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Neurosciences and Behavioral Health Center

Acromegaly

Acromegaly is the result of a pituitary adenoma that produces growth hormone (GH). Elevated GH causes excessive bone and soft tissue growth. It can lead to gigantism in children and adolescents. After puberty, bones lose their ability to grow and therefore adults don' t grow tall when they develop acromegaly.

The average age at diagnosis is 40-45 years, but acromegaly can develop at any age. Because symptoms and signs are not always obvious, the diagnosis is usually delayed 10-15 years after the condition's development.

Acromegaly is associated with many complications and may cause premature death.

Symptoms

Symptoms and complications in adults may include the following:

  • Abnormally large growth and deformity of the:    
    • Hands 
    • Feet 
    • Face (protrusion of brow and lower jaw)
    • Jaw (overbite such that lower teeth close in front of upper teeth)
    • Lips
    • Tongue (causing snoring and obstructive sleep apnea)
    • Sinuses, vocal cords and soft tissues of the throat larynx (causing deep sonorous voice)
  • Carpal tunnel syndrome, which causes numbness, tingling and pain in the hand and arm
  • Skin change:
    • Thickened, oily skin
    • Severe acne
    • Excessive sweating and offensive body odor due to enlargement of the sweat glands
    • Coarsening of facial features
  • Fatigue and weakness in legs and arms
  • Sleep apnea
  • Arthritis and other joint problems particularly of the hips, knees and temporomandibular joint of the jaw
  • Enlargement of the liver, kidneys, spleen, heart and/or other internal organs
  • Diabetes mellitus
  • High blood pressure
  • Cardiac disease
  • Galactorrhea (abnormal production of breast milk)         
  • Gonadal dysfunction
  • Colon polyps

In women, symptoms may also include:

  • Irregular menstrual cycles

In men, symptoms may also include:

  • Erectile dysfunction, in about 50 percent of cases

Diagnosis & Treatment at UVA

Tests may include:

  • Insulin-like growth factor (IGF-I) blood test: IGF is growth hormone-dependent and is made primarily in the liver. The level is elevated in acromegaly and gigantism.
  • Oral glucose tolerance test: This test determines whether GH levels suppress appropriately for a normal person and is the most reliable test for acromegaly. In this test, blood growth hormone levels are measured after drinking a glucose drink. In patients with acromegaly, GH levels either do not suppress or increase.

Treatment aims to:

  • Restore production of GH to normal
  • Stop and reverse the symptoms of acromegaly
  • Correct other endocrine abnormalities
  • Remove and or destroy the tumor to restore endocrine function to normal and to relieve any symptoms directly related to the tumor 

Medication

Your doctor may prescribe medication to reduce the level of GH secretion. These include medications that act like dopamine and growth hormone antagonists.

Surgery

In most cases, removal of the tumor through surgery is the preferred treatment. This can be done with a tranassphenoidal operation (through the nose) without disturbing the brain or the eye nerves.

Once your surgeon removes the tumor, the imbalance of IGF and GH hormone returns to normal; this may take several months. Many acromegaly symptoms improve, and you can eventually sleep better and discontinue taking medications for diabetes and high blood pressure. This usually takes weeks to months. 

Unfortunately, many of the physical changes do not revert back to their original appearance; however, certain features such as skin appearance usually improve.

Radiation Therapy

Radiotherapy is most often performed after surgery has removed the majority of the tumor, but some tumor remains.

Because any type of pituitary tumor may recur, regular follow up with blood tests is necessary. If a recurrent tumor is found, additional treatment is necessary.

MAKE AN APPOINTMENT

Call 434.924.1825.

 

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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