Acromegaly

What is acromegaly?

Acromegaly is a hormonal disorder. It happens when your pituitary gland, located deep in the brain, makes too much growth hormone (GH). Growth hormone affects growth of all tissues of the body, especially bone. Too much of this hormone can cause:

• abnormal growth of the head, face, hands, or feet
• diabetes
• coronary artery disease
• high blood pressure
• enlarged heart, kidneys, liver, spleen and other organs.

How does it occur?

Acromegaly is nearly always caused by a benign (noncancerous) tumor of the pituitary gland called an adenoma. The tumor makes too much growth hormone. The cause of these tumors is not known. In some cases, tumors in other parts of the body, such as the pancreas, lung and other areas of the brain, cause your body to have too much growth hormone.

What are the symptoms?

The most common symptoms of acromegaly are hands and feet that have gotten bigger. It may also cause:

• bones and features of the face, including the tongue, that have gotten bigger
• deep husky voice
• changes in your skin, such as oiliness and more sweating
• headaches
• vision problems
• loss of sex drive
• irregular menstrual periods
• trouble having an erection.

Acromegaly usually develops very slowly. The slow physical changes may not be noticed for several years.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have one or more of these tests:

• blood tests to measure growth hormone levels or insulin growth factor 1 (IGF-1)
• blood tests to check on the other hormones produced by the pituitary gland
• blood tests to measure blood sugar levels (glucose tolerance test)
• magnetic resonance imaging (MRI) scans
• computerized tomography (CT) scans

How is it treated?

The goals of treatment are to:

• Lower the amount of growth hormone your body makes
• Relieve the pressure of the growing pituitary tumor on other parts of the brain
• Keep the pituitary gland working normally.
• Lessen your symptoms.

Current treatment choices are surgery, medicine, and radiation. You may need more than 1 type of treatment. Your treatment will depend on the size and location of your tumor as well as how fast it’s growing.

Surgical removal of the tumor is often the first treatment choice. Most pituitary tumors can be removed, at least partially. Then you will have less pressure on the brain and lower growth hormone levels. Within a few days after the surgery, your face should start going back to its normal appearance. You will have less swelling. Surgery can also bring high blood pressure back to a normal level.

Radiation may be used to shrink the tumor before surgery or to make it smaller if surgery has not removed all of the tumor.

Medicines are sometimes used to lower growth hormone levels and their effects before surgery. More often, medicines are used after surgery if the surgery doesn’t stop all of the extra growth hormone. Three types of medicines may be used:

• Medicines that stop growth hormone production. Octreotide (Sandostatin) is one of these drugs. It is given by injection (shots), several times daily at first and then once a month.
• Medicines that block the effects of growth hormone on the body. These medicines don’t actually lower the amount of growth hormone in the body but they block the effects. An example of this medicine is Pegvisomant (Somavert). Somavert is a daily shot.
• Dopamine-like medicines, such as bromocriptine (Parlodel). These drugs are not as effective in lowering the amount of growth hormone. But they can be helpful if the other drugs are causing difficult side effects. These drugs can be taken as pills.

How long will the effects last?

Usually after surgery hormone levels get better but they do not go back completely to normal. You may always need to take medicines to keep growth hormone levels low. Or you may need to take medicines to keep the tumor from getting bigger. You will need to be checked regularly by your healthcare provider.

How can I take care of myself?

• Be sure to keep your follow-up appointments with your healthcare provider.
• If you are taking medicine, take it exactly as prescribed.
• If you notice new or returning symptoms, see your healthcare provider right away.
• Follow your healthcare provider's advice about diet and exercise.