Acromegaly

Overview

Acromegaly is a hormonal disorder that occurs when the pituitary gland produces too much growth hormone during adulthood. This excessive growth hormone leads to an increase in bone size, causing physical changes in the body over a long period of time. The condition often starts with enlarged hands and feet, and can progress to affect other parts of the body, causing serious health problems if left untreated. Some common symptoms include coarse, oily, thickened skin, excessive sweating, small outgrowths of skin tissue, fatigue, joint or muscle weakness, pain, limited joint mobility, and vision problems. Early diagnosis and proper treatment are important to prevent complications and improve symptoms.

Understanding the disease

Symptoms

The symptoms of acromegaly include enlarged hands and feet, gradual changes in the shape of the face such as a protruding lower jaw and brow bone, an enlarged nose, thickened lips, and wider spacing between the teeth. Other symptoms may include coarse, oily, thickened skin, excessive sweating and body odor, small outgrowths of skin tissue (skin tags), fatigue, joint or muscle weakness, pain, limited joint mobility, a deepened, husky voice, severe snoring, vision problems, headaches, menstrual cycle irregularities in women, erectile dysfunction in men, and loss of interest in sex. Early diagnosis is important to prevent serious health problems. Acromegaly occurs when the pituitary gland produces too much growth hormone (GH) over a long period of time.

Risk Factors

Risk factors for developing acromegaly include:

1. Pituitary tumors: Most cases of acromegaly are caused by a noncancerous tumor (adenoma) in the pituitary gland, which leads to excessive production of growth hormone.
2. Nonpituitary tumors: In some individuals, tumors in other parts of the body, such as the lungs or pancreas, can cause acromegaly by secreting growth hormone or by producing a hormone called growth hormone-releasing hormone (GH-RH), which stimulates the pituitary gland to produce more growth hormone.
3. Inherited conditions: Rarely, acromegaly can be inherited due to genetic mutations that lead to the overproduction of growth hormone. One such inherited condition is multiple endocrine neoplasia type 1 (MEN1), which is characterized by the development of tumors in multiple endocrine glands.
4. Radiation exposure: In rare cases, exposure to radiation, particularly during childhood, can increase the risk of developing a pituitary tumor and acromegaly later in life.
5. Age: Acromegaly most commonly develops in middle-aged adults, generally between the ages of 40 and 60. The risk of developing acromegaly increases with age. It is important to note that the majority of cases are caused by pituitary tumors and not related to the mentioned risk factors. Early diagnosis and treatment of acromegaly can help prevent complications and improve quality of life.

Development

Acromegaly develops when the pituitary gland, located at the base of the brain, produces excessive amounts of growth hormone (GH) over a prolonged period. This excessive GH production results in increased levels of a hormone called insulin-like growth factor-1 (IGF-1), which causes the bones and other tissues to grow abnormally. The most common cause of excessive GH production in adults is a tumor in the pituitary gland. These tumors, called pituitary adenomas, can cause the gland to produce and release too much GH into the bloodstream. In some cases, these tumors may be benign (non-cancerous) or malignant (cancerous). In rare instances, acromegaly can also be caused by excessive GH production by non-pituitary tumors or by the use of certain types of medications. However, in most cases, it is due to pituitary adenomas.

Assessment and Diagnosis

Triage

If you have signs and symptoms associated with acromegaly, it is important to contact your doctor for an exam. Early diagnosis is crucial for receiving proper care, as acromegaly can lead to serious health problems if left untreated. This can include complications such as high blood pressure, high cholesterol, heart problems, osteoarthritis, type 2 diabetes, enlargement of the thyroid gland, precancerous growths in the colon, sleep apnea, carpal tunnel syndrome, increased risk of cancerous tumors, spinal cord compression or fractures, vision changes or vision loss, and more. Therefore, it is advisable to consult a healthcare professional if you suspect you may have acromegaly.

Diagnosis

To diagnose acromegaly, your doctor will typically start by asking about your medical history and conducting a physical exam. Based on these initial evaluations, your doctor may recommend the following steps:

1. IGF-1 measurement: Your doctor will take a blood sample to measure the IGF-1 level in your blood. An elevated IGF-1 level suggests acromegaly.
2. Growth hormone suppression test: This is the best method for confirming an acromegaly diagnosis. During this test, your GH blood level is measured both before and after you drink a preparation of sugar (glucose). In people who don't have acromegaly, the glucose drink typically causes the GH level to fall. But if you have acromegaly, your GH level will tend to stay high. Based on these tests, your doctor will determine if you have acromegaly and create a treatment plan tailored to your specific situation.

Management and Treatment

Complications

The potential complications of acromegaly include high blood pressure (hypertension), high cholesterol, heart problems, particularly enlargement of the heart (cardiomyopathy), osteoarthritis, type 2 diabetes, enlargement of the thyroid gland (goiter), precancerous growths (polyps) on the lining of your colon, sleep apnea, a condition in which breathing repeatedly stops and starts during sleep, carpal tunnel syndrome, increased risk of cancerous tumors, spinal cord compression or fractures, vision changes or vision loss, and early treatment of acromegaly can prevent these complications from developing or becoming worse.

Home Remedies

It is important to consult a healthcare professional for proper diagnosis and treatment of acromegaly.

Treatment

Acromegaly can be treated through various methods, depending on the severity of symptoms, the location and size of the tumor, and the patient's age and overall health. Treatment options typically include surgery or radiation to remove or reduce the tumor, medication to help normalize hormone levels, and additional treatments to manage complications. Surgery: This is often the first treatment option for acromegaly. The goal is to remove as much of the tumor as possible. This can help lower GH and IGF-1 levels and relieve symptoms. Radiation: Radiation therapy can be used when surgery is not feasible or has not successfully removed the entire tumor. This treatment option slowly reduces GH levels over time, but its effects may not be noticeable for 10 or more years after treatment. Medications: Oral medications, such as cabergoline and bromocriptine, can help lower GH and IGF-1 levels in some people. Pegvisomant, a growth hormone antagonist, can also be used to block the effect of GH on the body's tissues. These medications can help relieve symptoms but may cause side effects like nausea, tiredness, and sleep problems. It's important to work closely with your doctor to determine the best treatment plan for you, as each case of acromegaly is unique. Regular follow-up visits may be necessary to monitor hormone levels, check for any complications, and adjust the treatment plan as needed.

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