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Acromegaly

Somatotroph adenoma; Growth hormone excess; Pituitary giant (in childhood)

 

Acromegaly is a condition in which there is too much growth hormone in the body.

Causes

 

Acromegaly is a rare condition. It is caused when the pituitary gland makes too much growth hormone. The pituitary gland is a small  endocrine gland  attached to the bottom of the brain. It controls, makes, and releases several hormones, including growth hormone.

Usually a noncancerous (benign) tumor of the pituitary gland releases too much growth hormone.

In children, too much growth hormone causes gigantism rather than acromegaly.

 

Symptoms

 

Symptoms of acromegaly may include any of the following:

  • Body odor
  • Carpal tunnel syndrome
  • Decreased muscle strength ( weakness )
  • Decreased peripheral vision
  • Easy fatigue
  • Excessive height (when excess growth hormone production begins in childhood)
  • Excessive sweating
  • Headache
  • Hoarseness
  • Joint pain , limited joint movement, swelling of the bony areas around a joint
  • Large bones of the face, large jaw and tongue, widely spaced teeth
  • Large feet (change in shoe size), large hands (change in ring or glove size)
  • Large glands in the skin (sebaceous glands), thickening of the skin, skin tags (growths)
  • Sleep apnea
  • Widened fingers or toes, with swelling, redness, and pain

Other symptoms that may occur with this disease:

  • Colon polyps
  • Excess hair growth in females ( hirsutism )
  • Type 2 diabetes
  • Weight gain (unintentional)

 

Exams and Tests

 

The health care provider will perform a physical exam and ask about your symptoms.

The following tests may be ordered to confirm diagnosis of acromegaly:

  • Blood glucose
  • Growth hormone  
  • High insulin-like growth factor 1 (IGF-1) level
  • Spine x-ray
  • MRI of the brain , including the pituitary gland
  • Echocardiogram
  • Prolactin

Other tests may be ordered to check whether the rest of the pituitary gland is working normally.

 

Treatment

 

Surgery to remove the pituitary tumor that is causing this condition often corrects the abnormal growth hormone. Sometimes the tumor is too large to be removed completely and acromegaly is not cured. In this case medicines and radiation (radiotherapy) may be used to treat acromegaly.

Some people with tumors that are too complicated to remove by surgery are treated with medicines instead of surgery.

After treatment, you will need to see your provider regularly to make sure that the pituitary gland is working normally and that acromegaly does not come back. Yearly evaluations are recommended.

 

Outlook (Prognosis)

 

Pituitary surgery is successful in most people, depending on the size of the tumor and the experience of the surgeon.

Without treatment, the symptoms will get worse. Conditions such as high blood pressure, diabetes, and heart disease may result.

 

When to Contact a Medical Professional

 

Call your provider if:

  • You have symptoms of acromegaly
  • Your symptoms do not improve with treatment

 

Prevention

 

Acromegaly cannot be prevented. Early treatment may prevent the disease from getting worse and help avoid complications.

 

 

Open References

References

Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab . 2014;99:3933-3951. PMID: 25356808 www.ncbi.nlm.nih.gov/pubmed/25356808 .

Melmed S. Acromegaly. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 12.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    Tests for Acromegaly

     
       

      Review Date: 10/28/2015

      Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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