DefinitionAcromegaly is a long-term condition in which there is too much growth hormone and the body tissues get larger over time.
Alternative NamesSomatotroph adenoma; Growth hormone excess; Pituitary giant
Causes, incidence, and risk factorsAcromegaly 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.
SymptomsBody 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 testsHigh 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
TreatmentSurgery 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.
ComplicationsOther 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 providerCall your health care provider if: You have symptoms of acromegalyYour symptoms do not improve with treatment
PreventionThere are no methods to prevent the condition, but early treatment may prevent complications of the disease from getting worse.
ReferencesMelmed 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.