Acromegaly is a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood. . In adults, too much of this hormone causes bones, cartilage, body organs, and other tissues to increase in size. Common changes in appearance include enlarged or swollen nose, ears, hands and feet.
When you have too much growth hormone, your bones increase in size. In childhood, this leads to increased height and is called gigantism. But in adulthood, a change in height doesn’t occur. Instead, the increase in bone size is limited to the bones of your hands, feet and face, and is called acromegaly. Acromegaly is most often diagnosed in middle-aged adults, but symptoms can appear at any age. In children, too much growth hormone causes a condition called gigantism. rather than acromegaly. Gigantism occurs when excess GH begins before the end of puberty, when children’s growth plates fuse or close. Having too much GH before the growth plates close causes children to grow tall in height.
Symptoms for Acromegaly
The symptoms of acromegaly can be difficult to detect since they usually develop slowly over time. For example, you may notice over a period of several months that you have a ring that feels increasingly tight on your finger and one day it no longer fits. You may also find that you need to go up a size in shoes 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 brow
• Excessive growth spurts, which are more common in people who’ve had abnormal growth before adolescence
• Weight gain
• Swollen and painful joints that limit movement
• Spaces between the teeth
• Hands and feet become larger and swollen—you may notice a change in ring or shoe size, especially shoe width
• Lips, nose, and tongue become larger
• Bone changes: brow and lower jaw jut out, bridge of the nose gets bigger, and space between teeth increases
• Skin becomes thick, coarse, and oily
• Sweating and skin odor increase
• Voice becomes deeper
• Skin tags—small, usually flesh-colored growths of skin that have a raised surface—may get larger or darker
• Severe snoring due to obstruction of the upper airway
• Vision problems
• Headaches, which may be persistent or severe
• Menstrual cycle irregularities in women
• Erectile dysfunction in men
• Loss of interest in sex
Causes of Acromegaly
Acromegaly develops when the pituitary gland releases too much GH into the body over a long period of time. When GH enters the blood, this signals the liver to produce another hormone, called insulin-like growth factor I (IGF-I). IGF-I is the hormone that actually causes bones and body tissue to grow. High levels of this hormone also cause changes in how the body processes blood glucose (blood sugar) and lipids (fats), which can lead to type 2 diabetes, high blood pressure, and heart disease. When the pituitary gland releases GH into your bloodstream, it triggers your liver to produce a hormone called insulin-like growth factor-1 (IGF-1) sometimes also called insulin-like growth factor-I, or IGF-I. IGF-1 is what causes your bones and other tissues to grow. Too muchGH leads to too much IGF-1, which can cause acromegaly signs, symptoms and complications. In adults, a tumor is the most common cause of too much GH production:
Pituitary tumors. Most acromegaly cases are caused by a noncancerous (benign) tumor (adenoma) of the pituitary gland. The tumor produces excessive amounts of growth hormone, causing many of the signs and symptoms of acromegaly. Some of the symptoms of acromegaly, such as headaches and impaired vision, are due to the tumor pressing on nearby brain tissues. Depending on its size and location, the tumor may press against other.
Pituitary tissue. Possible effects include
- Changes in menstruation NIH external link in women
- Erectile dysfunction in men
- Changes in thyroid hormone, which can affect weight, energy levels, hair and skin
- Decreases in cortisol, which can cause weight loss, dizziness, tiredness, low blood pressure and nausea
Nonpituitary tumors. In a few people with acromegaly, tumors in other parts of the body, such as the lungs or pancreas, cause the disorder. Sometimes, these tumors secrete GH. In other cases, the tumors produce a hormone called growth hormone-releasing hormone (GH-RH), which signals the pituitary gland to make more GH. But more often, the tumors produce growth hormone-releasing hormone (GHRH), a hormone that signals the pituitary gland to make growth hormone.
Blood tests. Doctors most often diagnose acromegaly by ordering two blood tests that help determine if your body is making too much GH.
IGF test. Levels of GH in the blood can change throughout the day. A reliable way to track GH in the body is by measuring the level of IGF-I in the blood. In most cases, a high IGF-I level suggests that you have acromegaly.
Oral glucose tolerance test. To confirm the diagnosis, your doctor will order an oral glucose tolerance test. For this test, you will drink a sugary liquid. A health professional will then test your blood every half hour for 2 hours to measure growth hormone levels. The sugar in the drink will normally cause GH levels to fall
Growth hormone suppression test. This is the best method for confirming an acromegaly diagnosis. During this test, your GH blood level is measured both before and after you drink a preparation of sugar (glucose). In people who don’t have acromegaly, the glucose drink typically causes the GH level to fall. But if you have acromegaly, your GH level will tend to stay high.
Imaging. Your doctor may recommend an imaging test, such as magnetic resonance imaging (MRI), to help pinpoint the location and size of a tumor on your pituitary gland. If no pituitary tumors are seen, your doctor may order other imaging tests to look for nonpituitary tumors.
Acromegaly treatment varies by person. Your treatment plan will likely depend on the location and size of your tumor, the severity of your symptoms, and your age and overall health.
To help lower your GH and IGF-1 levels, treatment options typically include surgery or radiation to remove or reduce the size of the tumor that is causing your symptoms, and medication to help normalize your hormone levels.
• Reduce growth hormone production to normal levels
• Relieve the pressure a tumour may be putting on surrounding tissues
• Treat any hormone deficiencies
• Improve your symptoms
Most people with acromegaly have surgery to remove a pituitary tumour. Medicine or radiotherapy may sometimes be needed after, or instead of, surgery.
Surgery is usually effective and can completely cure acromegaly. But sometimes the tumour is too large to be removed entirely, and you may need another operation or further treatment with medicine or
In some cases, your surgeon may not be able to remove the entire tumor. If this is the case, you may still have elevated GH levels after surgery. Your doctor may recommend another surgery, medications or radiation treatments.
Your doctor may recommend one of the following medications — or a combination of medications — to help your hormone levels return to normal:
Drugs that reduce growth hormone production (somatostatin analogues). In the body, a brain hormone called somatostatin works against (inhibits) GH production. The drugs octreotide (Sandostatin) and lanreotide (Somatuline Depot) are man-made (synthetic) versions of somatostatin.
If your surgeon wasn’t able to remove the whole tumor during surgery, your doctor may recommend radiation treatment. Radiation therapy destroys any lingering tumor cells and slowly reduces GH levels. It may take years for this treatment to noticeably improve acromegaly symptoms.
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