Treatment and Diagnosis of Acromegaly | Endocrinology

Acromegaly

What is acromegaly?

Acromegaly is a hormonal illness that develops when the pituitary gland produces too much growth hormone during adulthood. When this occurs, the bones increase in size, including those in the hands, feet, and face. Acromegaly usually affects middle-aged adults.

Acromegaly usually affects middle-aged adults, although it can develop at any age. In children who are static growing, too much growth hormone can cause a condition called gigantism. These children have exaggerated bone growth and abnormal growth in height.

Because acromegaly is rare and physical changes occur gradually, the condition sometimes takes a long time to be recognized. If not treated promptly, acromegaly can lead to serious illness and can even be life-threatening. But available treatments can reduce your risk of complications and significantly improve the characteristics of the condition, including expanding its characteristics.

Symptoms of acromegaly

Symptoms of acromegaly can be difficult to detect, as they usually develop slowly over time. For example, you may notice over a period of several months that you have a ring that feels tighter and tighter on your finger, and one day it will no longer fit. You may also need to go up a shoe size if you have this condition.

Common symptoms of acromegaly are:

  • Enlarged bones in the face, feet, and hands
  • Excessive hair growth in women
  • An enlarged jaw or tongue
  • A prominent eyebrow
  • Excessive growth spurts, which are more common in people who have had abnormal growth before adolescence
  • Weight gain
  • Swollen and painful joints that limit movement
  • Gaps between teeth
  • Fingers and toes extended
  • A deep, hoarse voice
  • Fatigue
  • Headaches
  • Inability to sleep
  • Muscular weakness
  • Profuse sweating
  • Body odor
  • Enlarged sebaceous glands, which are oil-producing glands in the skin
  • Thickened skin
  • Skin tags, which are non-cancerous growths

You should see your doctor if you have noticed one or more of these symptoms.

Causes of acromegaly

GH is part of a group of hormones that regulate the growth and development of the body. People with acromegaly have too much GH. Accelerates bone growth and organ enlargement. Because of this growth stimulation, the bones and organs of people with acromegaly are much larger than the bones and organs of other people.

GH is produced in the pituitary gland of the brain. According to the National Institutes of Health (NIH), more than 95 percent of people with acromegaly have a benign tumor affecting their pituitary. This tumor is called an adenoma. Adenomas are common. They affect about 17 percent of people. In most people, these tumors do not cause excess GH, but when they do they can lead to acromegaly.

Risk factors for acromegaly

Common risk factors in the development of acromegaly are the risk factors for the development of pituitary adenoma. These risk factors include a family history of pituitary adenoma, Macon Albright syndrome, lung cancers, and adrenal tumors.

Diagnosis of acromegaly

Because acromegaly symptoms appear slowly, it can take a long time, possibly years, to make a diagnosis.

If the pointers and feet swell and grow to a larger size, this can be an early sign of acromegaly. Oftentimes, people will notice it when their gloves or shoes no longer fit.

A series of tests can confirm the attendance of acromegaly.

Insulin-like growth factor-1 (IGF-1): Tests can show if the level is too high. IGF-1 is a hormone that is made in the liver. It promotes growth. People with acromegaly usually have high levels of this hormone, because high levels of GH stimulate the production of IGF-1.

Other pituitary hormones can also be measured.

Oral Glucose Tolerance Test (OGTT) – This can provide a more accurate reading of GH levels.

The patient will need to fast overnight before drinking a concentrated glucose solution and then giving a blood sample. Ingesting glucose would normally cause a drop in hormone levels. In a person with acromegaly, hormone levels would remain high, because the body produces too much GH.

MRI of the brain: This can determine the location and size of the tumor.

Treatment for acromegaly

Treatment will rest on the location of the tumor, the person’s age, and medical history.

Treatment will aim to reduce excessive hormone production, relieve pressure caused by the tumor, regulate hormone levels, and improve symptoms.

Surgery

Surgery may be done to remove the pituitary tumor. This would stop the overproduction of GH and relieve pressure on the surrounding tissue.

Transsphenoidal surgery contains inserting an endoscope through the nasal cavity to access the pituitary gland. The endoscope will pass from the nasal cavity to the sphenoid bone, which is a bone that separates the brain from the rest of the facial structures.

Removal of the tumor should cause a decrease in growth hormone levels. However, even if the tumor is removed successfully, hormone levels may not return to normal and additional therapies may be needed.

Radiotherapy

Radiation therapy can be used alone or as part of a combined approach.

After surgery, radiation therapy can kill the remaining tumor cells. It can also be used in conjunction with medications to lower growth hormone levels.

Conventional radiation therapy is given 5 days a week, for up to 6 weeks, but it can take up to 10 years for growth hormone levels to return to normal.

In stereotactic radiosurgery, intense and highly focused beams of radiation are directed at the tumor, minimizing damage to the surrounding tissue. This involves fewer sessions than conventional radiation therapy and can lower growth hormone levels in less time.

Medicines to control growth

Acromegaly can be treated with medication alone if surgery is reflected too risky or unbearable due to the location of the tumor.

Medications include somatostatin analogs (SSA), dopamine agonists, and growth hormone receptor antagonists (GHRA). These aim to stop the rapid growth caused by preventing the secretion or action of growth hormone.

A combination of treatments is probably the best option.

Complications

It is also possible to develop complications of acromegaly if not treated well, which is why it is so important to work closely with your doctor to monitor hormone levels.

Bone complications due to acromegaly

Too much growth hormone (GH) secreted by a tumor (usually a pituitary tumor) can cause the bones to grow too large.

Overgrowth of bones is especially noticeable on the face and can cause tooth problems if the jaw grows too large. Unfortunately, this excessive bone growth cannot be reversed, but it can be stopped by treating acromegaly.

To treat enlarged bones, you may need to have surgery to reshape the bones, but that is not recommended until levels of growth hormone and insulin-like growth factor-1 (IGF-1 ) are back in the normal range.

Bone health can also be affected by acromegaly. Too much GH can change the way your body uses vitamin D, a vitamin that is absolutely essential for bone health. Without it, your body can’t use calcium well, so your bones don’t get the calcium they need. This can lead to osteoporosis (low bone density) and that puts you at higher risk for a fracture.

Hypercalcemia (too much calcium in the blood) and hypercalciuria (too much calcium in the urine) are likely complications of acromegaly; both unkind that your body is not using calcium. However, with treatment, your body should be able to use vitamin D and calcium correctly again to build strong, healthy bones.

Soft tissue complications from acromegaly

Unlike excessive bone growth, soft tissue changes are usually reversible with the treatment of acromegaly to control GH and IGF-1. Soft tissues, such as cartilage and ligaments, can become enlarged and lead to joint problems. Enlarged soft tissues can make it painful to move because the joints may not work as well as they should.

Once your GH and IGF-1 levels arrive in normal, your soft tissues should also return to a more normal extent and you should have less joint pain.

However, if joint pain is caused by arthritis, and not just soft tissue enlargement, joint pain may not change due to acromegaly treatment. If that’s the case (you have arthritis in addition to acromegaly), your doctor will treat arthritis separately from acromegaly.

Pituitary hormone deficiencies

In some people with pituitary tumors that cause acromegaly, the tumor can actually affect the other hormones that the pituitary gland releases. The pituitary gland helps regulate the function of other endocrine glands; If your hormones are off, that can cause other endocrine-related problems. Your physician should closely monitor the levels of other pituitary hormones to make sure they stay in a normal range.

Sleep apnea

Due to overgrowth of the airways, people with acromegaly can sometimes develop sleep apnea (when you have long pauses in breathing while sleeping). This leads to not-so-restful sleep, and lack of sleep can affect many areas of your life.

Treatment of acromegaly can eliminate sleep apnea and help the soft tissues of the airways return to normal size. However, treatment is not a guarantee that you will no longer have sleep apnea; you and your doctor should follow up to see if the sleep apnea goes away.

Heart problems

Too much growth hormone can cause the heart to grow too large, putting people with acromegaly at higher risk for cardiovascular disease, including arrhythmia (abnormal heartbeats). Your doctor should monitor your heart health and see if reducing GH levels improve your heart function.

Diabetes

As you know, excessive GH secretion causes the body to produce too much insulin-like growth factor-1. Too much IGF-1 in the body changes the way your body uses glucose (a source of energy), as well as causing tissue overgrowth. People with acromegaly can develop diabetes due to changes in the way their body processes glucose.

Again, controlling GH levels can help you better control your blood glucose levels. If you develop diabetes, your doctor will give you typical treatment recommendations for that.

Colon polyps

In addition to causing the growth of bones, ligaments, and cartilage, GH can cause the growth of polyps in the colon. Polyps can be a precursor to colon cancer, and people with acromegaly should be watched for polyps to prevent them from becoming cancerous. Your doctor will recommend regular colonoscopies to find and treat any polyp.

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