Acromegaly is a rare endocrinological disorder; only three to four cases are diagnosed per million people each year.
You can get acromegaly when the pituitary gland produces more amount of growth hormones than normal for the age. Acromegaly typically happens between 30-50 years of age. It is a slowly progressive condition. It usually takes many years before the signs and symptoms appear and the condition is diagnosed.
The pituitary gland is a small endocrine gland located in your brain, just at the level of your nose. It normally secretes growth hormone and other hormones. The growth hormone plays an important role during your physical growth. Once you reach 20 years of age, most body parts cease to grow. However, excessive production of growth hormone stimulates the overproduction of another hormone called insulin-like growth factor 1 (IGF-1). IGF-1 stimulates the growth of skin, bone, and other tissues and gives the rise to the signs and symptoms of acromegaly.
Now, the pituitary gland may secrete more growth hormones due to any of the following causes:
- Pituitary tumor: A benign growth (tumor) in the pituitary, known as pituitary adenoma, is the cause of acromegaly in more than 95% of cases. It may also press on adjacent nerves and give rise to the signs and symptoms of acromegaly, such as headaches and blurred vision.
- Tumors in other organs: Tumors in organs, such as the pancreas or lungs, can release a hormone known as growth hormone-releasing hormone. This hormone can stimulate the pituitary gland to release more quantity of growth hormone, thus giving rise to acromegaly.
How is acromegaly diagnosed?
The doctor will suspect acromegaly by looking at your physical appearance and taking your medical history. To confirm their diagnosis, they will order additional tests that include:
- Growth hormone suppression test: This is the best method for confirming an acromegaly diagnosis. During this test, your blood growth hormone level is measured both before and after you drink glucose (sugar preparation). In people who don't have acromegaly, the glucose drink typically causes the growth hormone level to fall. However, if you have acromegaly, your growth hormone level stays high.
- IGF-1 level: This is a blood test that can be done at any time of the day. However, the levels of IGF-1 fluctuate several times a day, hence you may need to get your IGF-1 level tested a few more times. High levels of IGF-1 suggest acromegaly.
- Imaging tests: Once acromegaly has been confirmed, a magnetic resonance imaging (MRI) test will be ordered to check if you have a pituitary adenoma.
Is acromegaly curable?
Acromegaly can be treated in most cases. The treatment is more effective if the condition is diagnosed and treated early. The definitive treatment is surgery to remove the pituitary tumor. The surgery is done through the nose to excise the tumor. Sometimes, not the whole of the tumor can be removed. In such cases, doctors may need to:
- Perform another surgery
- Manage the remainder of signs and symptoms through life-long medications
- Administer radiation therapy
What happens if acromegaly is left untreated?
If left untreated, the increasing growth hormone levels can have serious complications. The possible complications include:
- Uncontrolled diabetes
- Extra growths on the colon, such as polyps that turn into cancer
- Loss of vision
- Hypertension (high blood pressure)
- High cholesterol levels
- Cardiomegaly (enlarged heart)
- Sleep apnea (temporary cessation of breathing during sleep)
- Goiter (enlargement of the thyroid gland)
- Uterine fibroids
- Carpal tunnel syndrome
Without treatment, your life expectancy may reduce by as many as ten years if you have uncontrolled growth hormone levels and conditions, such as diabetes and heart disease. With treatments that bring your IGF-1 and growth hormone levels to normal, you can have a normal life expectancy.
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Schwartz RA. Gigantism and Acromegaly. Medscape. https://emedicine.medscape.com/article/925446-overview
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