What are the symptoms of acromegaly?

Acromegaly is a rare hormonal disorder that occurs when the pituitary gland produces too much growth hormone (GH) after the growth plates have closed at the end of puberty. This excess GH causes bones and tissues to grow gradually over time. The symptoms of acromegaly can vary widely and often develop slowly, making the condition challenging to diagnose.

Common symptoms of acromegaly include:

1. Enlarged hands and feet: One of the most noticeable signs of acromegaly is the enlargement of the hands and feet, often resulting in an increase in glove or shoe size.
2. Facial changes: The bones of the face, particularly the jaw and brow, can become enlarged, leading to changes in facial appearance such as a protruding jaw or brow ridge, enlarged nose, and thickened lips.
3. Enlarged organs: Internal organs, including the heart, liver, and kidneys, can enlarge in people with acromegaly, which can lead to complications if left untreated.
4. Joint pain: The growth of tissues around joints can cause pain, stiffness, and limited mobility.
5. Thickened skin: The skin can become thickened and coarse, particularly on the hands, feet, and face.
6. Increased sweating: People with acromegaly may experience excessive sweating, particularly at night.
7. Fatigue and weakness: The enlarged organs and tissues can lead to fatigue and weakness.
8. Headaches: Some people with acromegaly experience headaches due to the pressure caused by the enlarged pituitary gland.
9. Vision problems: The enlarged pituitary gland can press on the optic nerves, leading to vision problems such as blurred or double vision, loss of peripheral vision, and in severe cases, blindness.
10. Sleep apnea: The enlargement of tissues in the throat can lead to sleep apnea, a condition characterized by pauses in breathing during sleep.

It’s important to note that the symptoms of acromegaly can develop slowly over many years, and some people may not realize they have the condition until complications arise. If you experience any of these symptoms, particularly if they are persistent or worsening, it’s important to see a healthcare professional for evaluation and diagnosis.

What are the causes of acromegaly?

Acromegaly is primarily caused by a noncancerous tumor (adenoma) of the pituitary gland, called a growth hormone-secreting adenoma. This tumor produces excessive amounts of growth hormone (GH), leading to the characteristic signs and symptoms of acromegaly.

The exact cause of pituitary adenomas is not always clear, but several factors may contribute to their development:

1. Genetics: In some cases, genetic mutations may increase the risk of developing pituitary adenomas.
2. Age: Acromegaly typically occurs in adults between the ages of 30 and 50, although it can develop at any age.
3. Gender: Acromegaly is slightly more common in women than in men.
4. Family history: People with a family history of pituitary adenomas or other endocrine disorders may have an increased risk of developing acromegaly.
5. Other pituitary conditions: Certain conditions affecting the pituitary gland, such as multiple endocrine neoplasia type 1 (MEN1) syndrome, can increase the risk of developing pituitary adenomas.
6. Previous radiation therapy: Radiation therapy to the head or neck, particularly during childhood, may increase the risk of developing pituitary adenomas later in life.
7. Other factors: Some research suggests that factors such as obesity and insulin resistance may play a role in the development of acromegaly, but more research is needed to understand these relationships.

It’s important to note that while pituitary adenomas are the most common cause of acromegaly, there are other rare causes, such as tumors of the hypothalamus or pancreas that produce growth hormone-releasing hormone (GHRH), which stimulates the pituitary gland to produce excess GH. Additionally, some cases of acromegaly may be idiopathic, meaning the cause is unknown.

What is the treatment for acromegaly?

Treatment for acromegaly aims to reduce the production and effects of excess growth hormone (GH) and, if possible, to shrink or remove the tumor causing the condition. Treatment options may include:

1. Surgery: Transsphenoidal surgery is the most common treatment for acromegaly. In this procedure, the tumor is removed through the nose or mouth, minimizing damage to surrounding tissues. Surgery is often successful in reducing GH levels and alleviating symptoms, especially if the tumor is small and accessible.
2. Medications: Medications may be used to lower GH levels and reduce the effects of excess GH. Somatostatin analogs (e.g., octreotide, lanreotide) are commonly used to inhibit GH secretion. Dopamine agonists (e.g., cabergoline) may also be used in some cases. Pegvisomant, a GH receptor antagonist, can block the effects of excess GH.
3. Radiation therapy: Radiation therapy may be used to shrink or control the growth of pituitary tumors that are not completely removed by surgery or that recur after surgery. It is often used as a secondary treatment when surgery and medications are not effective.
4. Monitoring and follow-up: Regular monitoring of GH and insulin-like growth factor 1 (IGF-1) levels is important to assess the effectiveness of treatment. Additional imaging studies may be done to monitor the size of the tumor.
5. Lifestyle changes: Managing acromegaly often involves making lifestyle changes to improve overall health and reduce the risk of complications. This may include maintaining a healthy weight, exercising regularly, and managing other health conditions such as diabetes and high blood pressure.

Treatment for acromegaly is typically managed by an endocrinologist, a doctor who specializes in hormone-related conditions. The choice of treatment depends on the size and location of the tumor, the severity of symptoms, and the individual’s overall health and preferences. Early diagnosis and treatment are important to prevent complications and improve long-term outcomes for people with acromegaly.

TL;DR: Acromegaly Summary

Acromegaly is a rare hormonal disorder caused by excessive production of growth hormone (GH) by the pituitary gland, usually due to a benign tumor called an adenoma.

Here are some key points about acromegaly:

1. Causes:

• In most cases (over 90%), acromegaly is caused by a non-cancerous tumor (adenoma) in the pituitary gland, which produces excessive amounts of growth hormone.
• Rarely, it can be caused by tumors in other parts of the body that produce GH or GH-releasing hormone (GHRH).

1. Symptoms:

• Gradual enlargement of the hands, feet, and facial features (such as the jaw, nose, and tongue), leading to a coarse, enlarged appearance.
• Excessive sweating, oily skin, and body odor.
• Joint pain and stiffness.
• Headaches and vision problems (due to pressure on the optic nerves).
• Fatigue, sleep apnea, and other respiratory problems.
• Insulin resistance, leading to increased risk of diabetes.

1. Diagnosis:

• Blood tests to measure levels of GH and insulin-like growth factor-1 (IGF-1), which is produced in response to GH.
• Imaging tests (MRI or CT scan) to detect the presence and location of a pituitary tumor.
• Oral glucose tolerance test to assess GH suppression after glucose intake.

1. Treatment:

• Surgery to remove the pituitary tumor is often the first line of treatment, especially for larger tumors.
• Medications, such as somatostatin analogs (e.g., octreotide, lanreotide) or GH receptor antagonists (e.g., pegvisomant), can help suppress GH production or block its action.
• Radiation therapy may be used if surgery is not possible or if there is residual tumor growth after surgery.

1. Complications:

• Untreated acromegaly can lead to serious complications, including cardiovascular problems (hypertension, heart disease), respiratory disorders, diabetes, and an increased risk of certain cancers.
• Early diagnosis and treatment are crucial to prevent or manage these complications.

Acromegaly is a chronic condition that requires lifelong monitoring and management. With proper treatment, most people with acromegaly can achieve good control of their GH levels and reduce the risk of associated complications, improving their quality of life.