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Acromegaly
What Is It?Acromegaly is a syndrome caused by excessive secretion of growth hormone from a pituitary adenoma, a benign pituitary tumor. The high levels of growth hormone lead to a characteristic appearance with thickened, coarse facial features and large hands and feet.As opposed to pituitary gigantism, acromegaly occurs in adults after their growth plates have closed in their long bones. Therefore, the height of the individual does not change, their tissues and bones simply get thicker and coarser. The syndrome can also lead to other metabolic and physiologic changes which can cause long-term health problems. Many famous people have suffered from gigantism and/or acromegaly. A couple notable examples are Andre the Giant and Richard Kiel ("Jaws" in the James Bond movies). What Types of Symptoms Are Typical?All pituitary tumors can lead to general symptoms like headache, vision changes due to compression of the optic chiasm and loss of normal pituitary function.In the case of acromegaly, the pituitary tumor secretes growth hormone which causes several changes to metabolism and growth. Most notably, patients slowly develop soft tissue swelling of the hands, feet, nose, lips, ears and general thickening of the skin. Parts of the skull and jaw are enlarged with a protruded brow and jaw. This characteristic appearance occurs slowly, usually over years or even decades, so that sometimes the patient is not aware of it until they compare their appearance to earlier photos. In addition to the externally visible features, internal changes occur as well. These can include enlargement of the heart, arthritis, carpal tunnel syndrome, high blood pressure, diabetes mellitus, and heart and kidney failure. Left untreated the high blood pressure, diabetes and heart enlargement can lead to significant cardiac and vascular disease which can be a major source of illness and even death. How Is The Diagnosis Typically Made?As with other pituitary adenomas, a neurological evaluation typically includes a CT scan and/or MRI scan to detect the tumor.Blood testing to evaluate the pituitary hormones will demonstrate high levels of growth hormone. They will also demonstrate high levels of insulin-like growth factor (IGF-1) which is increased with increased GH levels. What Are Some Common Treatments?As with other pathologies, each tumor and patient is different, so it is hard and inappropriate to make generalizations about what treatment plan is most appropriate. Each patient should discuss their options with their own physician team. However, most patients with acromegaly will require an operation to remove the tumor to lower the levels of growth hormone and prevent the long-term heart and kidney complications of the disease. As with other pituitary adenomas, this is usually accomplished through a transsphenoidal procedure through the nasal passages. Some patients with a growth hormone secreting tumor will undergo medical treatment with a dopamine agonist or somatostatin agonist drug. These drugs are effective in controlling the tumor and secretion of growth hormone only in a small subset of patients. Return to the Nervous System Diseases home page. Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education. |
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