A hormonal disorder in which the pituitary gland produces high amounts of growth hormone in adulthood is called acromegaly. People with high growth hormone levels usually notice an increase in bone size. While increased height in childhood is known as gigantism, height changes do not happen in adulthood. However, in adults with acromegaly bone size changes are limited to face, feet, and hands.
Commonly, it is challenging to diagnose this condition because physical changes occur gradually over time. Moreover, acromegaly occurs quite rarely. If this condition is left untreated it may lead to serious (life-threatening) health problems. Early diagnosis and proper treatment, help reduce the risk of complications and lessen the symptoms including enlargement of the features.
Symptoms
The most common symptom of acromegaly is enlarged hands and feet. For instance, people who experience previous symptoms may notice that are unable to put on rings used to fit and that shoe size significantly increases.
Moreover, those who have acromegaly also may notice changes in the face’s shape including an enlarged nose, thickened lips, wider space between teeth, and a protruding lower jaw and brow bone.
This condition progresses slowly and people may notice physical changes even after years. Some people notice differences by comparing old and new photos.
Generally, symptoms in people with acromegaly occur differently and include the following ones. For example:
- Limited joint mobility and pain
- Extreme tiredness (fatigue)
- Muscle or joint weakness
- Skin tags (small outgrowths of the skin tissue)
- Excessive sweating and body odor
- Thickened, oily, and coarse skin
- Enlarged hands, feet, and facial features (such as facial bones, lips, nose, and tongue)
- Enlarged vocal cords and sinuses that cause voice changes
- Vision changes
- Persistent headaches
- Irregular menstrual cycle
- Erectile dysfunction (ED)
- Reduced sex drive
Sometimes, even family members may not notice acromegaly symptoms because they develop slowly over time. However, early diagnosis and treatment is recommended. Otherwise, you may experience life-threatening health problems. If you experience any of the previous symptoms, do not hesitate to see a doctor.
Causes
This condition occurs when the pituitary gland produces high amounts of growth hormone (GH). The symptoms appear slowly because the amount of growth hormone increases gradually too. A small gland located at the base of the brain is called the pituitary gland. It is responsible for producing and releasing certain vital hormones. Growth hormone is essential for physical development and growth.
If this gland begins to release more growth hormone than is needed in the bloodstream, it causes the liver to produce increased amounts of a hormone (known as insulin-like growth factor-1 or IGF-1). As a result, the bones and other tissue begin to grow abnormally. Furthermore, increased GH and IGF-1 cause acromegaly symptoms and complications. Check below some causes that usually cause the pituitary gland to produce more hormones:
- Pituitary tumors – Most diagnosed acromegaly cases occur due to a benign (noncancerous) tumor (adenoma) of the pituitary gland. Thus, the tumor makes increased growth hormone amounts, which causes symptoms of acromegaly. Headaches and impaired vision usually occur due to tumors that put pressure on the brain tissues.
- Nonpituitary tumors – There are some tumors in other body parts (such as the pancreas, lungs, or others) that produce high amounts of growth hormone. Furthermore, in some cases, these tumors make a hormone known as growth hormone-releasing hormone (GH-RH) that causes the pituitary gland to produce more growth hormones.
Risk Factors
Those who suffer from certain genetic disorders (such as multiple endocrine neoplasia, type 1 also called MEN 1) are more likely to develop acromegaly. In people with MEN 1 the parathyroid glands, pancreas, and pituitary gland grow tumors that release too much growth hormones. As a result, acromegaly occurs.
What Are The Possible Complications of Acromegaly?
Those who ignore the symptoms and do not treat the condition may experience serious health problems. Check below some complications:
- Type 2 diabetes
- Precancerous growths (polyps) of the colon lining
- Sleep apnea
- Carpal tunnel syndrome
- Osteoarthritis
- Heart conditions (including cardiomyopathy)
- High cholesterol
- Hypertension (high blood pressure)
- Vision problems or blindness
- Spinal cord compression or fractures
- Elevated risk of cancerous tumors
- Goiter (thyroid gland enlargement)
Early treatment of this condition usually helps prevent previous complications or worsening if any of them occur. If you do not get treatment for acromegaly it may lead to premature death.
Diagnosis
Physicians usually diagnose this condition by performing a physical examination to check for acromegaly symptoms. They may also ask you some questions about your medical and family history. However, doctors may perform additional tests to confirm the condition. These include:
- IGF-1 measurement – This test is often done after you have fasted overnight. For this test, doctors will get a sample of blood to measure the IGF-1 level. If results show you have high IGF-1 levels it may indicate acromegaly.
- Growth hormone suppression test – This is one of the most accurate tests used to confirm this condition. It involves blood samples to measure GH levels, which are done before and after you drink a preparation of sugar. Thus, for people who do not have this condition the sugar drink will cause a reduction of GH but if the levels of growth hormone elevate it is considered you have acromegaly.
- Imaging tests – Healthcare providers may perform an MRI (magnetic resonance imaging) scan to get detailed images to check for nonpituitary tumors.
Treatment
The treatment for people with acromegaly usually differs because it depends on several factors. These include existing health conditions, size and location of the tumor, age, and others.
Commonly, to reduce IGF-1 and GH levels doctors recommend surgery or radiation to remove or reduce the tumor’s size that causes symptoms. Check below some treatment options usually prescribed by doctors for those who suffer from acromegaly:
Surgery
Healthcare professionals often remove roughly all pituitary tumors by transsphenoidal surgery. Surgeons work through the nose during this procedure. However, if the tumor that causes high GH levels is located in other body parts, your doctor may recommend another surgery.
The GH returns to normal levels after surgery, especially if the tumor is small. It also helps lessen the symptoms (such as headaches and vision problems) caused by pressure that the tumor puts on the pituitary gland and nearby tissues.
Sometimes, it is not possible to remove the tumor completely and GH levels may remain high even after surgery. Thus, physicians will prescribe additional treatments (such as surgery, radiation therapy, medicines, or others).
Medicines
Physicians may prescribe one or more medicines listed below to help return GH levels to normal range. For example:
- Somatostatin analogs – There is a specific hormone in the brain that works against GH production. Medicines such as Octreotide and Lanreotide are a synthetic form of somatostatin that helps reduce the production of growth hormones. These medications are usually injected into the muscles of the buttocks.
- Dopamine agonists – Medications such as Bromocriptine and Cabergoline are used to reduce GH and IGF-1 levels sometimes. These drugs help reduce tumor size. Previous medicines should be taken in high doses to treat acromegaly. Nausea, vomiting, stuffy nose, tiredness, dizziness, sleeping problems, and mood changes are the most common adverse reactions of dopamine agonists.
- Growth hormone antagonist – This group of medicines includes specific medications (such as Pegvisomant) that block GH production. Previous medication is usually prescribed by doctors when other treatment options do not work.
Radiation Therapy
This therapy is recommended by doctors when surgery is not possible. It uses powerful energy beams to destroy tumors. However, it may take several years to reduce acromegaly symptoms with this treatment option.
Radiation therapy usually is used to reduce levels of other pituitary hormones, not GH only. Check below some radiation therapy types commonly used to treat acromegaly symptoms:
- Conventional radiation therapy – This type usually is performed daily over 4-6 weeks but the improvements may be noticed even after 10 years or more.
- Stereotactic radiosurgery – This radiation therapy type uses 3D imaging to deliver a high dose of radiation to the tumor. Commonly, growth hormone levels return to normal within 5-10 years.
Frequently Asked Questions
What is the life expectancy of people with acromegaly?
With proper treatment, the life expectancy usually is not affected and people have a normal lifespan. For more details, discuss it with your doctor.
What is the primary cause of acromegaly?
This condition happens when the pituitary gland begins to produce high amounts of growth hormone. It usually occurs due to pituitary tumors but sometimes, it may occur due to a tumor in other body parts.
What happens if acromegaly is left untreated?
This condition requires immediate treatment and if it is not treated may lead to serious health problems. Check below some acromegaly complications:
- Hypertension (high blood pressure)
- Arthritis
- Sleep apnea
- Precancerous growths
- Bone problems
- Kidney failure
- Vision changes
- Diabetes
- Heart disease
If you suspect you have any of the complications listed above, do not hesitate to see a doctor.
