What is it?
In a condition known as acromegaly, the pituitary gland overproduces growth hormone (GH), which leads to excessive and rapid bone growth. Around age 40, this condition typically affects both men and women equally. It is difficult to detect it before any symptoms appear because of its gradual progression.
Prognosis
Acromegaly takes time to develop. In order to prevent potentially fatal complications, it is imperative that prompt action be taken. Once you begin treatment, you will, in most cases, return to your pre-condition state. But later on, your quality of life might suffer.
What are the symptoms?
You might not experience any acromegaly symptoms for years. The primary symptom of this condition is abnormal hand and foot growth, which you may notice if your shoes or rings no longer fit.
A change in appearance, with enlarged lips, nose, jaw, and forehead (which can also result in occlusal disorders), is another common symptom.
Other signs and symptoms could be:
- excessive sweating
- oily skin
- vision impairment
- articular range of motion reduction and joint pain
- carpal tunnel syndrome
- generalised fatigue and muscle pain
- an increase in the size of your organs
- vocal cords alteration, leading to a deeper voice
- sleep apnoea
- pendulous fibroids
While men may suffer from erectile dysfunction, women may also notice changes in their menstrual patterns, including amenorrhea.
How is it diagnosed?
Clinical testing and physical examinations can be used to diagnose acromegaly.
An MRI scan and CT scan may be helpful in identifying pituitary tumours; growth hormone levels and insulin-like growth factor-1 (IGF-1) levels testing can determine whether there is an actual growth hormone overproduction.
The most accurate test to confirm an acromegaly diagnosis is a GH suppression test performed after an oral glucose load. If GH levels don’t go down after the glucose load, that means you actually have this condition.
What causes it?
Acromegaly is caused by a persistent overproduction of growth hormone by the pituitary gland, which is located in the brain behind the nose. In children, growth hormone is responsible for the proper development of bones, while in adults, it preserves the functionality of bones and muscles. An excess of growth hormone is typically caused by a malignant tumor of the pituitary gland, which results in the symptoms listed above. In rarer cases, a tumor affecting the adrenal gland, pancreas, or lungs may release a hormone that stimulates the pituitary gland, which causes the pituitary gland to release more growth hormone. In still rarer cases, this condition can be linked to using drugs to gain muscle mass, particularly in body-builders.
How is it treated?
Acromegaly treatment consists in lowering GH levels, as well as in removing the pituitary gland tumour. Endonasal transphenoidal surgery (that is, through the nose) is a successful procedure to eliminate the tumour cells in the pituitary gland. Should there be other tumour cells after the surgery, you may have to get started on radiotherapy – one of the secondary effects also being a decrease in GH levels. However, it may take a few years to start seeing the results of radiotherapy, which could also have some side effects on the hypothalamic–pituitary–somatotropic axis (HPS axis).
Which doctor should I talk to?
If you think you may have acromegaly, you should see an endocrinologist. Should you need to have surgery, you’ll also need to see a surgeon.