Acromegaly
Acromegaly is a rare hormonal disorder that develops when the pituitary gland produces too much growth hormone during adulthood. When you have too much growth hormone, your bones will increase in size.
In childhood, this condition causes an increase in height called gigantism. However, in adulthood, body changes do not occur. Instead, the increase in bone size is limited to the bones of the hands, feet, and face, and is called acromegaly.
Symptoms of Acromegaly
Symptoms of acromegaly can vary and usually develop slowly. Initially, symptoms usually include:
- Swelling of the hands and feet. Usually, marked by changes in ring and shoe size.
- Fatigue and difficulty sleeping.
- Snoring.
- Changes in facial appearance, such as the eyebrows, lower jaw, and nose becoming larger, and the gaps between the teeth becoming wider.
- Numbness and weakness in the hand caused by pressure on the nerves in the hand.
- In children and teenagers, it will be very high.
In advanced conditions, complaints may increase, such as:
- Large hands and feet.
- The size of the nose and lips, as well as the large tongue.
- Skin changes, such as becoming thicker, rougher, and oilier or sweating more often.
- The voice becomes deeper.
- Joint pain.
- Chest pain.
- Headache
- Visual disturbances.
- Decreased libido.
- Menstrual disorders in women and erectile dysfunction in men.
Risk Factors for Acromegaly
Acromegaly is usually related to genetics, so a family history of acromegaly can be a risk factor.
It is also important to note that acromegaly can begin at any time after puberty. However, it is more common in middle age. People are usually unaware of the condition. This is because changes in the body occur slowly over many years.
Causes of Acromegaly
Acromegaly occurs when the pituitary gland produces too much growth hormone (GH) over a long period of time. The pituitary gland is a small gland at the base of the brain, just behind the bridge of the nose.
This area produces growth hormone and a number of other hormones. It is important to note that growth hormone plays an important role in managing physical growth.
When the pituitary gland releases GH into the bloodstream, it triggers the liver to produce a hormone called insulin-like growth factor-1 (IGF-1). Insulin is what causes bones and other tissues to grow.
Too much GH can lead to too much IGF-1, which can cause the signs, symptoms, and complications of acromegaly.
In adults, tumors are a common cause of too much GH production:
1. Pituitary tumor
In most cases, acromegaly is caused by a noncancerous (benign) tumor of the pituitary gland. The tumor produces excessive amounts of growth hormone, causing many of the signs and symptoms of acromegaly.
Some symptoms of acromegaly, such as headaches and visual disturbances, are caused by the tumor pressing on surrounding brain tissue.
2. Non-pituitary tumors
In some people with acromegaly, a tumor in another part of the body, such as the lung or pancreas, causes the condition. Sometimes, these tumors secrete GH.
In other cases, the tumor produces a hormone called growth hormone-releasing hormone (GH-RH), which signals the pituitary gland to make more GH.
Diagnosis of Acromegaly
To diagnose acromegaly, the doctor will ask about the patient’s medical history and perform a physical examination. Then, the doctor may recommend the following tests:
- IGF-1 measurement. Before performing this test, your doctor will ask you to fast overnight. On the day of the test, your doctor will take a blood sample to measure the level of IGF-1 in your blood. Elevated IGF-1 levels indicate acromegaly.
- Growth hormone suppression test. This is the best method to confirm a diagnosis of acromegaly. During this test, your blood GH levels are measured before and after you drink sugar (glucose). In people who do not have acromegaly, a glucose drink usually causes GH levels to drop. However, if you have acromegaly, your GH levels will tend to remain high.
- Imaging tests. Your doctor may recommend imaging tests, such as magnetic resonance imaging (MRI), to help determine the location and size of a tumor on your pituitary gland. If a pituitary tumor isn’t visible, your doctor may recommend other imaging tests to look for non-pituitary tumors.
Treatment and Side Effects of Acromegaly
Treatment for acromegaly usually depends on the symptoms experienced. In acromegaly sufferers who have a pituitary gland tumor, it is usually recommended to remove the tumor through surgery, which may need to be followed by drug therapy or radiation therapy.
1. Surgery
Tumor removal therapy is one of the effective therapies for acromegaly sufferers due to pituitary tumors. The choice of tumor removal requires prior examination to ensure its benefits.
In conditions where the tumor is too large and cannot be removed completely, a partial removal is usually performed. This will then be followed by medication or radiotherapy before further surgery.
Pituitary gland tumor removal surgery is an operation that requires general anesthesia and is performed in the operating room.
Surgery or surgical procedures to remove pituitary gland tumors have several risks, such as the risk of damaging healthy tissue and infection of the meninges.
The surgeon will provide an explanation before performing the procedure and will try to minimize any risks that may occur.
2. Medicine
The doctor will give medication after surgery or in conditions where surgery cannot be done for some reason. The purpose of giving medication is to reduce the production of growth hormone.
Types of drugs that can be given include dopamine agonists, somatostatin analogs, and growth hormone antagonists. Somatostatin analogs can cause side effects on the stomach or digestive tract, such as diarrhea and nausea or gallstones.
3. Radiation
Radiation may be used to destroy large tumors or any remaining tumors after surgery, or when other treatments are ineffective. This method can slowly help lower GH levels when used in conjunction with medications.
Reducing GH levels using this method may take several years. At least the sufferer needs to be given radiation therapy in several sessions, four to six weeks.
The types of radiation therapy that may be used are:
- Conventional radiation therapy. This type of radiation therapy is usually given daily for four to six weeks. People may not see the full effects of this therapy for 10 years or more after treatment.
- Stereotactic radiosurgery. This method uses 3D imaging to deliver high doses of radiation to tumor cells while limiting the amount of radiation to surrounding normal tissue. Usually, this type of radiation can be given in a single dose. GH levels can return to normal within five to 10 years with this method.
Unfortunately, radiation can interfere with fertility. In rare cases, this treatment method can cause someone to lose their vision, have brain injuries, or have secondary tumors.
Prevention of Acromegaly
Until now, no method has been found that can prevent acromegaly, so early detection and treatment is the most effective step in treating this disease.
Complications of Acromegaly
If left untreated, acromegaly can cause serious health problems. Complications of this rare disease include:
- High blood pressure ( hypertension ).
- High cholesterol.
- Heart problems, especially an enlarged heart (cardiomyopathy).
- Osteoarthritis.
- Type 2 diabetes
- Enlargement of the thyroid gland (goiter).
- Precancerous growths (polyps) in the lining of the colon.
- Sleep apnea
- Carpal tunnel syndrome.
- Changes or loss of vision.
When to See a Doctor?
If you experience symptoms or complaints that indicate acromegaly, talk to your doctor immediately to get the right treatment.