Acromegaly

Specialty of Endocrinology, diabetes & metabolism

What is it?

Acromegaly is a condition where the pituitary gland produces too much growth hormone (GH), causing the bones to grow too much and too quickly. This condition usually affects men and women (equally) around 40. Given its slow progression, it is quite hard to identify it before it starts showing any symptoms.

Prognosis

Acromegaly develops slowly. That is why it is essential to act as soon as possible to avoid potentially life-threatening complications. In the vast majority of cases, once you get started on the treatment you will be back to how you were before the condition. However, your quality of life may be affected afterwards.

What are the symptoms?

It may take years before you catch any of the symptoms of acromegaly. The main sign of this disorder is an abnormal growth of hands and feet, which you may notice because your rings or shoes won’t fit any more. Another typical symptom is a change in your appearance: the forehead, nose, lips and jaw will be enlarged (leading to occlusal disorders as well). Other symptoms may include: excessive sweating, oily skin, vision impairment, articular range of motion reduction and joint pain, carpal tunnel syndrome, generalised fatigue and muscle pain, an increase in the size of your organs, vocal cords alteration leading to a deeper voice, sleep apnoea, and pendulous fibroids. Women may also notice an alteration in their menstrual pattern (including amenorrhoea), whereas men may experience erectile dysfunction.

How is it diagnosed?

Acromegaly can be diagnosed with physical examination and clinical testing. An MRI scan and CT scan may be helpful in identifying pituitary tumours; growth hormone levels and insulin-like growth factor-1 (IGF-1) levels testing can determine whether there is an actual growth hormone overproduction. GH suppression test following an oral glucose load is the most reliable test to confirm a diagnosis of acromegaly. If GH levels don’t go down after the glucose load, that means you actually have this condition.

What causes it?

Acromegaly occurs when there is a sustained overproduction of growth hormone by the pituitary gland, located in the brain, behind the nose. In children, GH is responsible for the adequate development of the bones, whereas in adults it preserves bones and muscles functionality. A GH excess is usually due to a benignant tumour of the pituitary gland, leading to the above-mentioned symptoms. In more rare cases, a tumour affecting the lungs, pancreas or adrenal gland may release a hormone which in turn stimulates the pituitary gland, releasing more GH. In even rarer cases, this condition can be traced back to taking drugs to increase your muscles (especially in body-builders).

How is it treated?

Acromegaly treatment consists in lowering GH levels, as well as in removing the pituitary gland tumour. Endonasal transphenoidal surgery (that is, through the nose) is a successful procedure to eliminate the tumour cells in the pituitary gland. Should there be other tumour cells after the surgery, you may have to get started on radiotherapy - one of the secondary effects also being a decrease in GH levels. However, it may take a few years to start seeing the results of radiotherapy, which could also have some side effects on the hypothalamic–pituitary–somatotropic axis (HPS axis).

Which doctor should I talk to?

If you think you may have acromegaly, you should see an endocrinologist. Should you need to have surgery, you’ll also need to see a surgeon.

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