Acromegaly

Acromegaly is a rare hormonal disorder caused by too much growth hormone. It leads to unusual growth in hands, feet, and face. It develops slowly, making it hard to spot early.

The main cause is a benign tumor on the pituitary gland, called a pituitary adenoma. Genetics can also contribute to it. Symptoms include big hands and feet, coarse facial features, too much sweating, and joint pain.

It’s important to catch and treat acromegaly early to avoid serious problems. Without treatment, it can cause heart disease, sleep apnea, and vision issues. Treatment may include surgery, medication, or radiation, based on the case.

What is Acromegaly?

Acromegaly is a rare hormonal disorder. It happens when the pituitary gland makes too much growth hormone (GH). This causes more insulin-like growth factor-1 (IGF-1) in the body. This extra IGF-1 makes tissues and organs grow too much.

The main signs of acromegaly are enlarged features. This includes bigger hands, feet, and face. The forehead can stick out, and the nose and lips can get bigger. The space between teeth also grows.

Hands and feet get bigger because of cartilage and soft tissue growth. This is called acral enlargement. It makes fingers and toes look large and broad.

Acromegaly also affects other parts of the body. It can cause joint pain, too much sweating, and tiredness. People might also have headaches and changes in vision.

If not treated, acromegaly can lead to serious health issues. These include diabetes, heart disease, and sleep apnea.

Acromegaly often takes years to develop, making it hard to catch early. It usually comes from a non-cancerous tumor in the pituitary gland. This tumor makes too much growth hormone. Sometimes, tumors in other places can also cause it by making the pituitary gland work too hard.

Causes of Acromegaly

Acromegaly happens when the pituitary gland makes too much growth hormone. This gland is at the brain’s base. Usually, a pituitary adenoma, a non-cancerous tumor, causes this hormone imbalance.

A pituitary adenoma grows from the gland’s cells. These tumors can be small or quite large. The bigger they get, the more growth hormone they make. This leads to the symptoms of acromegaly.

Pituitary Adenoma

Pituitary adenomas that cause acromegaly are not cancerous. But, as they grow, they can press on nearby nerves. This can cause vision problems. Large tumors can also mess with the gland’s hormone work.

Genetic Factors

Most acromegaly cases happen by chance. But, some are linked to genetic disorders. Conditions like Multiple Endocrine Neoplasia Type 1 (MEN1) and Familial Isolated Pituitary Adenoma (FIPA) raise the risk. These cases are called familial acromegaly.

Knowing why someone has acromegaly helps doctors treat them better. They can plan treatments based on the cause, like a tumor or a genetic issue.

Symptoms and Signs of Acromegaly

The symptoms of acromegaly start slowly, making them hard to notice at first. The gradual onset can lead to a late diagnosis. As the condition gets worse, the changes become more obvious, affecting a person’s looks and health.

Enlarged Hands and Feet

One of the most obvious signs is the growth of hands and feet. People may find their rings, gloves, and shoes don’t fit anymore. This is due to the thickening of soft tissue and bone growth.

Facial Changes

Acromegaly can also change a person’s face, leading to:

• Coarse facial features
• Protruding brow and enlarged jaw
• Increased spaces between teeth
• Skin thickening and oiliness
• Enlarged lips, nose, and tongue

Excessive Sweating

People with acromegaly often sweat a lot, mainly in their hands and feet. This can be annoying and may mean they need to change clothes often.

Joint Pain

As the condition worsens, joint pain and stiffness can occur. This is because of the growth of cartilage and changes in the joints. The most common affected joints are:

Diagnosing Acromegaly

Diagnosing acromegaly requires several tests to check growth hormone levels and the pituitary gland. The first test is a blood test for IGF-1 levels. IGF-1 is a liver protein made when growth hormone is present.

If IGF-1 levels are high, a glucose tolerance test follows. This test sees how growth hormone reacts to glucose. In healthy people, glucose lowers growth hormone. But in those with acromegaly, growth hormone stays high.

An MRI scan is used to look at the pituitary gland. This imaging test finds and sizes pituitary tumors, the main cause of acromegaly. The MRI shows the brain and pituitary in detail, helping doctors find the adenoma’s location and size.

More tests might check how excess growth hormone affects other body systems:

• Colonoscopy to screen for colon polyps
• Echocardiogram to evaluate heart function
• Sleep study to check for sleep apnea
• Vision tests to detect vision problems from pituitary tumor pressure on the optic nerves

Getting a quick and correct acromegaly diagnosis is key to avoiding problems and starting treatment. If you think you might have acromegaly, see your doctor. They can order the needed tests and send you to a pituitary specialist.

Treatment Options for Acromegaly

Acromegaly treatment aims to lower excess growth hormone, ease symptoms, and prevent problems. The right treatment depends on the tumor’s size, location, and the patient’s health. A team of doctors, including endocrinologists and neurosurgeons, works together for the best care.

Surgery

Most patients with acromegaly get treated with surgery. This surgery, called transsphenoidal, removes the tumor through the nose. It’s a small procedure that can be very effective, but it’s harder for bigger tumors.

Medication

When surgery isn’t an option, medicine is used. Somatostatin analogs, like octreotide, are the first choice. They stop the pituitary gland from making too much growth hormone. Dopamine agonists and growth hormone receptor antagonists are also used, depending on the patient.

How well these medicines work can vary. Here’s a table showing their effectiveness:

Radiation Therapy

Radiation therapy is for those who don’t get better with surgery and medicine. It can take years to work and might cause hypopituitarism, needing hormone replacement forever.

Acromegaly and Gigantism

Acromegaly and gigantism both come from too much growth hormone. But, they happen at different times. Acromegaly starts in adults, making hands, feet, and faces bigger. Gigantism happens in kids, before their bones stop growing.

Childhood-onset acromegaly, or pituitary gigantism, makes kids grow too tall. They can grow over 7 feet tall. This is because their bones keep growing from too much growth hormone.

Pituitary gigantism is very rare, much rarer than acromegaly. It’s usually caused by a benign tumor on the pituitary gland. Because it starts before puberty, it affects height more.

It’s important to catch and treat pituitary gigantism early. This stops more growth and prevents problems. Treatments are the same as for acromegaly: surgery, medicine, and sometimes radiation.

Complications of Untreated Acromegaly

Untreated acromegaly can cause serious health issues. These problems can greatly affect a person’s life quality and how long they live. Common complications include heart disease, sleep apnea, type 2 diabetes, colon polyps, and vision problems.

Cardiovascular Disease

Too much growth hormone can make the heart muscle grow too big. This is called cardiomyopathy. It can lead to heart failure if not treated. Also, people with acromegaly are more likely to get high blood pressure, which is hard on the heart.

Sleep Apnea

The growth of soft tissues in the throat can block the airway at night. This causes sleep apnea. It leads to poor sleep, feeling tired all day, and raises the risk of heart problems.

Type 2 Diabetes and Colon Polyps

Acromegaly can make it hard for the body to use insulin, raising the risk of type 2 diabetes. It’s important for people with acromegaly to get checked for diabetes often. They also have a higher chance of getting colon polyps, which can turn into cancer if not caught and removed early.

Vision Problems

The growing tumor can press on the optic chiasm. This can cause vision issues like losing side vision, blurry vision, or even blindness. It’s key to get regular eye exams to catch any vision changes early.

Getting acromegaly diagnosed and treated quickly is vital. It helps avoid these serious problems and improves health. Working with doctors and following a treatment plan can help manage acromegaly. This way, people can live healthier lives and avoid long-term health issues.

Living with Acromegaly

Managing acromegaly needs a team effort. Patients should team up with doctors, including endocrinologists and neurosurgeons. Together, they create a treatment plan that fits each person.

It’s key to keep an eye on growth hormone and IGF-1 levels. This ensures the treatment is effective and makes any needed changes.

Changing your lifestyle can also help. Eating well, staying active, and managing stress are important. These habits can improve your health.

It’s also vital to watch for long-term issues. Things like heart disease, sleep problems, and vision issues need early attention. This way, you can catch and treat them quickly.

Dealing with acromegaly can be tough, both in body and mind. Having support from loved ones and support groups is very helpful. It offers understanding, encouragement, and valuable advice from others who get it.

With the right care, lifestyle changes, and support, you can manage acromegaly well. This way, you can live a happy and fulfilling life.