Acromegaly is a hormonal disease characterized by excess production of the growth hormone by the pituitary gland. The growth continues even after the age of 18-25 when the normal growth of the body in human stops. The progression of the disease is very slow; hence it is quite difficult to diagnose the condition at an early stage. In most of the cases the disease is diagnosed when facial changes due to disease become noticeable. This condition is more common in middle aged person.
Common presentations include enlargement of hands and feet, changes in the facial appearance like protrusion of the jaw bones, oily skin with enlarged facial features, snoring, restricted joint mobility etc.
Excess secretion of growth hormones can also be seen in children who are yet to reach the pubertal age group, this condition is known as gigantism. Inadequate treatment may worsen of the already present symptoms due to progression of the disease. Rarely the affected person may also die because of the associated complications of the disease.
The presenting symptoms of acromegaly vary from person to person both in the severity and nature of the symptoms.
Common presenting symptoms include
1. Gradual enlargement of the hands and feet, often identified by the patient when rings used to fit do not fit properly,
2. Change in the facial features as characterized by protrusion of the lower jaw and the brows, enlargement of the nose, thickening of the lips and abnormal spacing between teeth, skin becomes oily, coarser and thick with appearance of skin tags,
3. Increased tiredness
4. Impairment of vision , headache
5. Enlargement of internal organs like liver, kidney, heart, spleen etc.
6. Menstrual irregularities in women and erectile dysfunction in men
7. Painful and restricted movement of the large joints of the body
8. Excessive sweating and foul body odor
Common complications of acromegaly include cardiovascular system related problems include hypertension, cardiac enlargement (cardiomyopathy), osteoarthritis, diabetes, polyp in the colon, sleep apnea characterized by interruption of sleep due to sudden uncontrolled stoppage of breathing, carpal tunnel syndrome, inadequate secretion of other pituitary hormones, fibroids in the uterus, compression of the spinal cord, visual problem, etc.
In most of the patients suffering with acromegaly, timely and adequate intervention reduces the chance of suffering from complications, however without treatment acromegaly can be fatal.
Acromegaly occurs due to excessive production and secretion of the growth hormone by the pituitary. Pituitary is one of the most important glands of our body responsible for secretion of number of important hormones. The gland is located at the base of the brain just behind the nasal bridge.
Under normal circumstances the circulating growth hormone stimulates the liver to produce a protein called insulin like growth factor I (IGF-I); IGF-I in turn facilitates the linear growth of the body. In Acromegaly excess growth hormone stimulates production of excess amount IGF-I resulting in excessive growth of the bones and soft tissues of the body and thus produces symptoms of growth hormone.
In most of the cases of acromegaly benign pituitary tumor (adenoma) is the most common cause. In very few cases of acromegaly tumors arising from the lungs, pancreas or the adrenal glands may produce growth hormone or growth hormone releasing hormone, which increases growth hormone secretion from the pituitary itself.
The objective of treatment is to suppress growth hormone secretion and to relieve the symptoms associated with the disease. There are mainly three types of treatment options like drugs like somatostatin analogs, dopamine agonists and growth hormone analogs, surgery through transsphenoidal routes and radiation which can be given as conventional radiation therapy and during. stereotactic surgical techniques.