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Acromegaly

Overview

Acromegaly is an extremely rare hormonal disease. It develops when a tumor of the pituitary, a small gland in the brain, produces excess growth hormone (GH). Almost all pituitary tumors, including the ones that cause acromegaly, are benign or noncancerous, However, they can become very large and expand beyond the standard confines of the pituitary gland. In rare cases, acromegaly can also be caused by a tumor located in other parts of the body. It affects muscle strength, bone health and energy levels. It can even lead to abnormal physical features and other medical complications like Type 2 diabetes, hypertension and sleep apnea. In some cases, it may take several years for the changes to appear.

Acromegaly is caused by the overproduction of the growth hormone (GH) by the pituitary gland over a long period of time. GH plays a vital role in managing physical growth in human beings. The pituitary gland is responsible for producing hormones that control vital body functions like growth and development, reproduction and metabolism. These hormones usually flow in a series, affecting each other's production or release into the bloodstream. In the bloodstream, they trigger the liver to produce a hormone called insulin-like growth factor-I (IGF-I). IGF-I stimulates the growth of bones and other tissues. When the pituitary gland produces excessive GH, it could lead to the high amounts of IGF-I. Extremely high levels of IGF-I can result in the abnormal growth of soft tissues and skeleton, further leading to other signs of acromegaly and gigantism.

 

One of the most common symptoms of acromegaly is the abnormal swelling of the hands and feet. This symptom sets in early, as patients notice a change in ring or shoe size. Gradually, the patient's facial features changes because of changes in the bone. For example, the brow and lower jaw protrude, the nasal bone becomes large, and even the teeth space out. The overgrowth of bone and cartilage can lead to arthritis.

Some other common symptoms of acromegaly:

  • Enlarged lips, nose, and tongue
  • Coarse, oily, thickened skin
  • Excessive sweating and skin odor
  • Joint ache
  • Small outgrowths of skin tissue or skin tags
  • Enlarged sinuses and vocal cords leading to deepening of the voice
  • Obstruction of the airway resulting in sleep apnea-breaks in breathing during sleep
  • Headache and fatigue
  • Impaired vision

Normally, acromegaly develops very slowly, even the patient’s family members may not notice the gradual physical changes that occur. An early diagnosis is critical for the patient to receive proper care.

 

The diagnostic process normally begins with the doctor taking a medical history and conducting a physical exam. This is followed by a recommendation of these steps:

Measurement of GH and IGF-I levels: After an overnight fast, the doctor takes a blood sample. High levels of these hormones indicate acromegaly.
Growth hormone suppression test: Often a fool-proof method for diagnosing acromegaly. Normally, glucose ingestion lowers the level of GH. In acromegaly patients, the GH level tends to remain high.
Imaging: Since most acromegaly cases are caused by a pituitary tumor, the doctor is likely to recommend a magnetic resonance imaging (MRI) scan of the pituitary gland. The MRI should reveal the exact location and size of the tumor.

 

Treatment of acromegaly usually focuses on minimizing the negative effects of the tumor on the pituitary gland. The patient may need more than one type of treatment, which aims at reducing the excess production of growth hormones and bringing it down to normal levels. This helps relieve the pressure of the growing pituitary tumor on the surrounding brain areas. The treatment also seeks to preserve the normal pituitary function and treat hormone deficiencies in the body. Modern treatment includes surgical removal of the tumor, medical therapy and radiation therapy of the pituitary.

 

Treatment of acromegaly can lessen the symptoms and patients can be restored to normal health. Although the treatment normally takes a little longer to be effective, benefits from surgery and drug therapy are often perceptible within days or weeks. After successful treatment, the hands and feet of the patient gradually become less swollen and decreases in size. Other symptoms like headaches can also be brought under control.

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