Acromegaly is a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood. When this happens, your bones increase in size, including those of your hands, feet and face. Acromegaly usually affects middle-aged adults.
In children who are still growing, too much growth hormone can cause a condition called gigantism. These children have exaggerated bone growth and an abnormal increase in height.
Because acromegaly is uncommon and physical changes occur gradually, the condition often isn't recognized immediately: sometimes not for years. If not treated promptly, acromegaly can lead to serious illness and even become life-threatening. However, available treatments for acromegaly can reduce your risk of complications and significantly improve your symptoms, including the enlargement of your features.
One of the most common signs of acromegaly is enlarged hands and feet. People with this disorder often notice that they can no longer put on rings that used to fit and that their shoe size has progressively increased.
Acromegaly may also cause you to experience gradual changes in the shape of your face, such as a protruding lower jaw and brow, an enlarged nose, thickened lips, and wider spacing between your teeth.
Because acromegaly tends to progress slowly, early signs may not be readily apparent for several years. Sometimes, people notice the condition only by comparing old photographs.
Acromegaly may produce the following signs and symptoms, which can vary from one person to another:
- Enlarged hands and feet
- Coarsened, enlarged facial features
- Coarse, oily, thickened skin
- Excessive sweating and body odor
- Small outgrowths of skin tissue (skin tags)
- Fatigue and muscle weakness
- A deepened, husky voice due to enlarged vocal cords and sinuses
- Severe snoring due to obstruction of the upper airway
- Impaired vision
- Enlarged tongue
- Pain and limited joint mobility
- Menstrual cycle irregularities in women
- Erectile dysfunction in men
- Enlarged liver, heart, kidneys, spleen and other organs
- Increased chest size (barrel chest)
When to see a doctor
If you have signs and symptoms associated with acromegaly, contact your doctor for an evaluation.
Acromegaly usually develops slowly, and even your family members may not initially notice the gradual physical changes that occur with this disorder. Early diagnosis is important, however, so that you can receive proper care. Acromegaly can lead to serious complications if it's not treated.
Acromegaly is caused by the pituitary gland overproducing growth hormone (GH) over time. The pituitary, a small gland situated at the base of your brain behind the bridge of your nose, produces a number of hormones. GH plays an important role in managing your physical growth.
When GH is secreted into your bloodstream, it triggers your liver to produce a hormone called insulin-like growth factor-I (IGF-I). In turn, IGF-I stimulates the growth of bones and other tissues. If your pituitary gland makes too much GH, excessive amounts of IGF-I can result. Too much IGF-I can cause abnormal growth of your soft tissues and skeleton and other signs and symptoms characteristic of acromegaly and gigantism.
In adults, a tumor is the most common cause of too much GH production:
- Pituitary tumors. Most cases of acromegaly are caused by a noncancerous (benign) tumor (adenoma) of the pituitary gland. The tumor secretes excessive amounts of growth hormone, causing many of the signs and symptoms of acromegaly. Some of the symptoms of acromegaly, such as headaches and impaired vision, are due to the tumor mass pressing on nearby brain tissues.
- Nonpituitary tumors. In a few people with acromegaly, tumors in other parts of the body, such as the lungs, pancreas or adrenal glands, cause the disorder. Sometimes, these tumors actually secrete GH. In other cases, the tumors produce a hormone called growth hormone-releasing hormone (GH-RH), which stimulates the pituitary gland to make more GH.
To begin the diagnostic process, your doctor will take a medical history and conduct a physical exam. Then he or she may recommend the following steps:
- GH and IGF-I measurement. After you've fasted overnight, your doctor will take a blood sample to measure your levels of GH and IGF-I. Elevated levels of these hormones suggest acromegaly.
- Growth hormone suppression test. This is the definitive method for verifying acromegaly. In this test, your blood levels of GH are measured before and after you drink a preparation of sugar (glucose). Normally, glucose ingestion depresses levels of GH. If you have acromegaly, your GH level will tend to stay high.
- Imaging. Your doctor may recommend that you undergo an imaging procedure, such as magnetic resonance imaging (MRI), to help pinpoint the location and size of a tumor of your pituitary gland. If radiologists, who usually perform the procedures, see no tumor of your pituitary gland, they may look for nonpituitary tumors that might be responsible for high levels of GH.
Progression of acromegaly can result in major health problems. Complications may include:
- High blood pressure (hypertension)
- Cardiovascular disease, particularly enlargement of the heart (cardiomyopathy)
- Diabetes mellitus
- Precancerous growths (polyps) on the lining of your colon
- Sleep apnea, a condition in which breathing repeatedly stops and starts during sleep
- Carpal tunnel syndrome
- Reduced secretion of other pituitary hormones (hypopituitarism)
- Uterine fibroids, benign tumors in the uterus
- Spinal cord compression
- Vision loss
Early treatment of acromegaly can prevent these complications from developing or becoming worse. If untreated, acromegaly and its complications can lead to premature death.
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