Acromegaly

Acromegaly

Somatotroph adenoma- Growth hormone excess- Pituitary giant

Acromegaly is a long-term condition in which there is too much growth hormone and the body tissues get larger over time.

Causes, incidence, and risk factors

Acromegaly occurs in about 6 of every 100,000 adults. It is caused by abnormal production of growth hormone after the skeleton and other organs finish growing.

Excessive production of growth hormone in children causes gigantism rather than acromegaly.

The cause of the increased growth hormone release is usually a noncancerous (benign) tumor of the pituitary gland. The pituitary gland, which is located just below the brain, controls the production and release of several different hormones, including growth hormone.

Symptoms

Body odor

Carpal tunnel syndrome

Decreased muscle strength (weakness)

Easy fatigue

Excessive height (when excess growth hormone production begins in childhood)

Excessive sweating

Headache

Hoarseness

Joint pain

Large bones of the face

Large feet

Large hands

Large glands in the skin (sebaceous glands)

Large jaw (prognathism) and tongue

Limited joint movement

Sleep apnea

Swelling of the bony areas around a joint

Thickening of the skin, skin tags

Widely spaced teeth

Widened fingers or toes due to too much skin growth, with swelling, redness, and pain

Other symptoms that may occur with this disease:

Excess hair growth in females

Weight gain (unintentional)

Signs and tests

High growth hormone level

High insulin-like growth factor 1 (IGF-1) level

Spine x-ray shows abnormal bone growth

Pituitary MRI may show a pituitary tumor

Echocardiogram may show an enlarged heart, leaky mitral valve, or leaky aortic valve

This disease may also change the results of the following tests:

Fasting plasma glucose

Glucose tolerance test

Treatment

Surgery to remove the pituitary tumor that is causing this condition usually corrects the abnormal growth hormone release in most patients. Sometimes the tumor is too large to remove completely. People who do not respond to surgery will have radiation of the pituitary gland. However, the reduction in growth hormone levels after radiation is very slow.

The following medications may be used to treat acromegaly:

Octreotide (Sandostatin) or bromocriptine (Parlodel) may control growth hormone release in some people.

Pegvisomant (Somavert) directly blocks the effects of growth hormone, and has been shown to improve symptoms of acromegaly.

These medications may be used before surgery, after surgery, or when surgery is not possible.

After treatment, you will need to see your health care provider regularly to make sure that the pituitary gland is working normally. Yearly evaluations are recommended.

Expectations (prognosis)

Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon.

Without treatment the symptoms will get worse, and the risk of high blood pressure, diabetes (high blood sugar), and cardiovascular disease increases.

Complications

Other health problems may include:

Arthritisin most joints, which along with excess bone growth may put pressure on the nerves of the spine or the spinal cord   

Carpal tunnel syndrome

Colonic polyps

Hypopituitarism

Sleep apnea    

Uterine fibroids

Vision problems

Calling your health care provider

Call your health care provider if:

You have symptoms of acromegaly

Your symptoms do not improve with treatment

Prevention

There are no methods to prevent the condition, but early treatment may prevent complications of the disease from getting worse.