Acromegaly

Acromegaly is a rare hormonal disorder that occurs when the pituitary gland produces too much growth hormone (GH) after normal growth has stopped. This excess GH causes the body's tissues and organs to grow abnormally, leading to a range of symptoms and complications.

Causes

The most common cause of acromegaly is a non-cancerous tumor on the pituitary gland, called an adenoma. This tumor produces excess GH, which leads to the characteristic symptoms of acromegaly. Other rare causes include:

• Genetic disorders
• Certain medical conditions, such as multiple endocrine neoplasia type 1 (MEN1)
• Tumors on other parts of the body, such as the pancreas or lungs, that produce GH or a related hormone called insulin-like growth factor-1 (IGF-1)

Symptoms

The symptoms of acromegaly can develop slowly over several years and may include:

• Enlargement of the hands and feet, with thickening of the skin
• Coarsening of the facial features, including a prominent jaw, nose, and forehead
• Joint pain and limited mobility due to cartilage and bone growth
• Carpal tunnel syndrome
• Sleep apnea
• Headaches
• Excessive sweating
• Body odor
• Thickening of the vocal cords, leading to a deepening voice
• Impotence or decreased libido in men
• Irregular menstrual periods in women

Diagnosis

Acromegaly is typically diagnosed through a combination of:

• Physical examination and medical history
• Blood tests to measure GH and IGF-1 levels
• Imaging studies, such as MRI or CT scans, to visualize the pituitary gland and detect any tumors

Treatments

The primary goal of treatment for acromegaly is to reduce GH production to normal levels. Treatment options may include:

• Surgery: Removal of the pituitary tumor, which can be performed through an endoscopic procedure or traditional open surgery.
• Medications:
  • Somatostatin analogs, such as octreotide and lanreotide, to reduce GH production
  • Dopamine agonists, such as bromocriptine and cabergoline, to decrease GH secretion
  • Growth hormone receptor antagonists, such as pegvisomant, to block the action of GH at the tissue level
• Radiation therapy: To shrink or destroy any remaining tumor tissue after surgery.
• Hormone replacement therapy: To manage hormonal deficiencies that may occur as a result of treatment, such as thyroid hormone or adrenal hormone replacement.

Complications

If left untreated, acromegaly can lead to several complications, including:

• Cardiovascular disease and high blood pressure
• Diabetes mellitus
• Sleep apnea and respiratory problems
• Joint damage and arthritis
• Cancer, particularly colon cancer

Prognosis

The prognosis for acromegaly is generally good if treatment is started early. With effective treatment, it is possible to:

• Reduce GH levels to normal or near-normal ranges
• Relieve symptoms and improve quality of life
• Prevent long-term complications and reduce the risk of mortality