What is Acromegaly? Symptoms, Causes, Diagnosis and Treatment Methods

Acromegaly

Acromegaly is a condition that develops due to the excessive secretion of growth hormone (GH) during adulthood. Acromegaly can affect many systems by leading to hormonal imbalances. When left untreated for a long time, it can seriously affect numerous systems, ranging from appearance to heart health, sugar metabolism, joint health, and sleep patterns. However, with correct diagnosis and treatment, life expectancy can be extended beyond expectations.

What is Acromegaly?

Acromegaly occurs as a result of excessive growth hormone secretion caused by a benign adenoma (tumor) formed in the pituitary gland (an organ the size of a walnut located in the brain, at the level of the nasal bridge). Growth hormone triggers the production of IGF-1 (insulin-like growth factor 1) in the liver. IGF-1 ensures the growth of bones and soft tissues. If GH/IGF-1 excess continues for a long time, permanent changes primarily in the hands, feet, and face, organ enlargements, and metabolic disorders develop.

This disease is called acromegaly when it begins after the epiphyseal plates have closed, meaning after linear growth has stopped.

What Are the Symptoms of Acromegaly?

Acromegaly symptoms may initially be mild enough not to affect daily life significantly. However, they gradually become more pronounced over time. Because of this slow change, individuals may sometimes fail to notice the disease or may attribute the symptoms to other causes. Acromegaly symptoms stand out particularly with the changes they create in appearance and can lead to diagnosis when noticed by people around the patient. The symptoms of acromegaly are as follows:

Enlargement of hands and feet: Thickening occurs in the fingers, rings may become tight, or shoe sizes increase over time. Patients often associate this with weight gain.

Pronounced changes in facial features: Acromegaly leads to changes in facial appearance over time, which can make recognition difficult. The jawbone protrudes forward (prognathism), the forehead bones become prominent, the nose widens, and the lips may thicken.

Widening of spaces between teeth: The growth of the upper and lower jaws causes gaps between the teeth. This condition is often prominent enough to require dental treatment.

Thickening of the skin and increased oiliness: Changes occur in the skin structure, becoming thick and coarse.

Tongue enlargement (macroglossia): A tongue larger than normal can create speech difficulties, make breathing harder, and cause snoring.

Deepening of the voice: Due to changes in the vocal cords, the tone of the voice becomes deeper and heavier. It can be easily noticed by acquaintances even during phone calls.

Joint pains and movement difficulties: Arthritis can develop due to joint enlargement and the thickening of soft tissue around the joints, and difficulty in movement may be experienced.

Carpal tunnel syndrome: Numbness, tingling, or loss of strength related to nerve compression in the hands and wrists can be observed.

Headache: Constant or intermittent headaches related to the pressure of the tumor in the pituitary gland can be seen. Headaches are generally dismissed by attributing them to other causes.

Vision problems: Due to the pituitary tumor putting pressure on the optic nerves, problems such as narrowing of the visual field, blurred vision, or double vision may be experienced.

Fatigue and low energy: Weakness, a feeling of exhaustion, and constant sleepiness during the day are among frequently encountered symptoms.

Sleep apnea and snoring: The enlargement of tissues in the tongue and throat can narrow the respiratory tracts, causing breathing pauses (apnea) during sleep.

Metabolic and hormonal disorders: The risk of Type 2 diabetes, hypertension, and heart diseases increases. Patients are usually suspected of having acromegaly when they visit a doctor for blood sugar or blood pressure problems.

What Causes Acromegaly?

One of the hormones secreted by the pituitary gland is growth hormone (GH). A benign tumor (adenoma) in the pituitary gland causes uncontrolled production of growth hormone. This excessively secreted hormone triggers the production of insulin-like growth factor-1 (IGF-1) in the liver and leads to tissue growth. In very rare cases, acromegaly may also develop due to non-pituitary causes; for example, tumors of the pancreas, lungs, or hypothalamus may secrete hormones that lead to the overproduction of growth hormone. Genetic factors also rarely play a role in acromegaly. In general, acromegaly is a later-developed disease that appears later in life.

How is Acromegaly Diagnosed?

To diagnose acromegaly, the patient's experienced symptoms are first evaluated, and a physical examination is performed by the physician. Enlargements in tissues such as hands, feet, face, and tongue, along with complaints like joint pain, generally create a suspicion of acromegaly in the doctor. However, these symptoms are not sufficient for a definitive diagnosis, and additional tests are performed. Blood tests are of critical importance in diagnosis. Especially since the measurement of growth hormone (GH) levels fluctuates, the level of IGF-1 (Insulin-Like Growth Factor-1), which is a more reliable method, is checked. An elevated IGF-1 level is an important clue for acromegaly. Subsequently, if the GH level does not drop after glucose administered during an Oral Glucose Tolerance Test (OGTT), the diagnosis of acromegaly is confirmed.

Imaging methods are also utilized for definitive diagnosis. Magnetic resonance imaging (MRI) is preferred to determine the presence of a tumor in the pituitary gland and measure its size. MRI clearly reveals the size of the tumor and its effect on surrounding tissues.

How is Acromegaly Treated?

The treatment of acromegaly usually requires a multidisciplinary approach. The aim is to control growth hormone levels and prevent developing complications. The surgical method most commonly used today is endoscopic transnasal surgery. In this method, the pituitary tumor is removed by entering through the nose. If surgery is successful, growth hormone and IGF-1 levels return to normal, and the disease is brought under control.

If acromegaly surgery does not achieve complete success or in patients who cannot undergo surgery, medical treatment is preferred. Medications used in drug therapy keep symptoms and complications under control by reducing growth hormone secretion. Another group of drugs, GH receptor antagonists, block the effects of GH on the body. In some patients, medications such as dopamine agonists may also be used adjunctively. Acromegaly injections are administered at regular intervals to suppress growth hormone secretion.

When no response is obtained from surgery and drug therapy, the radiotherapy option is evaluated. Radiotherapy shrinks the size of the pituitary tumor and suppresses hormone production. However, its effects appear within a few years. Following all these treatments, regular follow-ups must be performed, hormone levels monitored, and the risk of disease recurrence kept in mind. In some cases, treatment can last a lifetime. However, with early diagnosis and the right approach, most patients can lead a normal life.

Frequently Asked Questions

The answer to the question "Which hormone is acromegaly related to?" is growth hormone. IGF-1, secreted from the pituitary gland, triggers uncontrolled growth in bones, muscles, and other tissues, causing the symptoms of the disease. During diagnosis, both GH and IGF-1 levels are usually found to be high. Acromegaly is generally not genetic and mostly arises later in life. However, in rare cases, it can be seen in hereditary genetic diseases such as MEN-1 (Multiple Endocrine Neoplasia Type 1) syndrome. In this case, the presence of pituitary or other endocrine tumors may also exist in the patient's family. Nevertheless, in general, the vast majority of acromegaly cases are non-genetic, spontaneously developing conditions that appear later in life. Conditions similar to acromegaly can also be seen in childhood. However, in this case, the disease is defined as gigantism. Although gigantism and acromegaly stem from similar hormonal disorders, gigantism is seen in childhood. Gigantism is the excess growth hormone that appears in children whose growth plates have not yet closed. In gigantism, linear growth is extremely pronounced, and the height of children increases very rapidly compared to their peers. If GH excess develops after the epiphyseal plates have closed, this condition is called classic acromegaly. Pituitary tumors causing acromegaly are usually benign (adenomas). However, the elevated IGF-1 level in acromegaly can lead to some conditions such as colonic polyps and indirectly to an increased risk of colon cancer. Therefore, regular follow-ups and screenings for colon cancer are recommended in individuals diagnosed with acromegaly. Acromegaly patients are usually successfully treated with surgical methods. If growth hormone and IGF-1 levels return to normal values after the removal of the pituitary tumor via endoscopic transnasal surgery, the disease is controlled. However, sometimes the entire tumor cannot be removed, or hormone production may continue. In this case, additional methods such as medical treatment for acromegaly or radiotherapy can be applied post-surgery. Risks of acromegaly surgery may include infection, hypopituitarism, and vision disorders. Certain typical changes in facial shape are observed in acromegaly. Under the influence of growth hormone, the jawbone grows and protrudes forward (prognathism), the forehead bone becomes coarse, the nose widens and grows, and the lips thicken. Widening occurs between the teeth, and speech and breathing difficulties can also be seen due to tongue enlargement. Since these changes develop over time, they can sometimes be difficult to notice, but a distinct difference draws attention when compared with old photographs. If left untreated, acromegaly can shorten life expectancy. Because uncontrolled growth hormone increase raises risks such as cardiovascular diseases, hypertension, diabetes, and respiratory problems. When left untreated, these conditions lower patients' quality of life and shorten life expectancy. However, with early diagnosis and correct treatment, most patients achieve normal life expectancy and risks can be controlled. The most important point acromegaly patients must pay attention to is regular doctor follow-up. Regular control of growth hormone levels and other hormones is of great importance. In addition, it is necessary to undergo regular screenings regarding complications that acromegaly can cause, such as heart health, blood sugar levels, colon health, and vision problems. Adopting a healthy lifestyle, exercising regularly, eating a balanced diet, and receiving psychological support if necessary can positively affect the quality of life. The first step for the diagnosis of acromegaly is blood tests. Especially, an elevated IGF-1 level is the most important indicator of the disease. In addition, an Oral Glucose Tolerance Test (OGTT) is performed to see that the growth hormone level is not suppressed. Imaging methods such as magnetic resonance imaging (MRI) are utilized to confirm the diagnosis and view the pituitary tumor. Furthermore, to evaluate hormone balance, the levels of hormones such as ACTH, TSH, prolactin, LH, and FSH are measured, and additional tests such as cardiac evaluations, colonoscopy, and eye screenings are applied to determine additional complications. Acromegaly treatment may vary in each patient. In some patients, surgical treatment can provide complete recovery. However, if the tumor could not be completely removed or hormone production continues, additional methods such as medication or radiotherapy are required. In some cases, lifelong medication use may be necessary to keep hormone levels under control. Therefore, the duration of treatment is determined individually according to the condition of the tumor, the success of treatment methods, and whether hormone levels are controlled. The treatment plan must definitely be maintained under doctor supervision and with regular follow-ups.

Acromegaly is a condition that can be brought under control with early diagnosis and correct treatment.

At Hisar Hospital, the diagnosis and treatment of acromegaly are planned individually through a multidisciplinary approach where Endocrinology, Neurosurgery, Radiology, and all related branches work together.

If you are experiencing symptoms related to growth hormone excess or suspect acromegaly, you can make an appointment with our expert Endocrinology physicians to receive a detailed evaluation and information about our modern treatment options.