The condition acromegaly occurs when too much growth hormone (GH) is produced by the body. GH plays an important role in maintaining the body's growth and normal functions. When GH levels are too high, they can cause a variety of problems in the bones, organs, and tissues.
The main cause of acromegaly is the overproduction of GH by the pituitary gland. The pituitary gland is a small organ at the base of the brain that controls many hormones in the body. Pituitary hormone production normally occurs when the pituitary gland receives signals from other parts of the brain or when blood glucose levels fall.
However, in some cases, there may be an abnormal increase in GH production due to one or more of the following factors:
The pituitary gland is a non-cancer (benign) growth that secretes excess growth hormones into the bloodstream. These tumors are either primary (originating in the pituitary gland) or secondary (originating elsewhere and spreading to the pituitary gland). The most common pituitary tumor causing acromegaly is a somatotroph adenoma.
Growth hormone-releasing hormone (GHRH), a hormone that stimulates the pituitary gland to make more growth hormone, is also known as ectopic tumors. Other parts of the body can also suffer from ectopic tumors, including the lungs, pancreas, adrenal glands, and intestines.
The body's ability to regulate GH production or respond to GHRH can be affected by rare genetic disorders. Due to mutations in certain genes on chromosome 17, people with familial isolated GH deficiency (FIGHD) have low levels of both GH and GHRH.
Corticosteroids, for example, are anti-inflammatory drugs that suppress GHRH production and decrease GH levels.
Acromegaly can affect different parts of the body depending on where most of the excess GH is produced. The most common symptoms of acromegaly include:
As a result of abnormal cartilage and bone growth, people with acromegaly have enlarged hands, feet, ears, noses, lips, jawlines, foreheads, and chins. The thyroid gland (goiter), liver (hepatatomegaly), kidneys (nephromegaly), heart (cardiomegaly), lungs (pleural effusion), or intestines may also be enlarged.
People with acromegaly have high levels of insulin-like growth factor 1 (IGF-1), a substance that promotes cell division and growth. Blood sugar regulation (diabetes mellitus), blood pressure regulation (hypertension), cholesterol metabolism (hypercholesterolemia), bone health (osteoporosis), and reproductive health (infertility) can all be affected by high IGF-1 levels.
As a result of hormonal imbalances or psychological stress, people with acromegaly may experience depression, anxiety, irritability, aggression, impulsivity, or social withdrawal.
Physical complications: People with acromegaly may develop various complications due to their enlarged bones and tissues affecting their organs and systems. Some examples are:
Vision problems: People with acromegaly may have blurred vision due to increased pressure inside their eyes (glaucoma) or cataracts.
Sleep apnea: People with acromegaly may have difficulty breathing during sleep due to enlarged tonsils or adenoids blocking their airway.
Headaches: People with acromegaly may suffer from frequent headaches due to increased blood flow to their brain or nerve compression.
Joint pain: People with acromegaly may experience pain and stiffness in their joints due to inflammation or arthritis.
Carpal tunnel syndrome: People with acromegaly may develop numbness and tingling in their hands due to compression of a nerve at their wrist.
Heart problems: People with acromegaly may have increased risk of heart attack or stroke due to high blood pressure or irregular heartbeat.
The diagnosis of acromegaly is based on a combination of clinical features, laboratory tests, and imaging studies.
The doctor will examine your physical appearance, medical history, family history, and symptoms to look for signs of acromegaly.
Some common signs of acromegaly are:
Large hands Large feet , wide face, enlarged tongue and lips, and excessive sweating.
People with acromegaly can also experience headaches, sleep apnea, and digestive problems. They may also experience high blood pressure, high cholesterol, and an increased risk of heart disease.
Additionally, people with acromegaly may experience fatigue, depression, and sexual dysfunction. They may also have difficulty with vision, hearing, and mobility.
Treatment for acromegaly usually involves medication to reduce the levels of growth hormone. Surgery may also be necessary to remove the pituitary tumor.
Treatment of acromegaly depends on its cause, severity, and complications. The main goals of treatment are to lower GH and IGF-1 levels, shrink or remove the tumor, and prevent or treat complications.
Surgery is often the first treatment for acromegaly. It involves removing or destroying the tumor that is producing excess GH. There are several types of surgery for acromegaly, depending on where the tumor is located.
The surgeon can remove or destroy most pituitary tumors using heat, cold, electricity, or radiation during transsphenoidal surgery, a minimally invasive procedure.
Using a longer tube and more sophisticated tools and techniques, endoscopic transnasal transsphenoidal surgery can access and treat larger or more complex pituitary tumors.
This is a major surgery that involves making an incision in the skull in order to access and remove part or all of the pituitary gland. This surgery is usually reserved for tumors that are too large or too deep for transsphenoidal surgery.
In radiofrequency ablation, heat is generated by an electric current, which is used to destroy abnormal pituitary tissue. This type of surgery can be performed alone or in combination with other treatments.
Using high-energy beams of gamma rays, gamma knife radiosurgery targets and destroys abnormal tissue in the brain. It can be used on its own or in conjunction with other treatments.
Most people with acromegaly can be cured by surgery if they remove all or most of the tumor, but some may still have elevated GH levels after surgery due to residual tumor cells or other factors.
Drugs that either reduce GH production (somatostatin analogues) or block its action (leuprolide acetate) can help lower GH levels and shrink tumors after surgery for acromegaly.
Analogues of somatostatin include octreotide (Sandostatin) and lanreotide (Somatuline Depot).
Injections of leuprolide acetate are given every two weeks under the skin, for example, Lupron Depot and Lupron Injection.
Some complications of acromegaly can also be treated with medication by lowering IGF-1 levels or improving organ function.
Another option for treating acromegaly after surgery is radiation therapy, which uses high-energy beams like X-rays or protons to target and destroy abnormal brain tissue.
Nonpituitary tumors can be treated with radiation therapy alone or in combination with other treatments.
By reducing the growth potential of pituitary tumors, radiation therapy can also prevent recurrence.
It is best to avoid factors that stimulate GH production, such as stress, obesity, smoking, alcohol consumption, certain medications (such as corticosteroids), and certain medical conditions (such as hypothyroidism), to prevent acromegaly. In order to prevent complications and keep hormone levels under control, people with acromegaly should also follow their doctor's advice on regular monitoring and treatment.
You can develop acromegaly when your body produces too much growth hormone, a rare but serious condition. Pituitary tumors, ectopic tumors, genetic disorders, and medications are the main causes of acromegaly, which can cause various problems in your bones, organs, and tissues. There are a number of symptoms associated with acromegaly, including enlarged bones and tissues, hormonal imbalances, psychological changes, and physical complications. As a result of clinical findings, laboratory tests, and imaging studies, acromegaly is diagnosed. Treatments include surgery, medication, or radiation therapy based on your individual situation. It is important to avoid factors that can stimulate GH production and follow your doctor's recommendations about regular check-ups and care to prevent acromegaly.
