The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 7 0
Copyright © 2005 by The Endocrine Society
Patient Information Page from The Hormone Foundation |
Acromegaly
David Cook, MD and
Peter J. Trainer, MD, FRCP
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What is acromegaly?
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Acromegaly is a rare condition caused by too much growth hormone (GH) in the blood. GH is released into the bloodstream by the pituitary gland (located at the base of the brain). The blood carries GH to other parts of the body, such as bone and muscle. There it has specific effects. In children, GH stimulates growth and is also important for body development. In adults, GH affects energy levels, muscle strength, bone health, and your sense of well being.
Too much GH in children is called gigantism. This condition is extremely rare. Only about 100 cases have been reported in the United States. Acromegaly in adults occurs mainly in middle-aged men and women. Each year, about three new cases of acromegaly occur for every million people. The overall rate of acromegaly is about 60 cases for every million people.
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What causes acromegaly?
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Acromegaly is a serious condition. It is caused by a non-cancerous tumor in the pituitary gland (pituitary adenoma). The tumor produces too much GH and raises the level of GH in the blood. Too much GH also raises the level of a hormone called insulin-like growth factor-1 (IGF-1), which is produced in the liver.
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How is acromegaly diagnosed?
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If acromegaly is suspected, your doctor will do a blood test to check your level of IGF-1. This is a good screening test for acromegaly because of the link between too much GH and high levels of IGF-1 in the bloodstream.
Another way to diagnose acromegaly is to measure GH during an oral glucose tolerance test. This test is done by having the patient drink sugar water and measuring the levels of GH afterwards. Normally, the sugar water will make the pituitary gland stop producing GH. However, a pituitary tumor that produces GH will not stop producing GH. In this case, the levels of GH in the blood will not change. (A magnetic resonance imaging, or MRI, scan of the pituitary gland will show the tumor.)
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What are the signs and symptoms of acromegaly?
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A patient with acromegaly usually has large hands and feet, thick lips, coarse facial features, a jutting forehead and jaw, and widely spaced teeth. Often patients sweat a lot.
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Symptoms of acromegaly may include:
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- Headaches
- Numbness or burning of the hands or feet
- Carpal tunnel syndrome
- High blood sugar
- Heart problems (heart attack, heart failure, or enlarged heart)
- High blood pressure (hypertension)
- Arthritis
- Goiter (enlarged thyroid gland)
- Sleep apnea (breathing repeatedly stops and starts during sleep)
- Tiredness
- Menstrual disorders (irregular bleeding; absence of periods)
- Lower sexual desire
- Vision problems (tunnel vision; vision loss)
- Psychological problems (depression; anxiety)
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How is acromegaly treated?
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The main goal of treatment for acromegaly is to lower GH and IGF-1 levels to normal. Treatment may be surgery, pituitary irradiation (radiation therapy on the pituitary gland), medication, or a combination of these options.
If the cause of acromegaly is a pituitary tumor, surgery to remove the tumor is the first treatment. Complete removal of some tumors is hard and additional therapy is often needed to get normal GH and IGF-1 levels. If your GH level isn't normal after surgery, or if you aren't a candidate for surgery, then pituitary irradiation and medication are also options.
Irradiation can take a long time to bring GH levels down to normal. It may even take 10 to 20 years to be fully effective. Once the goal is reached, however, the effects of irradiation are permanent.
Drugs are also available for the treatment of acromegaly, but their effects are temporary. They do not cure the disorder. If surgery or radiation does not lower your GH levels, you'll have to take medication for the rest of your life. The most effective medications for acromegaly (somatostatin analogues and GH receptor antagonists) are usually given by injection. Another type of medication (dopamine agonists) is given in pills, but this type does not work for all most patients.
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What should you do with this information?
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Acromegaly is a rare disease and requires expert care. Too much GH and IGF-1 in the blood lower both your quality of life and how long you might live. An endocrinologist, a specialist in hormone-related conditions, can help diagnose and treat this condition.
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Resources:
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Find-an-Endocrinologist: www.hormone.org or call 1-800-HORMONE
Human Growth Foundation: www.hgfound.org
The Magic Foundation: www.magicfoundation.org
National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/health/endo/endo.htm
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Footnotes
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For more information on how to find an endocrinologist, download free publications, translate this fact sheet into other languages, or make a contribution to The Hormone Foundation, visit www.hormone.org/bilingual or call 1-800-HORMONE. The Hormone Foundation, the public education affiliate of The Endocrine Society (www.endo-society.org), serves as a resource for the public by promoting the prevention, treatment, and cure of hormone-related conditions. The development of this fact sheet was supported by an unrestricted educational grant from Novartis. and may be reproduced non-commercially by healthcare professionals and health educators to share with patients and students. (c) The Hormone Foundation 2005
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What is acromegaly?
What causes acromegaly?
