What is acromegaly? Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body. The pituitary, a small gland in the brain, makes GH. In acromegaly, the pituitary produces excessive amounts of GH. Usually the excess GH comes from benign, or noncancerous, tumors on the pituitary. These benign tumors are called adenomas.
Acromegaly is most often diagnosed in middle-aged adults, although symptoms can appear at any age. If not treated, acromegaly can result in serious illness and premature death. Acromegaly is treatable in most patients, but because of its slow and often “sneaky” onset, it often is not diagnosed early or correctly. The most serious health consequences of acromegaly are type 2 diabetes, high blood pressure, increased risk of cardiovascular disease, and arthritis. Patients with acromegaly are also at increased risk for colon polyps, which may develop into colon cancer if not removed.
1: WHAT ARE THE SYMPTOMS OF ACROMEGALY? The name acromegaly comes from the Greek words for “extremities” and “enlargement,” reflecting one of its most common symptoms—the abnormal growth of the hands and feet. Swelling of the hands and feet is often an early feature, with patients noticing a change in ring or shoe size, particularly shoe width. Gradually, bone changes alter the patient’s facial features: The brow and lower jaw protrude, the nasal bone enlarges, and the teeth space out. Overgrowth of bone and cartilage often leads to arthritis. When tissue thickens, it may trap nerves, causing carpal tunnel syndrome, which results in numbness and weakness of the hands. Body organs, including the heart, may enlarge.
Other symptoms of acromegaly include joint aches, thick coarse oily skin, skin tags, enlarged lips, nose, and tongue, deepening of the voice due to enlarged sinuses and vocal cords, sleep apnea-breaks in breathing during sleep due to obstruction of the airway, excessive sweating and skin odor, fatigue and weakness, headaches, impaired vision, abnormalities of the menstrual cycle and sometimes breast discharge in women, erectile dysfunction in men, decreased libido
2: WHAT CAUSES ACROMEGALY? Acromegaly is caused by prolonged overproduction of GH by the pituitary gland. The pituitary produces several important hormones that control body functions such as growth and development, reproduction, and metabolism. But hormones never seem to act simply and directly. They usually “cascade” or flow in a series, affecting each other’s production or release into the bloodstream…read up more on theboxshowafrica.com
How common is acromegaly? Small pituitary adenomas are common, affecting about 17 percent of the population. However, research suggests most of these tumors do not cause symptoms and rarely produce excess GH. Scientists estimate that three to four out of every million people develop acromegaly each year and about 60 out of every million people suffer from the disease at any time. Because the clinical diagnosis of acromegaly is often missed, these numbers probably underestimate the frequency of the disease.
– Very rare in Nigeria- Fewer than 10 thousand cases per year
– The late WWE Superstar ANDRE THE GIANT suffered Acromegaly
3: HOW IS ACROMEGALY DIAGNOSED?
- Blood tests: If acromegaly is suspected, a doctor must measure the GH level in a person’s blood to determine if it is elevated
- Imaging: After acromegaly has been diagnosed by measuring GH or IGF-I levels, a magnetic resonance imaging (MRI) scan of the pituitary is used to locate and detect the size of the tumor causing GH overproduction
4: HOW IS ACROMEGALY TREATED? Currently, treatment options include surgical removal of the tumor, medical therapy, and radiation therapy of the pituitary.
Goals of treatment are to:
- reduce excess hormone production to normal levels
- relieve the pressure that the growing pituitary tumor may be exerting on the surrounding brain areas
- preserve normal pituitary function or treat hormone deficiencies
- improve the symptoms of acromegaly
- Surgery: Surgery is the first option recommended for most people with acromegaly, as it is often a rapid and effective treatment. The surgeon reaches the pituitary via an incision through the nose or inside the upper lip and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days
- Medical Therapy: Medical therapy is most often used if surgery does not result in a cure and sometimes to shrink large tumors before surgery. Three medication groups are used to treat acromegaly.
– Somatostatin analogs (SSAs) are the first medication group used to treat acromegaly. They shut off GH production and are effective in lowering GH and IGF-I levels in 50 to 70 percent of patients
– The second medication group is the GH receptor antagonists (GHRAs), which interfere with the action of GH. They normalize IGF-I levels in more than 90 percent of patients. They do not, however, lower GH levels. Given once a day through injection, GHRAs are usually well-tolerated by patients
– Dopamine agonists make up the third medication group. These drugs are not as effective as the other medications at lowering GH or IGF-I levels, and they normalize IGF-I levels in only a minority of patients. Dopamine agonists are sometimes effective in patients who have mild degrees of excess GH and have both acromegaly and hyperprolactinemia—too much of the hormone prolactin. Dopamine agonists can be used in combination with SSAs. Side effects can include nausea, headache, and lightheadedness.
– Radiation Therapy: Radiation therapy is usually reserved for people who have some tumor remaining after surgery and do not respond to medications. Because radiation leads to a slow lowering of GH and IGF-I levels, these patients often also receive medication to lower hormone levels. The full effect of this therapy may not occur for many years.
Which treatment for acromegaly is most effective?
No single treatment is effective for all patients. Treatment should be individualized, and often combined, depending on patient characteristics such as age and tumor size.
Points to Remember
- Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body.
- In most people with acromegaly, a benign tumor of the pituitary gland produces excess GH.
- Common features of acromegaly include abnormal growth of the hands and feet; bone growth in the face that leads to a protruding lower jaw and brow and an enlarged nasal bone; joint aches; thick, coarse, oily skin; and enlarged lips, nose, and tongue.
- Acromegaly can cause sleep apnea, fatigue and weakness, headaches, impaired vision, menstrual abnormalities in women, and erectile dysfunction in men.
- Acromegaly is diagnosed through a blood test. Magnetic resonance imaging (MRI) of the pituitary is then used to locate and detect the size of the tumor causing GH overproduction.
- The first line of treatment is usually surgical removal of the tumor. Medication or radiation may be used instead of or in addition to surgery.
