Are you a Health Professional? Jump over to the doctors only platform. Click Here

Acromegaly

group of doctors
Print Friendly, PDF & Email

What is Acromegaly

Acromegaly is a chronic metabolic disorder caused by the presence of too much growth hormone – GH and IGF-I hypersecretion. Growth hormone is a hormone secreted by the pituitary gland in response to GHRH secretion from the hypothalamus, and in excess it results in gradual enlargement of body tissues including the bones of the face, jaw, hands, feet, and skull.

Statistics on Acromegaly

  • Incidence is 5.3 per 100000 per year;
  • Males and females are affected equally;
  • Highest incidence in middle age (4th and 5th decades);
  • It is estimated that six years elapse between the onset of symptoms and the diagnosis.

Risk Factors for Acromegaly

The cause is usually a benign pituitary tumour (pituitary adenoma). Hyperplasia from excessive GHRH secretion from the hypothalamus is the other main cause but that is rare. There are no known risk factors for acromegaly other than a prior history of a pituitary tumor.

Progression of Acromegaly

The life expectancy of a patient with untreated acromegaly is 50 years, most due to a hypertrophic cardiomyopathy and malignant ventricular arrhythmias. Osteoporosis and fractures are frequent complications. Although glucose intolerance is common very few develop ketoacidosis or other significant complications of diabetes mellitus. The tumour may compromise visual fields.

When it is adequately treated, life expectancy returns to normal and the other complications remit.

Prognosis of Acromegaly

Indicators of disease severity:

  • Symptoms;
  • Excessive sweating;
  • Skin tags;
  • Glycosuria;
  • Hypertension;
  • Increased loss of visual fields.

When effective control is achieved the characteristic overgrowth and related symptoms recede and the metabolic abnormalities improve.

How is Acromegaly Treated?

Treatment is indicated in all except elderly or those with minmal abnormalities (untreated leads to markedly reduced survival). The Aim is to reduce mean growth hormone levels to below 5 mU/l.

Surgery

Surger is the treatment of choice in suitable cases – transsphenoidal or transfrontal if the tumour is large. Surgery is often combined with radiotherapy because excision is rarely complete with large tumours.

External beam radiotherapy

Normally used after pituitary surgery fails to normalize growth hormone levels rather than as primary therapy. May take 1-10 years to be effective when used alone.

Drugs

Subcutaneous octreotide or lanreotide (somatostatin analogues). Treatments of choice in resistant cases. Given to shrink tumours before definitve treatment or to control symptoms. Bromocriptine is usually reserved for eldery and frail people.

Acromegaly References

  1. Braunwald E, Fauci AS, Kasper DL, et al. Harrison’s Principles of Internal Medicine (15th edition). New York: McGraw-Hill Publishing; 2001. Book
  2. Cotran RS, Kumar V, Collins T, Robbins SL. Robbins Pathologic Basis of Disease (6th edition). Philadelphia: WB Saunders Company; 1999. Book
  3. Davidson S, Haslett C. Davidson’s Principles and Practice of Medicine (19th edition). Edinburgh: Churchill Livingstone; 2002. Book
  4. Hurst JW (ed). Medicine for the Practicing Physician (4th edition). Norwalk, CT: Appleton and Lange; 1996. Book
  5. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002: pp 427-30. Book
  6. Longmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press; 2001. Book
  7. MEDLINE Plus
Print Friendly, PDF & Email

Dates

Posted On: 8 September, 2003
Modified On: 30 September, 2015

Tags



Created by: myVMC