Acromegaly: Causes, Symptoms, Treatment and Prevention

Acromegaly is a condition of the body that has excess growth hormone. This results in over-growing parts of the body such as the hands, feet, and face. It also affects the heart and bones. Another excess of growth hormone is gigantism.

The difference is that acromegaly occurs when the bone epiphyseal closes (that means the bone no longer gets longer and a person no longer gets taller) so that the bone that grows eventually becomes too thick, whereas in gigantism, excess growth hormone occurs from before the epiphyseal bone closes (that means someone can still get taller) so that the sufferer will be higher than normal humans his age.

There are several treatments for acromegaly, and each case is different. In most cases, treatment should be needed before the patient has acromegaly symptoms. Most people who experience acromegaly are adults. If children have problems with too much growth hormone production, this condition is called gigantism.

Causes of Acromegaly

The most common cause of this condition is benign tumors in the pituitary gland, which is located under the brain. This pituitary tumor is not cancer. Because of this tumor, the body makes too much growth hormone. In most cases, the tumor is a pituitary gland adenoma.

Occasionally, tumors in the pancreas, liver, or parts of the brain can cause high levels of growth hormone which leads to higher hormone levels than other hormones, which are also called growth hormones such as insulin or insulin-like growth factor-I (IGF-I). Too much IGF-I causes abnormal soft tissue growth and bone skeleton, and other symptoms that are typical of acromegaly and gigantism.

Acromegaly Risk Factors

Common risk factors in the development of acromegaly are associated with risk factors for the development of pituitary adenomas. Pituitary adenomas are the most common cause of acromegaly.

Common risk factors in acromegaly development include:

  • Family history of pituitary adenomas
  • MacCun Albright Syndrome
  • Lung cancer
  • Adrenal tumor

Less common risk factors for acromegaly development are:

  • Early menopausal women
  • Menopause due to surgery
  • Young women when giving birth first

Acromegaly Symptoms

The characteristics of acromegaly are usually seen in the hands and feet that begin to enlarge. Sufferers will see changes in shoe circumference, shoe size, especially shoe width.

Facial features such as on the lips, nose, and tongue often change to become bigger, swollen, and wider. Teeth will enlarge so that there is less place and look forward. The eyebrows will appear lower because the jawbone and forehead start to swell.

Other acromegaly symptoms may include:

  • Joint pain, possibly caused by arthritis
  • Coarse body hair
  • The voice is deeper and hoarse
  • Pinched nerve problems, especially nerves coming out of the spine due to the enlarged bone size so that the roots (nerve roots) coming out of the spinal cord will be pinched
  • High blood pressure
  • Heart disease
  • Thickening of the skin
  • Lots of sweating with oily skin
  • Headache
  • Snore and sleep apnea (shortness of breath when sleeping)
  • Weakness and tiredness
  • Carpal tunnel syndrome (tingling or pain in the fingers)
  • Vision problems
  • Low sex drive
  • Changes in the menstrual cycle and breast size in women
  • Erectile dysfunction in men

Acromegaly sufferers can sometimes have problems such as type 2 diabetes, high blood pressure, a higher risk of heart disease, and an enlarged heart.

When to see a doctor?

If you experience the characteristics of acromegaly mentioned above, consult a doctor immediately for examination and treatment. Acromegaly is a disease that usually develops slowly and takes years.

Acromegaly may not initially be aware of the gradual physical changes that occur with this disorder, but early diagnosis is an important step to get proper treatment. If not treated immediately, acromegaly can cause serious complications.

Acromegaly Diagnosis

Although acromegaly is classified as a rare disease, many acromegaly sufferers do not know to experience this disease because the symptoms are slow. However, if you are suspected of having acromegaly, your doctor can do a test. Acromegaly is the disease most often diagnosed in middle-aged adults, but the characteristics of acromegaly can appear at any age.

Here are some tests to diagnose acromegaly:

1. Blood test

Blood tests can determine whether you have too much growth hormone, but this is not always accurate because growth hormone levels fluctuate throughout the day. Instead, the doctor can do a glucose tolerance test. This test requires the patient to drink as much as 75 to 100 grams of glucose and then do a test for growth hormone levels.

If the body secretes normal growth hormone levels, excess glucose will cause the body to suppress growth hormone levels. People who have acromegaly will still show high levels of this hormone.

2. IGF-1 test

The doctor can also do a protein test called insulin-like growth factor 1 (IGF-1). IGF-1 levels can indicate if there is abnormal growth in the body. The IGF-1 test can also be used to monitor the development of other hormone treatments.

3. Imaging

If the doctor suspects the patient has acromegaly, X-rays and scanning magnetic resonance imaging (MRI) may be done to check the growth of excess bone. The doctor will also do a physical examination, and recommend a sonogram to check the size of internal organs.

After being diagnosed with acromegaly, the doctor can use MRI and computerized tomography (CT) scan to help find pituitary tumors and determine how large they are.

If you do not find a tumor in the epiphyseal gland, your doctor will look for tumors in the chest, abdomen, or pelvis that might cause excessive growth hormone production.

Acromegaly Complications

Acromegaly is a disease that can cause enlargement of organs such as the heart, thyroid gland, liver, and kidneys. If not treated immediately, acromegaly can cause serious and even life-threatening health problems.

Here are a number of common complications of acromegaly:

  • Pressure on the spinal cord
  • Vision loss
  • Uterine fibroids in women – benign uterine tumors
  • Carpal tunnel syndrome
  • The release of the pituitary hormone is reduced, which is called hypopituitarism
  • S.apnea leep
  • Precancerous growth, or polyps in the lining of the large intestine
  • Goiter – enlargement of the thyroid gland that causes swelling of the neck
  • Type 2 diabetes
  • Arthritis
  • High blood pressure (hypertension)
  • Heart disease, especially an enlarged heart

Acromegaly Treatment

Acromegaly treatment is based on age and overall health condition. Treatment for acromegaly to restore levels of GH production to normal, relieve pressure around the growing pituitary tumor, maintain normal pituitary function, treat hormone deficiencies and improve the symptoms of acromegaly.

Here are some treatments that can treat acromegaly:

1. Operation

Surgery to remove tumors that cause excess growth hormone is the first choice that is usually recommended by doctors to sufferers of acromegaly. This treatment is fast and effective in reducing levels of growth hormone, which can improve symptoms.

One possible complication is damage to the pituitary tissue surrounding the tumor. If this happens, this indicates that the patient must receive lifelong pituitary hormone replacement treatment. These complications are rare but serious, including cerebrospinal fluid leakage and meningitis.

2. Medicine

Drug use is usually given if surgery fails to reduce GH levels, and can also be used to shrink large tumors before undergoing surgery. The following types of drugs are used to regulate or inhibit the production of growth hormones:

  • Somatostatin analogues (lanreotide or octreotide)
  • Growth hormone receptor antagonists (pegvisomant)
  • Dopamine Agonist (kabergolin and bromocriptine)

3. Radiation Therapy

Radiation is used to destroy large tumors or tumors that remain after surgery or when the use of drugs is ineffective. Radiation is done slowly can help reduce levels of growth hormone when used in conjunction with treatment.

A drastic reduction in growth hormone levels using this type of treatment may take several years, with radiation given in several sessions around four to six weeks. But radiation therapy can damage fertility. In rare cases, this treatment can cause vision loss, brain injury, or secondary tumors.

Acromegaly Prevention

Acromegaly cannot be prevented, but early diagnosis and treatment are the most effective way to treat, manage, prevent the disease from getting worse and help avoid acromegaly complications.

Source:

  1. Hale, Kathryn L. No Year. Acromegaly FAQs.
  2. Healthline Editorial Team. 2016 Acromegaly.

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