Acromegaly

Acromegaly is a condition where your body produces too much growth hormone, usually after you've stopped growing. This extra growth hormone affects your bones, making them bigger.

A key symptom of acromegaly is a noticeable change in the size of your face, hands, and feet. Your brow bone, lower jaw, nose, and lips might get bigger and wider. This happens gradually, over many years, which is why it's sometimes hard to spot right away.

Unlike in childhood, where excess growth hormone causes a person to become very tall (a condition called gigantism), in adulthood the extra hormone doesn't cause you to grow taller. Instead, it causes the bones in your hands, feet, and face to thicken and enlarge.

Acromegaly is a rare condition. If left untreated, high levels of growth hormone can harm other parts of the body, potentially leading to serious, even life-threatening, health issues. These problems could include difficulties with organs like the heart, liver, and kidneys. However, treatment for acromegaly is available and can significantly improve the symptoms and reduce the risk of these complications. This includes the enlargement of facial features and other physical changes.

Acromegaly is a condition that gradually changes your body over time. A common early sign is noticing your hands and feet getting bigger. This might mean rings that used to fit no longer do, and your shoe size increases. Your face can also change, with a protruding jaw and brow, an enlarged nose, thicker lips, and wider spaces between your teeth. Since these changes happen slowly, they might not be noticeable for a while. Sometimes, people only realize they have these changes by looking at old photos compared to newer ones.

The signs and symptoms of acromegaly can vary from person to person, but here are some common ones:

• Larger hands and feet: This is often one of the first noticeable changes.
• Enlarged facial features: This includes the bones in your face, like your jaw and brow, as well as your nose, lips, and tongue.
• Changes in skin: Your skin might become thicker, oilier, and coarser. You might also experience more sweating and body odor.
• Skin tags: Small growths of skin tissue may appear.
• Fatigue and muscle/joint problems: You might feel tired more often, and your muscles and joints might ache or feel weak.
• Limited movement: Changes in your joints can make it harder to move them as much as you used to.
• Voice changes: Your voice might become deeper and sound husky, due to enlarged vocal cords and sinuses.
• Sleep problems: Acromegaly can cause severe snoring due to a blocked airway.
• Vision problems: Changes in your vision are also possible.
• Headaches: Frequent or severe headaches can be a symptom.
• Reproductive issues: Women may experience irregular periods, and men may have erectile dysfunction.
• Reduced interest in sex: This is another possible symptom.

It's important to remember that acromegaly develops gradually. Even family members might not notice the changes right away. But early diagnosis is crucial. If you have any of these signs, it's essential to see a doctor for an exam. Untreated acromegaly can lead to more serious health problems.

If you have any of the symptoms of acromegaly, it's important to see a doctor.

Acromegaly often develops slowly, so you or even your loved ones might not notice the changes in your body at first. This slow progression is why early diagnosis is so important. Catching acromegaly early allows for the best treatment and can help prevent more serious health problems down the road.

Acromegaly happens when your pituitary gland, a small gland at the base of your brain, makes too much growth hormone (GH) for a long time. This gland is located near the bridge of your nose and is responsible for producing many hormones, including GH.

Growth hormone's job is to help you grow. When the pituitary gland releases GH into your bloodstream, it tells your liver to make another hormone called insulin-like growth factor-1 (IGF-1). This IGF-1 is what makes your bones and other body tissues grow. If your pituitary gland makes too much GH, it leads to too much IGF-1, which is the cause of acromegaly's symptoms.

In most cases of acromegaly in adults, the problem is a non-cancerous tumor (called an adenoma) in the pituitary gland itself. This tumor produces extra growth hormone, which in turn causes the symptoms. Sometimes, the tumor presses on nearby parts of the brain, causing headaches and vision problems.

Less often, tumors in other parts of the body, such as the lungs or pancreas, can cause acromegaly. These tumors might directly make growth hormone, or they might produce a hormone called growth hormone-releasing hormone (GH-RH). GH-RH signals the pituitary gland to make even more growth hormone. This extra hormone then leads to the problems associated with acromegaly.

People with a rare genetic condition called multiple endocrine neoplasia type 1 (MEN 1) are more likely to get acromegaly. MEN 1 causes certain glands in the body, mainly the parathyroid glands, pancreas, and pituitary gland, to develop tumors. These tumors release extra hormones into the body. Sometimes, these extra hormones cause acromegaly. Acromegaly is a condition where the body produces too much growth hormone, often leading to unusual growth and changes in body features.

Acromegaly, if not treated, can cause serious health issues. This condition, which affects the body's growth hormone levels, can lead to a range of problems.

Possible complications include:

• High cholesterol: This can increase the risk of heart disease.
• Heart problems: Acromegaly can cause the heart to enlarge (cardiomyopathy), which weakens it and makes it harder to pump blood throughout the body.
• Joint pain and stiffness (Osteoarthritis): Extra growth hormone can put extra stress on joints, leading to pain and stiffness.
• Type 2 diabetes: Acromegaly can interfere with the body's ability to regulate blood sugar, increasing the risk of this common condition.
• Enlarged thyroid (goiter): The thyroid gland, which controls metabolism, might grow larger.
• Colon polyps: These are growths in the colon that can sometimes become cancerous if left untreated. Regular checkups are important to detect them early.
• Sleep apnea: Acromegaly can make it difficult to breathe properly during sleep, leading to repeated pauses in breathing. This can cause daytime fatigue and other health problems.
• Carpal tunnel syndrome: This condition, often characterized by numbness and tingling in the hands and wrists, can be triggered by the extra growth in the hands and wrists.
• Increased risk of cancer: People with untreated acromegaly have a higher risk of developing various types of cancer.
• Vision problems: Acromegaly can put pressure on the optic nerves, potentially leading to vision changes or loss.

Getting acromegaly treated early can prevent these problems from developing or getting worse. Without treatment, acromegaly and the related complications can significantly shorten a person's lifespan. Early diagnosis and treatment are crucial for managing the condition and improving quality of life.

To diagnose acromegaly, your doctor will first ask about your health history and perform a physical exam. Next, they might recommend these steps:

IGF-1 Measurement: After you've not eaten for a whole night (fasted), a blood sample will be taken to measure a substance called IGF-1. Higher than normal IGF-1 levels often point to acromegaly.

Growth Hormone Suppression Test: This test is the most reliable way to confirm acromegaly. Your doctor will measure the level of growth hormone (GH) in your blood before and after you drink a sugary liquid. Normally, the sugary drink causes the GH level to decrease. But if you have acromegaly, your GH level will likely stay elevated.

Imaging Tests: Your doctor might use imaging tests, such as an MRI (magnetic resonance imaging), to locate and size any tumors on your pituitary gland, a small gland at the base of your brain. If no pituitary tumors are found, other imaging tests, like a CT scan, might be needed to look for tumors in other parts of the body.

Treating Acromegaly: A Personalized Approach

Acromegaly is a condition where your body produces too much growth hormone (GH). This extra GH leads to various problems, and treatment depends on several factors. Your doctor will consider the size and location of the tumor causing the excess GH, the severity of your symptoms, your age, and your overall health.

Treatment Options

The goal of acromegaly treatment is to reduce GH and IGF-1 (a hormone affected by GH) levels. Several approaches are often used:

• Surgery: This is frequently the first line of treatment. A common surgical technique is called transnasal transsphenoidal surgery. The surgeon uses instruments inserted through your nose to access and remove the tumor in the pituitary gland. If the tumor isn't in the pituitary gland, another type of surgery will be needed. In many cases, removing the tumor brings GH levels back to normal. Sometimes, not all of the tumor can be removed. In these cases, further treatment like medication or radiation may be needed.

• Medication: Several medications can help reduce GH and IGF-1 levels and sometimes shrink the tumor.

  • Somatostatin Analogues: These medications, like octreotide and lanreotide, are synthetic versions of a natural hormone that inhibits GH production. They're usually injected monthly by a healthcare professional into the buttocks.
  • Dopamine Agonists: Medications like cabergoline and bromocriptine can lower GH and IGF-1 levels in some people. They may be taken orally, but are typically needed at higher doses, potentially increasing side effects like nausea, vomiting, stuffy nose, tiredness, dizziness, sleep problems, and mood changes.
  • Growth Hormone Antagonist: Pegvisomant blocks the effects of GH on the body. It's often a good option for those who haven't responded well to other treatments. It's injected daily and can reduce IGF-1 levels and symptoms but doesn't directly lower GH or shrink the tumor.

• Radiation Therapy: If surgery doesn't completely remove the tumor, radiation therapy can destroy remaining tumor cells and lower GH levels. However, it can take several years for the full effects to be seen. There are different types of radiation therapy:

  • Conventional Radiation Therapy: This involves daily treatments over several weeks. Its full effects may not be noticeable for 10 or more years.
  • Stereotactic Radiosurgery: This uses precise imaging to deliver a high dose of radiation directly to the tumor while minimizing harm to surrounding tissues. It often takes only one treatment and can bring GH levels back to normal within 5 to 10 years.

Important Considerations

Your doctor will tailor a treatment plan based on your specific situation. After treatment, regular follow-up appointments are crucial to monitor your hormone levels and ensure your pituitary gland is functioning correctly. Follow-up visits may be needed for the rest of your life.