Disease

Acromegaly

Definition

Acromegaly is a long-term condition in which there is too much growth hormone and the body tissues get larger over time.

Alternative Names

Somatotroph adenoma; Growth hormone excess; Pituitary giant

Causes, incidence, and risk factors

Acromegaly occurs in about 6 of every 100,000 adults. It is caused by abnormal production of growth hormone after the skeleton and other organs finish growing.Excessive production of growth hormone in children causes gigantism rather than acromegaly.The cause of the increased growth hormone release is usually a noncancerous (benign) tumor of the pituitary gland. The pituitary gland, which is located just below the brain, controls the production and release of several different hormones, including growth hormone.

Symptoms

Body odorCarpal tunnel syndromeDecreased muscle strength (weakness)Easy fatigueExcessive height (when excess growth hormone production begins in childhood)Excessive sweatingHeadacheHoarsenessJoint painLarge bones of the faceLarge feetLarge handsLarge glands in the skin (sebaceous glands)Large jaw (prognathism) and tongueLimited joint movementSleep apneaSwelling of the bony areas around a jointThickening of the skin, skin tagsWidely spaced teethWidened fingers or toes due to too much skin growth, with swelling, redness, and painOther symptoms that may occur with this disease:Excess hair growth in femalesWeight gain (unintentional)

Signs and tests

High growth hormone levelHigh insulin-like growth factor 1 (IGF-1) levelSpine x-ray shows abnormal bone growthPituitary MRI may show a pituitary tumorEchocardiogram may show an enlarged heart, leaky mitral valve, or leaky aortic valveThis disease may also change the results of the following tests:Fasting plasma glucoseGlucose tolerance test

Treatment

Surgery to remove the pituitary tumor that is causing this condition usually corrects the abnormal growth hormone release in most patients. Sometimes the tumor is too large to remove completely. People who do not respond to surgery will have radiation of the pituitary gland. However, the reduction in growth hormone levels after radiation is very slow.The following medications may be used to treat acromegaly:Octreotide (Sandostatin) or bromocriptine (Parlodel) may control growth hormone release in some people.Pegvisomant (Somavert) directly blocks the effects of growth hormone, and has been shown to improve symptoms of acromegaly.These medications may be used before surgery, after surgery, or when surgery is not possible.After treatment, you will need to see your health care provider regularly to make sure that the pituitary gland is working normally. Yearly evaluations are recommended.

Expectations (prognosis)

Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon.Without treatment the symptoms will get worse, and the risk of high blood pressure, diabetes (high blood sugar), and cardiovascular disease increases.

Complications

Other health problems may include:Arthritis in most joints, which along with excess bone growth may put pressure on the nerves of the spine or the spinal cord    Carpal tunnel syndromeColonic polypsHypopituitarismSleep apnea      Uterine fibroidsVision problems

Calling your health care provider

Call your health care provider if: You have symptoms of acromegalyYour symptoms do not improve with treatment

Prevention

There are no methods to prevent the condition, but early treatment may prevent complications of the disease from getting worse.

References

Melmed S, Kleinberg D. Pituitary masses and tumors. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 9.

Review Date: 12/11/2011
Reviewed By: Nancy J. Rennert, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medeicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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