Acromegaly

Slideshow

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  Slide

  People with acrogmegaly typically have thick lips, coarse facial features, a jutting forehead and jaw, and widely spaced teeth; and large hands and feet. They also often perspire excessively.

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  Causes

  A noncancerous tumor in the pituitary gland, known as a pituitary adenoma, is the usual cause of acromegaly. The tumor produces excess GH that in turns raises GH levels in the blood as well as insulin-like growth factor-1 (IGF-1) hormone in the liver, both of which promote growth.

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  Signs & Symptoms

  High GH levels due to acromegaly can cause numbness or burning of the hands or feet; Carpal tunnel syndrome; high blood glucose; heart failure or enlarged heart; hypertension; arthritis; goiter; tiredness; and sleep apnea.

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  Slide

  Hypopituitarism due to acromegaly can be responsible for menstrual disorders, including irregular bleeding or amenorrhea. It can also cause decreased sexual desire and tiredness.

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  Slide

  When the tumor is large enough to compress surrounding brain structures, people with acromegaly may experience headaches and vision problems, such as tunnel vision and vision loss.

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  Diagnosis

  Clinicians check for elevated IGF-1 levels using a blood test. An oral glucose tolerance test can also be used to measure levels of GH in the blood.

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  Treatment

  Acromegaly treatments are primarily aimed at normalizing GH and IGF-1 levels. If a pituitary tumor is the cause of acromegaly, first-line treatment usually includes surgery to remove the tumor.

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  Slide

  If complete tumor removal is not possible or if a patient is not a candidate for surgery, pituitary irradiation may be used. This treatment may take as long as 10 to 20 years to be fully effective. After achievement of the target levels, however, the effects are permanent.

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  Slide

  Drug therapy can be used, but patients will likely need to take these medications for the rest of their lives. Somatostatin analogs and GH receptor antagonists are usually most effective. In some cases, dopamine agonists may work. In other cases, a combination of these medications may be necessary.