tag:theconversation.com,2011:/us/topics/pituitary-gland-31257/articlespituitary gland – The Conversation2020-05-20T12:12:34Ztag:theconversation.com,2011:article/1377592020-05-20T12:12:34Z2020-05-20T12:12:34ZSex talk: Common misunderstandings doctors confront about preventing pregnancy<figure><img src="https://images.theconversation.com/files/332858/original/file-20200505-83730-1ckwnv3.jpg?ixlib=rb-1.1.0&rect=41%2C0%2C5556%2C3740&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Condoms can act as a disease barrier. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/women-with-condom-royalty-free-image/86479934?adppopup=true&uiloc=thumbnail_similar_images_adp">ThinkStockImages/Stockbyte Collection via GettyImages</a></span></figcaption></figure><p>Sex is one of the most natural things in the world – none of us would be here without it. Yet there are many things about sex that need to be learned. Even today, 60 years after the introduction of <a href="https://www.npr.org/2020/05/09/852807455/how-the-approval-of-the-birth-control-pill-60-years-ago-helped-change-lives">oral contraceptives</a>, almost half of pregnancies worldwide are <a href="https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/index.htm">unintended</a>. Avoiding pregnancy takes planning, and health professionals can do a lot to help patients better understand contraception. </p>
<p>As an <a href="https://medicine.iu.edu/faculty/6855/gunderman-richard">academic physician</a>, I teach an annual course at the Indiana University School of Medicine called “Sexuality for the Clinician,” an important topic often not <a href="https://www.sexhealthmatters.org/resources/summit-on-medical-school-education-in-sexual-health">well covered</a> in medical schools. In my classes, medical students report misunderstandings they encounter among patients about various topics, including contraception. </p>
<p>Some of these wrong ideas are mentioned year after year, and correcting them presents a prime opportunity to enhance sexual health. Here are four common ideas about contraception that are incorrect, each representing a real patient’s story.</p>
<h2>Rhythm method</h2>
<p>The pregnancy test of a patient in her 20s came back positive. She protested to her physician that she couldn’t be pregnant. Her physician asked what form of contraception she and her husband had been using. She responded that they scrupulously avoided sex during her “fertile time.” Upon further questioning, the patient revealed her understanding that pregnancy could only occur on a single day each month.</p>
<p>In reality, assuming a woman has a 28-day menstrual cycle, there are about <a href="https://www.ncbi.nlm.nih.gov/pubmed/7477165">six days</a> during each cycle when sex can result in pregnancy. While a woman’s egg retains its fertility for up to 24 hours after ovulation, the release of an egg from the ovary, sperm can remain viable in the female reproductive tract for up to five days.</p>
<p>This means that patients employing the so-called “rhythm method,” one of the least <a href="https://www.mayoclinic.org/tests-procedures/rhythm-method/about/pac-20390918">reliable</a> forms of contraception, need to avoid sex for at least six days in the middle of each cycle.</p>
<h2>The pill</h2>
<p>A teenager using oral contraceptives became pregnant. When her physician asked how she had been taking her pills, she said that whenever she missed a pill, she would double up the next day. Once she missed taking her pills for five consecutive days. So, on the sixth day she took six pills. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334546/original/file-20200513-82379-brjftm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pill was introduced in 1960.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/The-Pill-Turns-50/6cfc9837dff244dc88d906430d331ce2/90/0">AP Photo/Jerry Mosey</a></span>
</figcaption>
</figure>
<p>One way to help patients use medication properly is to explain how it works, including why they need to take it regularly. In this case, providing the patient with a basic explanation of how <a href="https://academic.oup.com/humrep/article/22/12/3078/2384734">oral contraceptives work</a> could be beneficial. </p>
<p>While there are different types of “the pill,” most contraceptives work by preventing ovulation. The brain’s pituitary gland, the so-called “<a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/the-pituitary-gland">master gland</a>” of the hormonal system, detects stable high levels of the pill’s ovarian hormones in the blood. As a result, the hormone that stimulates ovulation isn’t released. But a pill must be taken every day to keep levels sufficiently high to prevent an egg from being released.</p>
<h2>Breastfeeding</h2>
<p>A new mother with a four-month-old baby expressed her fear to her doctor that she was pregnant again. How could this be, she asked, since she had been breastfeeding her baby since birth? The patient was correct that breastfeeding can suppress ovulation, but only if breastfeeding is frequent enough.</p>
<p>As it turned out, while the patient had been breastfeeding her baby since birth, she had also been feeding the baby formula, limiting breastfeeding to two or three times each day. In addition, her menstrual cycle had resumed the previous month. </p>
<p>Breastfeeding can be effective as a means of <a href="https://www.llli.org/breastfeeding-info/fertility/">contraception</a> in the first six months after birth. The hormones produced by the mother’s body during breastfeeding naturally suppress the pituitary gland’s secretion of hormones necessary to ovulate. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=351&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=351&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=351&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=441&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=441&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334543/original/file-20200513-82375-1sygbf1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=441&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">World Breastfeeding Week.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Romania-Breastfeeding/7119b75d27bd4ca8baf9480e5bfae2dd/68/0">AP Photo/Andreea Alexandru</a></span>
</figcaption>
</figure>
<p>However, the baby must be exclusively breastfed and feed at least every four hours during the day and every six hours at night. Otherwise, breastfeeding will not adequately suppress pituitary secretion, and pregnancy can occur. </p>
<h2>Sexually transmitted disease</h2>
<p>A teenager came to a sexual health clinic complaining of symptoms of itching, rash and painful urination, which her physician suspected was the result of a sexually transmitted infection. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334541/original/file-20200513-82379-tq0pon.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The basic equipment for safe sex.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/conceptual-importance-of-using-condoms-royalty-free-image/1149026078?adppopup=true">lucapierro/via Getty Images</a></span>
</figcaption>
</figure>
<p>When her doctor asked her about contraception, she reported that she was “on the pill.” Therefore, she said, she could not have an STI. </p>
<p>Many patients mistakenly assume that, in addition to preventing pregnancy, contraceptives can prevent STIs. While oral and other types of contraceptives, such as IUDs and hormonal implants, are usually highly effective in preventing pregnancy, they do nothing to reduce the risk of <a href="https://www.ncbi.nlm.nih.gov/pubmed/11518896">STIs</a>. </p>
<p>The only widely used form of contraception that reliably prevents STIs is the condom. It creates a barrier between the skin and bodily fluids of sex partners. To prevent infection, condoms need to be used in addition to other forms of contraception.</p>
<h2>Sex and medicine</h2>
<p>These are a few examples of common <a href="https://www.ncbi.nlm.nih.gov/pubmed/11255825">misunderstandings</a> that patients may harbor about contraception. Others include the idea that pregnancy can occur only if the woman has an orgasm, if sex occurs in certain positions or if the woman refrains from various cleansing practices, such as douching or taking a shower. In fact, none of these situations is likely to alter the probability of pregnancy in a reliable way. </p>
<p>Misunderstandings about sex include not only contraception but topics such as sexual response, sexual dysfunction and sexually transmitted infections. Such misconceptions serve as stark reminders that many people have not been well educated about essential aspects of sexual health. Families, schools and health professionals have a lot of work to do. </p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/137759/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Gunderman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Doctors hear many of the same basic questions about sex from their patients.Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1227912019-10-04T02:49:04Z2019-10-04T02:49:04ZCurious Kids: why does my older sister not want to play LEGO with me anymore and stays in her room?<figure><img src="https://images.theconversation.com/files/290476/original/file-20190902-175673-1103xqc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C9577%2C5387&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Change is tough for everyone.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2NzQzMjM4MSwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTM1NDQ3MzYzNSIsImsiOiJwaG90by8xMzU0NDczNjM1L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJzUkxVTVpiNG9TcXlXQXA5UW1JdVZHTDJjZkkiXQ%2Fshutterstock_1354473635.jpg&pi=41133566&m=1354473635&src=-1-13">www.shuttershock.com </a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au.</em> </p>
<hr>
<blockquote>
<p><strong>Why does my older sister, aged 13, not want to play LEGO with me anymore and stays in her room the whole day? – Beth, age 10, Australia.</strong></p>
</blockquote>
<hr>
<p>I am sorry to hear your 13-year-old sister does not want to play LEGO with you anymore and stays in her room all day. This must make you feel sad and maybe a bit rejected. </p>
<p>It is not your fault. There are many reasons why this could be happening and I can’t say for sure what it is. In this article, I am going to talk mostly about one of the possible reasons that could be involved (but it may not explain everything).</p>
<p>Like many 13-year-old girls, your sister is going through a change in her mind and body called puberty. It may be making her behave differently. Puberty is when your body changes from being a child to becoming an adult.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-does-the-sun-spin-as-well-as-the-planets-119877">Curious Kids: does the Sun spin as well as the planets?</a>
</strong>
</em>
</p>
<hr>
<h2>What is puberty?</h2>
<p>During puberty, a person’s brain and body suddenly starts to produce a lot more hormones. Hormones are chemical messengers that send signals from the brain to body glands. </p>
<p>The main hormones that cause puberty changes are found in two parts of the brain – the hypothalamus and the pituitary. These brain parts make hormones called luteinising hormone and follicle stimulating hormone. The main puberty gland in girls are the ovaries, and in boys it is the testes. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=511&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=511&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=511&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=642&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=642&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=642&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The main hormones that drive puberty changes are found in two parts of the brain – the hypothalamus and the pituitary.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In girls, eggs are stored in the ovaries, which are in the lower belly. The ovaries make other hormones called estrogen and progesterone.</p>
<p>Estrogen and progesterone in girls cause lots of body changes like growing breasts and having periods (bleeding from the vagina) once a month. </p>
<h2>Hormones can affect how we feel</h2>
<p>The increase in all of the hormones in the brain also affects other parts of the brain to cause some people (girls and boys) to become sad and angry. They might be upset at times or really happy at other times. </p>
<p>As hormone levels go up and down, that can trigger changes in brain chemicals called “serotonin” and “dopamine”. Serotonin and dopamine can change a person’s mood and behaviour. Some people get very moody and feel really irritated by small things that did not bother them before. </p>
<p>Puberty changes in the brain can also make kids start to feel more grown up. Your sister might also look more like an adult woman in her body and feel that she is too grown up to play LEGO anymore. She might want more of her own space to chill out. </p>
<p>But it is important for your parents to find out why she is staying in her room so much – in case she is feeling too sad or actually depressed (which is severe sadness) and wanting help. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your sister may want more space these days.</span>
<span class="attribution"><span class="source">wwww.shuttershock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What do you do now?</h2>
<p>I suggest that you keep being nice to your sister and let her know that you care about her. Try waiting for her to chat to you. Change is tough for everyone. Your sister is trying to cope with the changes of puberty, and you are trying to deal with the changes in your sister. </p>
<p>Most brothers and sisters end up being good friends again – but it can take a bit of time. </p>
<p>Hang in there!</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-people-grow-to-certain-sizes-105131">Curious Kids: Why do people grow to certain sizes?</a>
</strong>
</em>
</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em> <em>Please tell us your name, age and which city you live in. We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/122791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Jayashri Kulkarni does not work for, consult with or own shares in any company or organisation that would benefit from this article.
She receives funding from the NHMRC for research, and has received honoraria from Servier, Jansen & Lundbeck Pharmaceutical companies for giving medical educational talks, none of which is related to this article. </span></em></p>Puberty can make us behave differently.Jayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/640002016-09-16T02:55:22Z2016-09-16T02:55:22ZUnusual conditions: what are gigantism and acromegaly?<figure><img src="https://images.theconversation.com/files/136683/original/image-20160906-21919-11k2sb7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Robert Wadlow is known as the tallest man who ever lived.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/paille-fr/24559019804">Paille/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Gigantism is embedded in the folklore of many civilisations – think of the giant Goliath who fought with the legendary King David in the Bible, for instance.</p>
<p>But it’s not all the stuff of legends. Present-day famous “giants” include André René Roussimoff, known as Andre the Giant (224cm), and Richard Kiel (218cm), otherwise known as Jaws in two James Bond movies. </p>
<p>Another real-life giant was Robert Wadlow, also known as the Alton giant. He was <a href="http://www.sciencealert.com/it-s-the-birthday-of-the-tallest-man-who-ever-lived">the tallest man ever</a>, standing at just over 272cm. Robert died in 1940 at the age of 22 after his foot became infected.</p>
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<figcaption><span class="caption">Actor Richard Kiel played ‘Jaws’ in two James Bond films.</span></figcaption>
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<p>Gigantism and its counterpart, acromegaly, <a href="http://www.mayoclinic.org/diseases-conditions/acromegaly/home/ovc-20177622">are rare conditions</a> caused by excessive production of growth hormone (GH), which stimulates the growth of the skeleton and all the tissues in the body.</p>
<p>Gigantism develops when a child experiences accelerated growth due to excessive GH production, which eventually leads to their tall stature. Acromegaly is what the condition is called when excessive GH production develops in an adult after he or she has reached their final height. It comes from the Greek words akron (extremity) and megas (big). </p>
<p>Continued stimulation of tissue growth causes large hands and feet, nose, jaw and forehead, which are the most noticeable features. Acromegaly affects <a href="http://www.ncbi.nlm.nih.gov/pubmed/11081170">around 60 people per million</a>. There are <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/acromegaly">an estimated 1,200 people</a> living with the condition in Australia.</p>
<h2>What causes it?</h2>
<p>Growth hormone is produced by the pituitary gland, at the base of the brain. The gland produces several hormones that control growth, metabolism, development, and reproduction.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=720&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=720&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=720&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=905&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=905&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136391/original/image-20160902-20213-mi7mkd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=905&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The pituitary gland is located at the base of the brain.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>A <a href="http://www.mayoclinic.org/diseases-conditions/pituitary-tumors/symptoms-causes/dxc-20157631">tumour in the pituitary gland</a> can secrete uncontrolled amounts of any of its hormones. Pituitary tumours are benign, can vary in size and develop at any time through life. </p>
<p>Their effects on health <a href="http://www.mayoclinic.org/diseases-conditions/pituitary-tumors/symptoms-causes/dxc-20157631">depend on the hormone type and amount secreted</a>. In the case of acromegaly, too much GH is produced. If the tumour is large, it may cause headaches and can compress the nerves to the eyes, impairing vision.</p>
<p>The cause of tumour formation is not well understood, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25470569">but evidence points</a> to gene mutations that control cell growth and hormone secretion.</p>
<h2>Symptoms</h2>
<p>In contrast to the marked tall stature that characterises the childhood onset of the disease, manifestations in adults are different.</p>
<p>Symptoms of acromegaly develop gradually from slow growth of soft tissue, organs and bones. It can take more than ten years from when the first symptoms develop to diagnosis. Patients may be unaware of the progressive enlargement of their hands and feet, <a href="http://www.sciencedirect.com/science/book/9780123809261">although specific questioning usually elicits</a> a history of ring- and shoe-size increase.</p>
<p>Daytime sleeping, fatigue and poor concentration are common from sleep disruption caused by an enlarged tongue that blocks breathing during sleep. The <a href="http://www.sciencedirect.com/science/book/9780123809261">enlarged tongue</a> also causes heavy snoring, drooling, and difficulties with speech and chewing. </p>
<p>Carpal tunnel syndrome can also develop due to compression of a major nerve tissue growing at the base of the hand. The tumour may also be large enough to cause visual field loss from pressure on the nerves to the eyes.</p>
<p>People with gigantism and acromegaly are <a href="http://www.ncbi.nlm.nih.gov/pubmed/14764779">two to three times more at risk</a> of premature death than the general population. But life expectancy is restored when the disease is adequately treated.</p>
<h2>Diagnosis and treatment</h2>
<p>Acromegaly and gigantism are diagnosed with a blood test that measures concentration of GH and another insulin-like growth hormone called IGF-I. It is produced mainly by the liver due to the stimulation of GH. </p>
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<img alt="" src="https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=471&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=471&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=471&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=592&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=592&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136393/original/image-20160902-20213-19nsn2l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=592&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Andre the Giant had gigantism as a child which developed into acromegaly in adulthood.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/noticeofmeowery/86288815/in/photolist-8CfEc-6uxxfF-fdtVSz-93hZ24-9BsNNa-drM7md-co7y65-6Sd7kJ-qUSNep-qUSNwt-qCqyGg-abAQGb-e2P89d-pY6nvZ-aLp8W6-9JutQm-qCqztr-aqqsX3-7QVjSS-5pKHQb-ihL6p-7GyC8Y-nQu7pA-fQRN5E-7apFBv-atpSgn-9Xcpdc-7ASEhe-ravhLB-cEgQay-e2PnVs-6f3rE3-9V56hx-4x2Ttk-e2P82W-azv7nC-qCin1d-avHxGs-bcZDHk-bqh3Pd-nNvouJ-bA3ZpQ-4RfpSP-5re9Qi-qSzQk5-4x72Gw-2wL27-4x72v7-4x72Vy-nQfP8K">John McKeon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Both conditions <a href="http://www.ncbi.nlm.nih.gov/pubmed/19208732">can be treated</a> by surgery, radiotherapy or medication. No single treatment is effective in every patient. </p>
<p>Surgically removing the tumour is done by approaching the pituitary gland through the nose. </p>
<p>Radiotherapy is used where it’s impossible to remove the tumour completely. The radiation kills off the remaining tumour but this occurs slowly and can take up to ten years. The radiation can also harm the neighbouring normal pituitary gland and lead to progressive loss of pituitary function. </p>
<p>Medications are used for those for whom surgery has been unsuccessful or not suitable, or as an interim treatment while waiting for radiotherapy to take effect.</p>
<p>Drugs called somatostatin analogues (SSAs), such as octreotide, lanreotide and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24423324">pasireotide</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/2404445">have an established place</a> in the treatment of acromegaly. They work by inhibiting the secretion of GH. </p>
<p>Drugs developed for rare diseases are not cheap. The cost of pasireotide, which is dosage-dependent, is <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2016-ley1408.htm">up to A$50,000 per year</a>. But as of the beginning of September, the government has listed Signifor on the Pharmaceutical Benefits Scheme.</p>
<p>Acromegaly has negative physical and psychological effects, including appearance changes. These are <a href="http://www.ncbi.nlm.nih.gov/pubmed/17555502">preventable and reversible</a> as long as the condition is diagnosed early and patients have access to effective treatments.</p><img src="https://counter.theconversation.com/content/64000/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Ho consults for Pfizer, manufacturer of pegvisomant, and receives speaker fees from Novartis, manufacturer of Signifor. </span></em></p>Gigantism and acromegaly are rare conditions where a benign tumour causes excessive production of growth hormone (GH), which stimulates the growth of the skeleton and all tissues in the body.Ken Ho, Professor, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.