyl®, Synthroid®, or Unithroid®) for the rest of their lives in order to make up for the decreased thyroid gland.
- Patients may take drugs called beta-blockers to decrease a rapid heartbeat. These medications are used in the short-term, until the hyperthyroidism is successfully treated.
- Hypothyroidism: Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormone.
- A condition called Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States. Hashimoto's thyroiditis occurs when the patient's immune system attacks the thyroid gland. Researchers have not discovered why the immune system mistakes the thyroid for a harmful invader, such as a virus. It has been suggested that many factors lead to the disorder, including age, heredity, and gender. This is because the condition is most common among middle-aged women. It also common among biological family members.
- Hypothyroidism may also occur if patients do not consume enough iodine in the diet. This is most common in poor countries where malnutrition is common.
- Common symptoms of hypothyroidism include sensitivity to cold temperatures, mild weight gain, fatigue, constipation, small thyroid gland, enlarged neck, dry skin, hair loss, muscle cramps, heavy and irregular menstruation, and difficulty thinking or concentrating. Less common symptoms main include facial swelling and joint stiffness. The most obvious sign of severe hypothyroidism is a goiter. A goiter is a severe swelling of the thyroid gland in the front of the neck.
- Hypothyroidism is diagnosed after a blood test is performed. The test measures the amount of thyroid hormone in the blood. If the patient has low levels of thyroid hormone in the blood, the patient is diagnosed with hypothyroidism.
- Patients with hypothyroidism receive thyroid hormone replacement therapy with levothyroxine (Levothroid®, Levoxyl®, Synthroid®, or Unithroid®). This man-made hormone is identical to the natural thyroid hormone called thyroxine. The medication is taken by mouth every day for life to help the body maintain normal functioning.
- Although goiters generally do not cause pain, a large goiter may interfere with swallowing or breathing and it may affect the patient's appearance and self-esteem. In many cases, goiters will be cured once hormone replacement therapy is started. However, some patients may need to have their goiter surgically removed.
- Patients should visit their healthcare providers every six to 12 months to monitor their hormone levels. Over time, the dosage may need to be changed. If the dose is too high, patients may develop a condition called osteoporosis, which causes the bones to become hollow and brittle. Also, excessive doses may lead to irregular heartbeats (arrhythmias). In order to prevent complications of overdose, patients with a history of heart disease, osteoporosis, or severe hypothyroidism may receive smaller doses that are gradually increased over time.
- General: The pituitary gland is a pea-sized gland that is located at the base of the brain. Many experts consider the pituitary gland to be the most important part of the endocrine system because it secretes hormones that regulate the functions of many other endocrine glands.
- The pituitary gland secretes growth hormone (GH), which regulates bone and tissue growth. It also helps maintain a healthy balance of muscle and fat tissue in the body. The gland secretes anti-diuretic hormone (ADH), which controls urine production and manages the water balance in the body. Thyroid-stimulating hormone (TSH) is also produced. This hormone signals the thyroid gland to secrete hormones that regulate the body's metabolism. The pituitary gland also secretes luteinizing hormone (LH), which regulates testosterone production in males and estrogen production in females. Follicle-stimulating hormone (FSH) is produced as well. This hormone signals sperm production in males and egg development and ovulation in females. Adrenocorticotropic hormone (ACTH) is produced to stimulate the adrenal glands to produce hormones, such as cortisol. The adrenal hormones help the body cope with stress and they regulate bodily functions, such as blood pressure. Prolactin is secreted to regulate the development of breasts and breast milk in females.
- Acromegaly: Acromegaly is a rare hormonal disorder that occurs when the pituitary gland secretes too much growth hormone. As a result, the bones in the hands, feet, and face increase in size. If left untreated, acromegaly may be life threatening. Serious complications may include high blood pressure, heart disease, and spinal cord compression.
- The condition usually occurs in middle-aged adults. However, children may also develop acromegaly. When children produce too much growth hormone, the condition is called gigantism. These children have large bones and are abnormally tall.
- Acromegaly is usually caused by a noncancerous tumor of the pituitary gland, which secretes too much growth hormone.
- Acromegaly may also develop in patients who have tumors in other parts of the body, such as the pancreas, adrenal gland, or lungs. In rare cases, these tumors may secrete growth hormone-releasing hormone (GH-RH), which signals the pituitary gland to release more growth hormone.
- Symptoms of acromegaly develop gradually over many years. The most common symptom of acromegaly is enlarged hands and feet. It may also lead to gradual changes in the shape of the face, such as enlarged nose, thickened lips, increased gaps between the teeth, or protruding lower jaw or brow.
- Other symptoms may include coarse or oily skin, increased sweating and body odor, fatigue, muscle weakness, small outgrowths of skin tissue (skin tags), deepened voice, impaired vision, severe snoring, headaches, enlarged tongue, joint pain, limited joint mobility, increased chest size, enlarged organs (such as heart, kidneys, and spleen), irregular menstrual cycle in women, and erectile dysfunction in men. Some of the symptoms of acromegaly, such as headaches and impaired vision, occur because the tumor is pressing on the brain.
- The standard diagnostic test for acromegaly is a growth hormone suppression test. During the procedure, a sample of blood is taken from the patient before and after he/she drinks a special fluid made with sugar (glucose). In healthy individuals, the sugar will cause the levels of growth hormone to decrease. However, patients with acromegaly will have high levels of growth hormone even after consuming sugar.
- Imaging studies, such as computerized tomography (CT) scans or magnetic resonance imaging (MRI) scans, may also be performed. CT scans and MRIs are noninvasive tests that can produce images of the pituitary gland. They can help healthcare providers locate tumors on the gland.
- Patients with acromegaly receive treatments to reduce the amount of growth hormone produced.
- Surgery may be performed to remove tumors that are causing the disorder. In most cases, the surgery can be performed during a procedure called transsphenoidal surgery. The surgeon removes the pituitary gland through the nose. Once the tumor is removed, the level of growth hormone in the body will return to normal.
- Sometimes the surgeon is unable to remove the entire tumor. In such cases, radiation therapy is often recommended to remove the rest of the tumor.
- Patients may also receive injections of man-made hormones, such as octreotide (Sandostatin® or Sandostatin LAR®), to reduce the amount of growth hormone that is released. Patients typically receive a short-acting injection to determine if the medication is safe and effective in the patient. If it is successful, patients will receive injections once a month for life.
- If other treatments are unsuccessful, patients may take medications called growth hormone antagonists, which block the effect of growth hormone on body tissues. Medications, such as pegvisoman (Somavert®), are injected into the patient. Although this treatment reduces symptoms, it does not lower the amount of growth hormone in the blood, and it does not reduce the size of the tumor.
- Hypopituitarism: Hypopituitarism is a hormonal disorder that occurs when the pituitary gland does not secrete enough of one or more hormones. Depending on the type and severity of the hormone deficiency, any number of the body's functions may be affected, including growth, blood pressure, and reproduction.
- The condition occurs when the pituitary gland becomes injured or damaged. Several conditions, including head injuries, brain surgery, brain tumors, radiation therapy, inflammation, stroke, brain infections (such as meningitis), tuberculosis, blood loss during childbirth, genetic mutations, and diseases (such as sarcoidosis or histiocytosis), may lead to hypopituitarism.
- Signs and symptoms of hypopituitarism vary depending on which hormone is deficient. Symptoms of adrenocorticotropic (ACT) hormone deficiency may include fatigue, low blood pressure, weight loss, weakness, depression, nausea, and vomiting.
- Symptoms of thyroid-stimulating hormone (TSH) deficiency may include constipation, weight gain, sensitivity to cold, decreased energy, and muscle weakness or aching.
- Symptoms of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) deficiency include irregular or stopped menstrual periods and infertility in women. Men may experience loss of body and facial hair, weakness, decreased libido, erectile dysfunction, and infertility.
- Symptoms of growth hormone deficiency in children may include short height, excessive fat around the waist and in the face, and poor overall growth. In adults, symptoms may include fatigue, decreased strength and exercise tolerance, weight gain, decreased muscle mass, and feelings of anxiety or depression.
- Symptoms of prolactin deficiency in women may include lack of milk production, fatigue, and loss of underarm and pubic hair. Prolactin deficiency has no known adverse effects in men and no symptoms are seen.
- Symptoms of anti-diuretic hormone (ADH) deficiency may include increased thirst and urination.
- Blood tests are used to diagnose hypopituitarism. Patients with low or non-existent levels of one or more hormones have the condition. In addition, imaging studies, including CT scans and MRI scans, may be used to detect tumors or abnormalities in the pituitary gland.
- Treating the underlying cause of hypopituitarism may lead to a partial or complete recovery. If a tumor is causing symptoms, it is usually surgically removed. If surgery is not possible or if only part of the tumor can be removed, radiation therapy may also be necessary.
- Some patients may require hormone replacement therapy. Corticosteroids, such as hydrocortisone or prednisone, may be taken by mouth to replace the adrenal hormones that are not being produced because of an ACTH deficiency. A man-made hormone called levothyroxine (Levoxyl® or Synthroid®) may be taken to replace low levels of thyroid hormones caused by TSH deficiencies. Patients with FSH or LH deficiencies may receive man-made sex hormones. Females receive a combination of estrogen and progesterone, while males receive testosterone. Patients with ADH deficiency may take a man-made hormone, called desmopresin (DDAVP®), by mouth or nasal spray. Patients with low levels of GH may receive injections with a man-made growth hormone called somatropin (Genotropin®).
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.