Abating Acromegaly
You may be going through a second puberty at age 47. Your hands and feet have gotten larger. Hats no longer fit because your head size has grown too. You may have acromegaly.
Acromegaly is a hormonal disorder caused by an excess of growth hormone, usually secreted by a lesion in the pituitary gland, located in the brain.
During childhood, growth hormone has a crucial role in attaining a person’s optimal height. In adulthood, growth hormone plays a subtler role in cholesterol management, blood sugar production, the production of protein, and phosphorus, sodium and water retention.
The word originates from the Greek words for extremities (acro-) and enlargement (-megaly). The word reflects one of the condition’s most common symptoms, the abnormal growth of the hands and feet.
Tumors are the most common cause of acromegaly. Ninety percent of people with the condition have oversecretion of growth hormone from the pituitary gland, but a small percentage can have secretion from a lesion in the pancreas, lung or adrenal gland.
Some changes to the body that happen when too much growth hormone is secreted include arthritis from the increase in size of bone and cartilage of the arms and legs. The growth of this tissue could also entrap nerves, leading to carpal tunnel syndrome.
A person can have enlargement of their lips, tongue, nose, deepening of their voice or increased hat or shoe size. You can develop diabetes, as growth hormone causes production of blood sugar by the liver and it can increase the risk of cardiovascular disease and hypertension, due to the metabolic effects of growth hormone. Patients with acromegaly also have an increased risk of colon polyps and cancer.
If you develop acromegaly during childhood before the long bones have fused, you can develop gigantism. If you develop acromegaly as an adult, after the long bones have fused, the changes may be subtler.
Some common symptoms of acromegaly are:
§ Elevated blood sugar
§ Hypertension
§ Thick, oily skin
§ Skin tags
§ Enlarging lips, tongue and nose
§ Worsening snoring
§ Excessive sweating
§ Deepening of the voice
§ Menstrual irregularities in women
§ Impaired vision
§ Enlargement of the liver, spleen, kidneys and heart
A diagnosis of acromegaly can be tricky to make, because if we just measure growth-hormone level, patients with the condition can have a normal level, and normal people can have a growth-hormone level five times above the upper limits of normal. This is because growth-hormone secretion is always changing.
A much more stable screening test is IGF-1, which is a protein made by the liver in response to secretion of growth hormone from the pituitary. If growth-hormone levels are consistently high over time, the IGF-1 level will likely be elevated.
An even better test is a glucose-suppression test, in which growth hormone is measured after 75 grams of a sugar drink. A normal response to this test is to have the growth hormone drop. In patients with acromegaly, growth hormone is not usually suppressed in this situation.
Treatment of this condition involves surgery, radiation or medication. The most successful treatment is surgical removal of the lesion that produces growth hormone. If the lesion is diagnosed in the later stages, medications and radiation may be needed to suppress production of growth hormone from the remaining tumor.
Once treated, there may be some improvement in the overall symptoms, but usually the body size does not change dramatically after normalization of growth-hormone levels.
Acromegaly is a rare and extremely unusual condition that alters your body. The good news is that is manageable and treatable. If you suspect that you have acromegaly, consult your health provider.
