Acromegaly

Introduction

Let us look into the concept of acromegaly. It is a condition in which your body produces too much growth hormone (GH). GH is a hormone that regulates the body’s physical growth and is produced mostly in the pituitary gland. When this hormone is overproduced in adults, it causes bones, cartilage, bodily organs and other tissues to grow in size. Acromegaly symptoms include an increase in the size of the hands and feet. An expansion of the forehead, jaw and nose is also possible.

Other signs and symptoms include joint discomfort, thicker skin, a deeper voice, headaches and eyesight issues. Type 2 diabetes, sleeplessness and high blood pressure are all possible complications of the condition. Acromegaly is caused by an adenoma, a benign pituitary gland tumor that produces too much growth hormone. As these tumors grow larger, they create an over-abundance of growth hormones and squeeze the surrounding brain regions.

They may compress the optic nerves in rare circumstances. The treatment aims to lower GH production to normal levels, reversing or improving the signs and symptoms of acromegaly, relieve the pressure that the developing pituitary tumor imposes on the surrounding brain regions, and retain normal pituitary function.

Meaning and Definition of Acromegaly

Acromegaly can be defined as a hormonal condition that happens when the pituitary gland generates an excessive amount of STH/ growth hormone in maturity. Your bones develop in size when you have too much growth hormone. This causes gigantism in children, defined as an increase in height. In adulthood, however, there’s no variation in height. Instead, acromegaly refers to an increase in bone size restricted to the bones of your hands, foot and face.

The disease is not passed down from one’s parents. A tumor causes acromegaly in another body section only in rare cases. Growth hormone is measured when a person drinks a glucose solution or insulin-like growth factor I is measured in the blood. Following a diagnosis, diagnostic imaging of the pituitary gland is performed to see if an adenoma is present. When too much growth hormone is generated throughout childhood, it causes gigantism rather than acromegaly.

Causes

A tumor causes the overproduction of growth hormone that is linked with acromegaly.

Adenoma of the Pituitary Gland

The most frequent form of a tumor in the pituitary gland is a pituitary adenoma, a non-cancerous or benign tumor. The pituitary gland produces too much growth hormone (GH), promoting abnormal growth. Pituitary tumors are not passed down through the generations. They can arise due to a tiny genetic mutation in one gland cell. This cell will multiply over time and produce an adenoma, a type of tumor. Adenomas are not cancerous since they do not spread to other body regions, but their size and placement might create difficulties. Cancer can exert strain on adjacent brain tissue as it develops. Because the skull is a confined region, this expansion can induce headaches and visual issues by crowding the remaining tissue. Because of the tumor’s location, it may potentially impact the synthesis of other hormones. Due to the hormone involved, the effect might differ between men and women. It may influence a woman’s menstrual cycle, while some males may have impotence.

Other Reasons

A tumor in another part of the body, such as the lungs, adrenal glands or pancreas, might cause GH overproduction, leading to acromegaly symptoms.

The tumors themselves may release growth hormone or the pituitary gland may be reacting to a signal by producing GH. Some hypothalamic tumors, for example, may create growth hormone-releasing hormone (GHRH), which instructs the body to make GH.

Increased growth hormone production outside the pituitary gland, such as from neuroendocrine tumors like small cell lung cancer or carcinoid tumors can cause acromegaly.

Symptoms

Enlarged hands and feet are a common symptom of acromegaly. You may notice for example, that you can no longer put on rings that used to fit and that your shoe size has gradually grown. Acromegaly can also lead to progressive changes in the form of your face, such as a projecting lower jaw and brow bone, an expanded nose, thickening lips and wider tooth spacing. Early indications of acromegaly may not be seen for years due to the gradual progression of the disease. However, individuals might sometimes see bodily changes when comparing old and new images.

Acromegaly signs and symptoms vary from person to person; however, they might include any of the following:

• Bones in the face, foot, and hands that are enlarged
• Excessive hair growth in women
• An expanded mouth or tongue
• A prominent brow is all signs of excessive growth spurts, which are more frequent in persons who have experienced abnormal growth before puberty

• Gaining weight
• Swelling
• Painful joints that restrict mobility 
• Deep voice weariness
• Headaches
• Muscular weakness
• Inability to sleep
• Increased sebaceous glands create oils in the skin, thicker skin tags, non-cancerous growths and excessive perspiration body odour

Diagnosis

Because the symptoms of acromegaly arise gradually, a diagnosis might take months, if not years. However, acromegaly can be detected early if the hands and feet swell and expand to a bigger size. In addition, people usually become aware of it when their gloves or shoes no longer fit.

A range of tests can be used to confirm acromegaly.

• IGF-1 (insulin-like growth factor-1): Tests can reveal whether the level is too high. The hormone IGF-1 is generated in the liver. It encourages development. Because high levels of GH promote the development of IGF-1, people with acromegaly frequently have high amounts of this hormone

• Measurement of other pituitary hormones is also possible

For example, an oral glucose tolerance test (OGTT) can provide a more precise GH level readout.

Before consuming concentrated glucose solution and delivering a blood sample, the patient must fast overnight. Normally, consuming glucose causes a drop in hormone levels. However, the hormone levels in a person with acromegaly would remain high because the body produces too much GH.

•  An MRI scan of the brain can detect the tumor’s location and size

Treatment

Treatment for acromegaly differs from person to person. The location and size of your tumor, the intensity of your symptoms and your age and overall health will all influence your treatment approach.

Treatment options for lowering GH and IGF-1 levels often involve surgery or radiation to remove or shrink the tumor causing your symptoms, as well as medicines to assist in restoring your hormone levels. In addition, if you’re dealing with acromegaly-related health issues, your doctor may suggest additional therapies to assist you in managing your symptoms.

1. Surgery: Surgery can significantly relieve or cure acromegaly symptoms in many situations. The tumor’s size and location will determine the surgery’s details. The objective of surgery is to remove the whole tumor that is producing too much growth hormone. You might not need any additional treatment if surgeons can remove enough of the tumor. However, if only a portion of a tumor can be removed, you may require medication or radiation therapy to control your symptoms and lower growth hormone production.

2. Medication: Somatostatin analogues for example, are injection drugs that can assist control hormone levels. Medications act in various ways to ease your symptoms and balance your body’s growth hormone levels. A person may need to take medicine until a tumor has shrunk in some circumstances. This may make it possible for surgeons to remove it through surgery safely. Others may require long-term treatment to regulate growth hormone levels and symptoms adequately.

3. Radiation Therapy: When drugs are ineffective, radiation treatment may be used to reduce growth hormone levels. Radiation therapy employs specialized equipment to direct radiation beams to the tumor. This treatment takes time to work. It may take numerous therapy sessions, with gaps in between, to completely impact, which might take several years.

Conclusion

Acromegaly can be defined as a hormonal condition that happens when the pituitary gland generates an excessive amount of STH/ growth hormone in maturity. Your bones develop in size when you have too much growth hormone. This causes gigantism in children, defined as an increase in height.