Acromegaly

Acromegaly

What is acromegaly? — Acromegaly is a disease that makes some parts of the body grow bigger than normal. This happens over a long period of time, often years.
Acromegaly is usually caused by a non-cancerous tumor in the pituitary gland. The pituitary gland is located at the base of the brain (figure 1). It makes many hormones, including one called "growth hormone," which the body needs to grow. A tumor in the pituitary gland can cause it to release too much growth hormone.
What are the symptoms of acromegaly? — The main symptoms involve too much growth in some parts of the body, such as:
Face and head – The nose, lips, ears, and forehead get larger. The tongue and lower jaw also grow, and the spaces between the teeth get wider.
Throat – The tissue inside the throat and around the voice box can grow bigger than normal. This can cause deepening of the voice or trouble breathing during sleep.
Hands and feet – The hands and feet become bigger and swollen. People with acromegaly usually notice that their rings and shoes become tighter. Some people develop "carpal tunnel syndrome," which is a condition that causes pain or tingling in the hands and fingers.
Skin – Skin might become thicker. Some people also get small growths of extra skin, called "skin tags."
Bones – The ends of the bones can grow too much. This can damage the cartilage (the rubbery material that keeps bones from scraping against each other), and eventually lead to arthritis.
Tumors – People with acromegaly have a higher risk of getting non-cancerous tumors. These can include fibroids (growths in the uterus, or womb) and colon polyps (small growths in the intestine).
Heart – The heart muscle can grow bigger than normal, which can make it hard for the heart to work well. People with acromegaly are also more likely to have high blood pressure.
If a tumor on the pituitary gland gets too big, it can press on the nerves that lead to the eyes. This sometimes causes vision problems.
Acromegaly also increases the chances that a person will get diabetes.
Is there a test for acromegaly? — Yes. Usually, a doctor or nurse suspects acromegaly based on a person's appearance. He or she can do a blood test to check if there is too much growth hormone in the blood.
If a blood test shows the person has too much growth hormone, the doctor or nurse will order an MRI. An MRI is an imaging test that creates pictures of the inside of your body. It can show if there is a tumor in the pituitary gland.
How is acromegaly treated? — Treatments include:
Surgery – In most cases, doctors do surgery to try to remove the tumor in the pituitary gland. An experienced surgeon makes a small cut in the nose and then uses a special tool to take the tumor out (figure 2). If the surgeon can completely remove it, the amount of growth hormone in the body will return to normal within hours. Some symptoms take a few months to get better.
Medicines – Some people with acromegaly need to take medicines. You might need medicine if you have a pituitary tumor that is too big for doctors to remove it completely with surgery. There are 3 kinds of medicine doctors use to treat acromegaly:
•Injections (shots) that stop the tumor from releasing hormones – These medicines are called "somatostatin analogs." Your doctor or nurse will probably give you a shot about once a month.
•Medicine that blocks the effects of growth hormone – This medicine is called pegvisomant (brand name: Somavert). To take it, you give yourself a shot once a day.
•Pills that stop the tumor from releasing hormones – These are called "dopamine agonists." They usually don't work as well as somatostatin analogs you get by injection. But they might be easier to take.
Radiation – Sometimes doctors treat pituitary tumors with radiation. Radiation uses high doses of X-rays to destroy the tumor.
All of these treatments can have side effects. Your doctor can talk to you about which treatments are best for you.
What if I want to get pregnant? — Many women with acromegaly are able to have normal pregnancies. Before trying to get pregnant, ask your doctors about which medicines are safe to take during pregnancy. You will also need to see your endocrinologist (the doctor who treats your acromegaly) regularly while you are pregnant.
What will my life be like? — Doctors can successfully treat most people with acromegaly. You will need to see your doctor regularly to make sure that your treatments are working, and make changes if needed.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 16728 Version 7.0
Release: 28.2.2 - C28.105
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