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 at which the disease develops. If the disease occurs before puberty—that is, before growth in height is complete—it results in what is known as gigantism or pituitary gigantism. In this case, normal body proportions are largely preserved. However, if the condition occurs after puberty, when growth has already ceased (after the epiphyseal plates have closed), growth is possible only at the bony extremities, in soft tissues such as the larynx, and in internal organs.
This results in organ enlargement, known as visceromegaly. The skin thickens, and hair growth is stimulated. Uncontrolled proliferation of joint cartilage leads to joint disorders. This type of growth causes the body’s proportions to appear coarse. The increased levels of growth hormone can lead to diabetes or, at the very least, impaired glucose tolerance, which brings about further symptoms.
In some cases, women experience a cessation of menstruation accompanied by seemingly unexplained milk production (galactorrhea-amenorrhea syndrome). In men, erectile dysfunction is a common consequence.
About one-third of patients suffer from high blood pressure, while two-thirds complain of numbness or tingling in the hands caused by carpal tunnel syndrome, which usually resolves after treatment of acromegaly.
Patients frequently complain of headaches, general fatigue, and bone pain. More than 90% of patients have sleep apnea syndrome, characterized by snoring, nocturnal breathing pauses, and sleep that is hardly restful. Those affected rarely notice the gradual changes in their facial appearance on their own. However, comparing their current appearance with old photographs can be revealing. Another clue is an increase in hat or shoe sizes in adulthood.
Orthodontic consultations due to increasing malocclusion are not uncommon. Serious complications arise when the growth of the pituitary tumor leads to visual field defects or other cranial nerve deficits.
Acromegaly is a difficult condition to diagnose. It progresses insidiously, and its symptoms are usually misinterpreted at first. In addition to the typical clinical presentation of the disease—which usually includes markedly enlarged hands and feet—measuring IGF-1 (insulin-like growth factor-1) levels in the blood is crucial for diagnosis.
Specialists in the treatment of acromegaly are physicians in the fields of neuroendocrinology and head and brain neurosurgery. The treatment of choice is surgical removal of the pituitary tumor. If the hormone-producing tissue cannot be completely removed, follow-up treatment with medication is necessary. Various medications are available for this purpose. It is also possible to use medication prior to surgery to reduce the size of larger tumors. Radiation therapy may also be used.
What is acromegaly?
Acromegaly is a hormonal disorder in which a benign pituitary tumor causes an overproduction of growth hormones. Unlike gigantism, acromegaly occurs after the end of linear growth, when the growth plates of the bones have already closed.
What are the symptoms of acromegaly?
Typical symptoms of acromegaly include enlarged hands and feet, coarse facial features, an enlarged lower jaw, and snoring due to changes in the larynx. Other symptoms of acromegaly may include diabetes, carpal tunnel syndrome, or enlargement of internal organs.
How is acromegaly diagnosed?
The diagnosis of acromegaly is based on measuring GH and IGF-1 levels in the blood. This is supplemented by magnetic resonance imaging (MRI) to visualize a pituitary tumor. Diagnosis is typically performed in the field of endocrinology.
How is acromegaly treated?
Treatment for acromegaly usually begins with surgical removal of the tumor, often via a transsphenoidal approach. If necessary, this is followed by drug therapy with somatostatin analogs or radiation therapy. The goal is to suppress the excess growth hormone.
What is the prognosis for acromegaly?
Without treatment, life expectancy is reduced in people with acromegaly. However, early diagnosis of acromegaly and consistent treatment can significantly improve the prognosis.
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