About Acromegaly (Growth Hormone Excess)
Acromegaly, a condition characterized by excess growth hormone (GH), is primarily caused by GH-secreting pituitary tumors. These tumors stimulate the production and release of insulin-like growth factor-1 (IGF-1), leading to the clinical manifestations of acromegaly. GH-secreting pituitary neuroendocrine tumors (PitNETs) are responsible for about 95% of acromegaly cases.
Risk factors include:
- Certain conditions can increase the risk of developing PitNETs, such as multiple endocrine neoplasia type 1 (MEN1) and McCune-Albright syndrome.
- Other possible factors include ectopic pituitary adenoma, excess growth hormone due to medical treatment, and peripheral tumors like small-cell lung cancer or medullary thyroid carcinoma.
It's important to note that these risk factors are not within an individual's control. If you suspect you have acromegaly or want to learn more about the condition, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.
The most common early symptoms of acromegaly include:
- Enlarged hands and feet
- Changes in facial appearance, such as a protruding jaw and enlarged nose, lips, and tongue
- Coarse, thickened skin
- Excessive sweating and body odor
- Joint pain and swelling
- Fatigue and muscle weakness
- Headaches
As acromegaly progresses or becomes more severe, additional symptoms may occur:
- Vision problems
- Deepening of the voice
- Skin tags (noncancerous growths)
- Enlarged organs, such as the heart or liver
- Sleep apnea and snoring
- Menstrual irregularities in women and erection problems in men
It's important to note that these symptoms can vary from person to person, and some individuals may not experience all of these symptoms. If you suspect you may have acromegaly or are experiencing any concerning symptoms, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.
Delayed treatment increases the risk of developing the following conditions:
- Type 2 diabetes
- High blood pressure
- Heart disease leading to cardiomyopathy
- Arthritis
- Bowel polyps which may turn into colon cancer if left untreated
To diagnose acromegaly, doctors may perform the following examinations, tests, and procedures:
- Physical examination: Your doctor will conduct a physical exam to look for physical signs of acromegaly, such as enlarged hands, feet, or facial features.
- Imaging studies: X-rays and MRI scans may be ordered to check for excess bone growth and to locate the pituitary tumor. If no tumor is found on the pituitary gland, other imaging tests may be done to look for tumors in the chest, abdomen, or pelvis that could be causing excess growth hormone production.
- Blood tests: Doctors may order blood tests to measure the levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Elevated levels of these hormones can indicate acromegaly.
To determine the stage or severity of acromegaly, additional examinations, tests, and procedures may include:
- Oral glucose tolerance test (OGTT): This test involves drinking a sugary liquid and having blood samples taken periodically to measure growth hormone levels. Failure of growth hormone levels to decrease significantly after consuming the sugar confirms the diagnosis of acromegaly.
- Pituitary magnetic resonance imaging (MRI): This imaging test helps assess the presence and size of a pituitary adenoma.
- Other imaging tests: If a pituitary tumor is not found, additional imaging tests may be performed to identify nonpituitary tumors that could be causing excess growth hormone production.
It's important to consult with your doctor about which examinations, tests, and procedures are appropriate for your individual situation.
The goals of treatment for acromegaly are as follows:
- Normalize growth hormone production levels: The primary goal is to bring GH levels back to normal. This can be achieved through various treatment options.
- Relieve pressure around pituitary tumors: Acromegaly is often caused by pituitary adenomas, which can exert pressure on surrounding tissues. Treatment aims to reduce the size of these tumors, relieving pressure and improving symptoms.
- Maintain normal pituitary function: Treatment should preserve the normal functioning of the pituitary gland, which is responsible for regulating hormone production in the body.
- Treat any hormone deficiencies: Acromegaly can lead to deficiencies in other hormones. Treatment may involve replacing these hormones to restore balance in the body.
- Improve symptoms of acromegaly: Treatment aims to alleviate the symptoms associated with excess growth hormone, such as enlarged hands and feet, joint pain, and facial changes.
The following treatment options may be recommended:
- Surgery: The first-line treatment is usually surgical removal of the pituitary tumor causing excess growth hormone production. This can effectively reduce growth hormone levels and improve symptoms. In some cases, surgery may be followed by lifelong pituitary hormone replacement therapy.
- Medication: If surgery is not successful or as a pre-surgical option, medications may be used to regulate or block growth hormone production. Somatostatin analogs and growth hormone receptor antagonists are commonly used medications that can help control growth hormone levels and shrink tumors.
- Radiation therapy: In some cases, radiation therapy may be used to destroy large tumors or residual tumor tissue after surgery or when medications alone are not effective.
It's important to note that specific treatment plans should be tailored to individual patients based on factors such as age, overall health, tumor size, and symptom severity. Health behavior changes may also be recommended to support overall well-being, but these should be discussed with a healthcare professional. Remember to consult your healthcare professional for personalized advice regarding medication types and therapies.