Acromegaly — Causes, Symptoms, Diagnosis and Treatment
What is Acromegaly?
Acromegaly is a hormonal disorder caused by overproduction of the growth hormone from the pituitary gland during adulthood. This hormonal disorder usually affects adults of middle age and is characterized by overgrowth of the bones, including the face, hands and feet.
If overproduction of the growth hormone from the pituitary gland occurs during childhood, this condition is called gigantism. Gigantism is characterized by exaggerated bone growth and an abnormal increase in height.
The physical changes and the growth of the bones occur over a long period of time. In many cases the condition is not recognized and diagnosed immediately, sometimes not for years. If not diagnosed and treated on time, Acromegaly can lead to serious complications which sometimes are even life threatening. Available treatments can significantly improve the signs and symptoms of this condition, as well as possible complications, including also the enlargement of your bones.
What causes Acromegaly?
As mentioned before acromegaly is caused from overproduction of the growth hormone from the pituitary gland. The pituitary gland is located at the base of the brain, behind the bridge of the nose. Once the growth hormone is produced from this gland, it gets secreted into the bloodstream. With the help of the bloodstream, the growth hormone gets into the liver where it triggers the production of insulin-like growth factor-I (IGF-I). This factor stimulates the growth of bones and other body tissue.
Tumors are the most common cause that affects the production of hormones from the pituitary glands. In most of the cases acromegaly occurs due to adenoma of the pituitary gland. In less common cases, acromegaly occurs due to non — pituitary tumors. Tumors that are localized and develop in other body parts like in the lungs, adrenal glands, pancreas, etc., cause the disorder. In some cases, tumors produce a hormone called growth hormone-releasing hormone (GH-RH), which stimulates the pituitary gland to make more GH.
Signs and symptoms of Acromegaly
Acromegaly is a medical condition which has a slow progression. The signs and symptoms usually are not visible for a couple of years.
The most common sign and symptom are enlarged hands and feet. One of the first things that people notice is that they can no longer wear the shoes they used to wear, or that they can no longer put on the ring that used to fit.
Acromegaly affects also the face, which is characterized by an enlarged nose, wider space between the teeth, thickness of the lips, protrusion of the jaw, etc.
Other signs and symptoms of acromegaly include: excessive sweating and body odor, thickened and oily skin, muscle weakness, fatigue, impaired vision, a husky voice due to an enlargement of the vocal cords, skin tags, enlarged tongue, snoring due to an obstruction of the upper airway, painful joints and limited joint movements, headaches, irregular menstrual cycles in women, erectile dysfunction in men, enlarged internal organs like the liver, spleen, heart, kidneys, etc.
As mentioned before, acromegaly is a disease with a slow progression where many complications are possible. The most common complications of acromegaly are:
• High blood pressure,
• Diabetes mellitus,
• Osteoarthritis,
• Vision loss,
• Uterine fibroids,
• Hypopituitarism,
• Sleep apnea, etc.
How is Acromegaly diagnosed?
A detailed anamnesis and a complete physical examination are very important when diagnosing acromegaly. Some of the tests needed are:
• GH and IGF-I measurement.
• Growth hormone suppression test
• Imaging (X-Ray, CT-Scan, MRI — Scan)
How is Acromegaly treated?
Treatment of acromegaly is focused on lowering the levels of the growth hormone and preventing its further secretion from the pituitary gland. Possible treatment options are:
• Surgery — tends to remove the tumor which will then normalize the growth hormone levels. In some cases it is not possible to remove the entire tumor, making it necessary for further treatment.
• Medications — various medications are available in order to reduce or block the secretion of the growth hormone from the pituitary gland. These medications include: Somatostatin analogues, growth hormone antagonists or dopamine agonists.
• Radiation — is necessary in cases when the tumor was not able to remove entirely. This therapy destroys the tumor cells, reducing also slowly the levels of the growth hormone. It may take some years until radiation treatment noticeably improves the signs and symptoms of acromegaly.
