Acromegaly

Acromegaly is a condition in adults caused by the pituitary gland producing an excess amount of growth hormone. This hormonal imbalance leads to physical changes, such as enlarged hands, feet, and lips, as well as thicker skin. Internal organs may also swell, and the vocal cords might thicken, resulting in a deeper voice. Additional signs include the enlargement of the skull, a more pronounced brow and jaw, increased spacing between teeth, and carpal tunnel syndrome. Treatment options often involve medications like ergot derivatives, somatostatin analogues, and growth hormone receptor antagonists.

Causes

• The primary cause of acromegaly is the overproduction of growth hormone.

• This typically occurs due to a benign tumor, known as an adenoma, on the pituitary gland.

• The pituitary gland, located at the brain's base, regulates growth by secreting growth hormone into the bloodstream.

• A pituitary adenoma leads to excessive growth hormone release, manifesting acromegaly symptoms such as enlarged extremities and facial features.

• Occasionally, tumors in other body parts, including the lungs or pancreas, may produce growth hormone or related hormones.

• These hormones can stimulate the pituitary gland to release more growth hormone.

• The overproduction results in increased insulin-like growth factor 1 (IGF-1), causing tissue and bone growth typical of acromegaly.

Symptoms

Acromegaly symptoms arise from an overproduction of growth hormone in adults and include:

• Enlarged hands and feet

• Altered facial features, such as a more prominent jaw, forehead, and nose

• Thicker, oilier skin and more skin tags

• Joint pain and headaches

• Carpal tunnel syndrome

• Deeper voice

• Excessive sweating

• Fatigue

Symptoms develop gradually over years, complicating early detection. It is crucial to consult a healthcare professional if these symptoms arise for accurate diagnosis and treatment.

Diagnosis

Diagnosing acromegaly requires a thorough process involving medical history reviews, physical exams, and specific testing. Initially, blood tests assess insulin-like growth factor 1 (IGF-1) levels. Elevated IGF-1 suggests excessive growth hormone, characteristic of acromegaly. If levels are high, a growth hormone suppression test follows. This test involves consuming a glucose solution to check if growth hormone levels decrease, as expected in healthy individuals. In acromegaly, these levels remain unchanged. To identify the source, typically a pituitary tumor, doctors use an MRI scan. If no tumor is found, further imaging tests are conducted to discover other contributing factors.

Treatments

Acromegaly treatment focuses on reducing hormone levels and alleviating symptoms. Surgery is usually the first approach, especially with pituitary gland tumors. The operation, often through the nasal passage, seeks to remove the tumor and normalize growth hormone levels quickly. If surgery is inadequate or impossible, medications follow. These include somatostatin analogs, like Octreotide and lanreotide, which decrease hormone production, and pegvisomant, which blocks hormone effects. Dopamine agonists can also be used to lower hormone levels. In cases that persist or recur, radiation therapy may be employed to eradicate remaining tumor cells, though effects may take years. Managing acromegaly often requires a combination of treatments and lifelong monitoring.

Medications

Managing acromegaly involves medications that control the condition by reducing or blocking excessive growth hormone levels. Key medications include:

• Somatostatin analogs (e.g., Octreotide, lanreotide): Reduce growth hormone production.

• Dopamine agonists (e.g., Cabergoline, Bromocriptine): Lower growth hormone levels and may shrink hormone-producing tumors.

• Pegvisomant: Acts as a growth hormone antagonist, blocking growth hormone actions and lowering IGF-1 levels. Patients on pegvisomant should have regular liver function tests due to potential liver-related side effects.

Medications are vital for long-term acromegaly management, often used alongside surgical or radiation strategies for comprehensive care.

Prevention

• Acromegaly results from excessive growth hormone production, usually due to a benign pituitary gland tumor. No known prevention methods exist as tumor causes are still unclear.

• Genetics might influence acromegaly development, though this is not well understood. The condition is rarely inherited, complicating preventive efforts.

• Without prevention options, early detection and management are crucial. Recognizing subtle signs like increased shoe size or enlarged hands can prompt timely medical evaluation.

• Early diagnosis and treatment help manage symptoms and prevent complications from untreated acromegaly.