Description

Acromegaly is a rare disease in adults which causes some bones, organs and other tissues in order to grow larger. A small gland in the brain called the pituitary gland units of these changes make too much growth hormone. This generally occurs due to a tumor of the pituitary gland. The tumor is not cancer.

When the body has too much growth hormone, the bones become larger. In childhood, this leads to an increase of the height as part of a condition called gigantism. In adults with acromegaly, a change in height does not happen. Instead, the bones of the hands, feet, and the largest side.

These changes occur slowly over many years. So, people with acromegaly and your loved ones can take a long time to notice the symptoms. And the health professionals can have a hard time finding and treating the disease early.

Without treatment, acromegaly can lead to other serious and sometimes life-threatening health conditions called complications. But treatments such as surgery, medication and radiation can reduce the risk of complications. The treatment can also improve many of the symptoms of acromegaly.

Symptoms

The symptoms of acromegaly can change the way in which some of the body parts look. The changes may include:

  • Thick ears and lips.
  • A wide nose.
  • Enlargement of the hands and feet.
  • One that stands out from the eyebrow or in the jaw.
  • The gaps between the teeth.
  • An enlarged tongue.
  • An expansion of the rib cage that can cause the chest to have a round shape.

Changes in the skin may include:

  • Acne.
  • Harmless skin growths called skin tags.
  • Thick, oily and thickened skin.
  • The inflammation in the tissue under the skin.

More often, people with acromegaly do not have all the possible changes to the body. And because the changes come slowly, that it can take years to realize. But over time, the rings no longer fit the fingers as before. Or shoes size larger. Sometimes, people notice the changes only through the comparison of the photos above with the new.

Other symptoms of acromegaly may include:

  • The vision of the problems, including the loss of your side vision.
  • More sweat and body odor than usual.
  • Extreme tiredness.
  • Headaches.
  • Pain in the joints.
  • In a deep voice.

When to see a doctor

Get a health checkup if you believe that you have symptoms of acromegaly. The condition usually develops slowly. Even the family members can take a long time to notice the physical changes that happen. But it is important that a health care professional to find the condition as soon as possible. The treatment can help prevent serious health conditions that can occur along with acromegaly.

Causes

The most common cause of acromegaly is a pituitary gland tumor. The tumor called an adenoma. It is not cancer. But it makes too much growth hormone during a long period of time.

Excess growth hormone causes many of the symptoms of acromegaly. Some of the symptoms, such as headaches and vision problems are due to the tumor pressing on nearby tissue of the brain.

In rare cases, tumors in other parts of the body because of the acromegaly. These include tumors of the lung or pancreas. Sometimes these tumors release growth hormone. Or that produce a hormone called growth hormone-releasing hormone. This tells the pituitary gland to produce more growth hormone.

The pituitary gland is located at the base of the brain, behind the bridge of the nose. This makes growth hormone and other hormones. Growth hormone plays an important role in the control of physical growth.

The pituitary gland releases growth hormone in the bloodstream. This triggers the liver to produce a hormone called insulin-like growth factor-1, also called IGF-1. IGF-1 is really what causes the bones and other tissues to grow. Too much growth hormone leads to an excess of IGF-1. And that can cause symptoms of acromegaly, and complications.

Risk factors

People who have a rare genetic condition called multiple endocrine neoplasia type 1 have a higher risk of acromegaly. This condition is also called MEN 1.

In MEN 1, the parathyroid glands, the pancreas, and the pituitary gland can grow tumors and the release of additional hormones. Additional parathyroid hormone can cause the bones to thin and stones in the kidneys. A pancreatic tumor can make the hormone insulin and cause low levels of sugar in the blood. If the tumor of the pituitary gland to produce more growth hormone, acromegaly results. Very rarely, acromegaly can run in families.

Complications

Without treatment, acromegaly can lead to other health problems called complications. These complications may include the following.

Diseases of the heart and blood vessels, such as:

  • The high blood pressure.
  • Increased risk of narrows the arteries, which can lead to a heart attack or a stroke.
  • A disease of the heart muscle called cardiomyopathy.

Cancer and diseases that can cause cancer:

  • Increased risk of some types of cancer.
  • Growths called polyps in the lining of the colon. Without treatment, these tumors may lead to colon cancer.

Sexual and reproductive health conditions such as:

  • Absence of menstruation or irregular vaginal bleeding.
  • Difficulty achieving or maintaining an erection, also called erectile dysfunction.
  • Less sexual desire.

Other serious conditions, including:

  • The most common type of arthritis called osteoarthritis.
  • Type 2 diabetes.
  • An abnormal growth of the thyroid gland, called a goiter.
  • A condition called sleep apnea, in which breathing stops and starts many times during sleep.
  • A condition called carpal tunnel syndrome, which causes numbness, tingling and weakness in the hand and the arm.
  • Compression of the spinal cord or fractures.
  • Changes in vision or loss of vision.

Principles of treatment of acromegaly may prevent these complications, or prevent it from getting worse. Without treatment, acromegaly and its complications can lead to an early death.

Diagnosis

The diagnosis consists of the steps that your health professional needs to find out if you have acromegaly. Your healthcare provider will ask about your medical history and do a physical exam. You may also need the following tests:

  • IGF-1 measurement. This blood test measures the level of IGF-1 in the blood. A high IGF-1 may mean that the level of growth hormone is also high. This can be a clue for acromegaly.
  • The growth hormone suppression test. This blood test measures the level of growth hormone before and after drinking a water type of sugar called glucose. In people who do not have acromegaly, the glucose drink normally causes the level of growth hormone for the fall. But if you have acromegaly, growth hormone level will tend to remain high.
  • Imaging tests. Magnetic resonance imaging (MRI) can help to identify the location and size of a tumor in your pituitary gland. If you don't pituitary tumors are seen, you may need more tests to look for other types of tumors. Your healthcare provider may also recommend X-rays of the hands and feet. These can help verify if the growth of the bone.

Treatment

Acromegaly the goal of treatment is to improve symptoms and prevent or treat complications. The goal is the reduction of the growth hormone and IGF-1 to return to their appropriate levels and keep them there.

To help lower the growth hormone (GH) and IGF-1 levels, treatment options often include:

  • The surgery to remove the tumor that is causing the symptoms. Most of the times, this is the first treatment of acromegaly, which is caused by a tumor of the pituitary gland.
  • Medication to help lower levels of the hormone. This is usually an option if the surgery does not lower the growth hormone to the proper level.
  • Radiation to reduce the size of the tumor. Often, this is a choice of treatment if surgery is not an option. It is also an option if surgery cannot remove all of the tumor or if the medication does not help enough.

Some people need a combination of these treatments. Your treatment plan depends on factors such as:

  • The location and the size of your tumor.
  • The seriousness of the symptoms.
  • Your age and general health.

It is common that some changes in the physical characteristics that improve with treatment. For example, the swelling of the soft tissues often goes down. And the skin becomes less oily and thick. But enlargement of the bones do not return the size of what they used to be.

If you also have other health problems due to acromegaly, you may need other treatments for management.

Surgery or other procedures

Surgeons can remove the majority of the tumors of the pituitary gland using a method called transsphenoidal surgery. A surgeon works through the nose to remove the tumor of the pituitary gland. If the tumor is causing symptoms is not found in the pituitary gland, the surgeon recommends another type of surgery to remove the tumor.

The removal of the tumor often returned to growth hormone to the right level, especially if the tumor is small. If the tumor was putting pressure on the tissues surrounding the pituitary gland, removal of the tumor may also help relieve headaches and changes in vision.

Sometimes, surgeons can't remove the entire tumor. When this happens, the level of growth hormone may still be too high after the surgery. Another surgery, drugs or radiation treatments may be necessary.

Medications

The medicine can help lower the levels of the hormone or block hormones effects. Your health care professional may recommend one or more of the following:

  • Medicines called somatostatin analogs, which causes the body to produce less growth hormone. In the body, a brain hormone called somatostatin limits the production of growth hormone. The drug octreotide (Mycapssa, Sandostatin) and lanreotide (Somatuline Depot) laboratory versions of somatostatin. Taking one of these medicines signals to the pituitary gland to produce less growth hormone. It also helps to lower IGF-1. These medications can also cause a pituitary tumor smaller. Take oral medications or receive a monthly shot.
  • Medicines called dopamine agonists that low levels of the hormone. The drug cabergoline and bromocriptine (Cycloset, Parlodel) may help to reduce the levels of GH and IGF-1 in some people. These drugs can also help make a tumor smaller. You are taking dopamine agonists for the mouth, and the doses are often high. That can increase the risk of side effects. Side effects may include upset stomach, vomiting, nasal congestion, fatigue, dizziness, sleep problems, and mood changes.
  • Medicine called an antagonist of growth hormone, which blocks the action of growth hormone. Medicine pegvisomant (Somavert) blocks the effect of growth hormone on the tissues of the body and results in lower levels of IGF-1. Pegvisomant does not lower the level of growth hormone or reduce the size of the tumor. It can affect the liver, so that your health care professional monitors the health of the liver with blood tests while you are on pegvisomant. The drug is administered as a single daily dose and may be used in conjunction with other medications.

Therapies

Radiation therapy destroys any remaining tumor cells after surgery to remove the tumor. It is also gradually decreases the level of growth hormone. It can take months or years for the radiation to improve the symptoms of acromegaly in ways that observes it.

The radiation is often decreased the levels of other hormones of the pituitary — not only of the growth hormone. If you receive the radiation, it is likely that you will need a regular follow-up health care visits. These visits allow your health care professional to check your hormone levels and make sure that your pituitary gland is working right. The follow-up care can last for the rest of your life.

Types of radiation therapy include:

  • Stereotactic radiosurgery. Stereotactic radiosurgery uses 3D imaging to provide a beam of high-dose radiation to the tumor cells. This treatment also limits the amount of radiation to the healthy tissue surrounding the tumor. More often, stereotactic radiosurgery was administered in a single dose. This type of radiation can bring the growth hormone back to the right, within 5 to 10 years. The most common technique that health professionals use to give this type of radiation is called Gamma Knife. This does not imply the use of a knife.
  • Proton beam radiation. This type of radiation is used with small particles called protons, which point to the tumor. May cause less damage to the pituitary gland and the surrounding tissue that makes conventional radiosurgery.
  • Conventional radiation therapy. This type of radiation is to receive small doses of radiation over 4 to 6 weeks. The risk of damage to the pituitary gland is higher than with proton beam radiation and stereotactic radiosurgery. You may not see the full effect of conventional radiation therapy for 10 years or more after treatment.

Preparing for your appointment

It is likely that you first consult your primary healthcare professional. Or you may be referred immediately to a doctor called an endocrinologist is found and is the hormone of conditions.

It is good prepare for your appointment. Here's some information to help you to be prepared and know what to expect from your health care professional.

What you can do

  • Be aware of the restrictions before the appointment. When you make the appointment, ask if there is something that you need to do to prepare for the test. For example, you may be asked to stop eating for a certain number of hours before a test. This is called fasting.
  • Write down your symptoms. Keep a record of everything that is causing you discomfort or concern. This can include headaches, changes in vision, or discomfort in their hands. Write down all your symptoms, even if they do not appear to be related to the reason why you made the appointment.
  • Write down key personal information, including any change in your sex life or menstrual cycle.
  • Make a list of all the medicines, vitamins, and supplements you are taking.
  • Make over old photos that your health care professional can use to compare against its appearance today. Your health care professional will probably be interested in photos from 10 years ago to the present.
  • Take along a family member or a friend if you can. This person can remember something that you miss or forget.
  • Write questions to ask their health professional.

Make a list of questions will help you make the most of your time with your health care professional. For acromegaly, some basic questions to ask include:

  • What is the most likely cause of my symptoms? There are other possible causes?
  • What tests do I need? And should I see a specialist?
  • What are the treatments available for this disease? The approach that is recommended?
  • How much time will I need treatment before my symptoms improve? Could the treatment helps to find and feel like I did before I developed the symptoms of acromegaly?
  • I'm going to have long-term complications of this condition?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?

Feel free to ask any questions you have.

What to expect from your doctor

Your healthcare provider will likely ask questions such as:

  • What are your symptoms, and when do they start?
  • Have you noticed changes in your appearance?
  • How much would you say that their roles have changed over time? Do you have old photos that I can use for comparison?
  • Have you noticed changes in his sexual life, or sleep? Do you have headaches or joint pain, changes in vision, or more sweat than usual?
  • Nothing seems to make your symptoms better or worse?
  • Do your old shoes and rings still fit? If not, how much have your setting changed with time?
  • Has had a colon cancer screening test?
Symptoms and treatment of Acromegaly