A pronounced enlargement of acra (protruding parts of the body and extremities) is called acromegaly and is caused by an overproduction of growth hormones in the pituitary gland (hypophysis).
Learn more about the causes, symptoms and treatment and find selected acromegaly specialists here.
In most cases, acromegaly is caused by a benign tumor of the pituitary gland(pituitary adenoma). Only rarely does a malignant pituitary tumor lead to acromegaly. This tumor produces the hormone somatropin, which is responsible for growth.
The symptoms of acromegaly depend on the age of onset. If the disease occurs before puberty, i.e. before length growth is complete, then so-called gigantism or pituitary gigantism occurs. The normal body proportions are largely retained. However, if the disease occurs after puberty, when growth is already complete (after closure of the epiphyseal joints), growth is only possible in the bony acres, soft tissues such as the larynx and internal organs.
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This leads to organ enlargement, known as visceromegaly. The skin becomes thicker and hair growth is stimulated. An uncontrolled proliferation of joint cartilage leads to joint diseases. The body proportions appear coarser due to this type of growth. The increased growth hormone can lead to diabetes or at least to impaired glucose tolerance, which causes further symptoms.
In women, in some cases there is a lack of menstruation with apparently unmotivated milk production (galactorrhea-amenorrhea syndrome). In men, erectile dysfunction is a common consequence.
Around a third of patients suffer from increased blood pressure, two thirds complain of numbness or tingling in the hands caused by carpal tunnel syndrome, which usually disappears after treatment of acromegaly.
Patients often complain of headaches and general fatigue as well as bone pain. More than 90 % of patients have sleep apnoea syndrome with snoring, nocturnal apnoea and barely restful sleep at night. Those affected rarely notice the slow transformation of their physiognomy themselves. However, a comparison with old photographs can be revealing. Another indication is an increase in hat or shoe sizes in adulthood.
Orthodontic consultations due to increasing malocclusion are not uncommon. Serious complications occur when the growth of the pituitary tumor leads to visual field defects or other cranial nerve deficits.
Acromegaly is a difficult disease to diagnose. It progresses gradually and its symptoms are usually misinterpreted at first. In addition to the typical clinical picture of the disease with usually grossly enlarged hands and feet, the determination of IGF-1 (insulin-like growth factor-1) in the blood is important for the diagnosis.
Specialists in the treatment of acromegaly are neuroendocrinologists and head and brain neurosurgeons. The treatment of choice is the surgical removal of the tumor of the pituitary gland. If the hormone-producing tissue cannot be completely removed, follow-up treatment with medication is required. Various medications are available here. There is also the option of drug treatment prior to surgery to reduce the size of larger tumors. Radiotherapy can also be used.
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