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Acromegaly is an endocrine disorder, which is caused by excessive production of the human growth hormone (HGH). The disease develops, when the tumour occur in the pituitary gland and increase its productivity. Usually it affects middle-aged adults, although in early phases it can remain unnoticed. If acromegaly affects child or teenager before epiphyseal plate closure, it leads to a gigantism. When untreated, this condition lead to several serious consequences, including death. The most common symptoms include abnormal growth of the hands, feet, jaw and forehead and widely spaced teeth.
The acromegaly is caused by one or more tumours occurring in the pituitary gland. This condition is commonly known as the pituitary adenoma. Pituitary is located inside the brain, and is responsible for the emission of the human growth hormone (HGH). Those tumours, usually benign in nature, are leading to increased production of the HGH, further causing an abnormal growth of bones and tissues. Although in most cases acromegaly affects adults, it may also occur during childhood. If the pituitary tumour will appear before epiphyseal plate closure, it will result in gigantism. This type of endocrine disorder may not be recognized in early phases, since it evolves slowly, and early symptoms are barely noticeable. When untreated, it leads to several serious consequences like diabetes, hypertension, heart failure and premature death.
Acromegaly causes and symptoms
In over 95% of the incidents, acromegaly is caused by a chronic overproduction of the human growth hormone, due to a benign tumour located in pituitary gland. In under 5% of the cases it is caused by other tumours, that may occur in pancreas, adrenal glands or lungs. Those other tumours lead to increased production of the growth hormone releasing hormone (GHRH), which is stimulating pituitary gland to produce HGH.
Acromegaly may result in several different symptoms, and not all of them are present simultaneously. What is more, the disease evolves slowly and it can remain unnoticed for many years. The most common sign is the abnormal growth of the feet and hands. It can be easily noticed by the patient, when the footwear or jewellery is no longer suitable. Another common symptom is face modification and increased teeth spacing. Certain parts of the head like lower jaw, nasal bone, brow ridge, ears, lips and tongue are becoming gradually larger.
The most common symptoms include:
- Enlargement of the feet, hands and facial features
- Joint pain
- Deepening of the voice
- Carpal tunnel syndrome (CTS)
- Excessive sweating
Acromegaly diagnosis and treatment
The diagnosis is usually based on two examinations, blood test and imaging. Blood test is done in order to define the exact level of growth hormone and insulin-like growth factor 1 (IGF-1). Measuring the level of HGH alone is useless, since levels of those hormone vary greatly, and can change significantly within few minutes. IGF-1 level rises respectively to HGH level, and it is more stable, thus diagnosis is going to be very accurate. Complete diagnosis should also include magnetic resonance imaging, which will reveal location and size of the tumour.
There are 3 main treatment methods, however, none of them is accurate for all patients. The course should be customized according to the body reaction. Those methods include surgery, radiation therapy or medications like somatostatin analogues, dopamine agonists and growth hormone receptor antagonists.