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Acromegaly – an endocrine disease: causes, symptoms, diagnosis, prevention and treatment

Acromegaly is an endocrine disease. It is caused by a benign tumor of the pituitary gland that secretes excessive growth hormone (GH). The pituitary controls multiple functions, including normal growth, metabolism, and reproductive activity. It is also caused by tumor compressing the normal pituitary gland and optic nerves. This disease can result in serious illness and premature death. It is a treatable disease but it is not often diagnosed early.

It causes dramatic bone and soft tissue changes and cardiovascular problems. If the tumor develops before bone growth is completed in adolescence, the result will be gigantism.

CAUSES OF ACROMEGALY
– Abnormally high levels of Growth Hormone (GH) are released.
– Insulin-like Growth Factor-1 (IGF-1) level increases whenever GH level increases.
– Ability of Somatostatin to control amount of growth hormone.

SYMPTOMS OF ACROMEGALY
– Enlargement of hands and feet.
– Enlargement of the forehead.
– Enlargement of jaw and tongue.
– Sleep apnea.
– Excessive sweating.
– Snoring.
– Fatigue.
– Tiredness.
– Depression.
– Diabetes Mellitus.
– Hypertension.
– Risk of colon cancer.
– Headaches.
– Visual loss.
– Impotence.
– Menstrual problems.
– Libido problem.
– Lactation.
– Arthritis.

DIAGNOSIS OF ACROMEGALY
The diagnosis of acromegaly is not easy but it is evident if someone compares the facial appearance in old and new pictures.
– Noticing the elevated levels of both GH and IGF-1.
– Oral glucose tolerance test is done.
– Hormonal testing that confirms acromegaly.
– MRI of pituitary gland.

TREATMENT OF ACROMEGALY
– Endonasal surgery is the first step in treatment, where the surgeon undertakes the removal of the tumor tissue (this procedure is called transsphenoidal surgery). It relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels; the operation typically results in a rate of remission of 50-80%. Remission may not be possible in patients with large or invasive adenomas.
– Medical therapy: Medical therapy is used in 2 cases – either where surgery is not possible, or where the therapy is used to shrink tumors before surgery. There are 3 medication groups that can be used to treat acromegaly; these are
Somatostatin analogs (SSAs), these shut off the production of GH
GH receptor antagonists (GHRAs), which interfere with the action of GH
Dopamine agonists, not as effective as the first 2 medication groups
All of these medication groups have side-effects
– Radiation therapy: When you have patients who still have a tumor remaining after surgeries, and treatment by medicines does not have an effect, then radiation therapy is used. Radiation therapy takes time to be effective, and sometimes requires medicines to be given along with radiation. There are 2 types of radiation therapy – conventional and stereotactic. With radiation therapy, there is a decline in the production of other types of pituitary hormones, because of which hormone treatment is needed.

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