What is acromegaly?

Acromegaly is a hormonal disorder in which the pituitary gland produces excess growth hormone. The pituitary gland is responsible for secreting and regulating the hormonal functions of the body and can develop benign masses called adenomas that produce a variety of hormones in excess. Acromegaly is not hereditary.

The overproduction of growth hormone has many effects. Affected children may grow excessively, known as gigantism. In adults, the bones widen rather than lengthen, and the feet, hands, nose, and tongue often increase in size.

ORIGIN OF THE WORD ACROMEGALY

Acro comes from the Greek word ákros, which means higher or higher and refers to the extremities of the body (such as the hands and feet). Megaly comes from the Greek word “great”, which means “enlarged”. Therefore, acromegaly literally means "large extremities ".

SYMPTOMS OF ACROMEGALY

Symptoms of acromegaly develop over several years and often go unnoticed, even when rings are tight or hats and shoes no longer fit. Excess growth hormone also disrupts metabolism, leading to weight gain, diabetes, hypertension, arthritis, and heart disease. If you want to be interested in a case, you can read the story of Raquel Ciriza.

Due to the insidious nature of these changes, most patients have symptoms for an average of 10 years before the diagnosis is made. The diagnosis is confirmed by measuring growth hormone levels in a blood sample.

Also, it is important to get a CT scan of the brain, as some adenomas can grow very large and cause headaches or vision loss by pressing on the brain. Although many problems can improve after successful treatment, some changes can be permanent and lead to persistent problems, so early diagnosis and intervention are important.

PHYSICAL CHANGES

The tumor produces abnormally high amounts of growth hormone (GH) that circulate in the blood, causing slow but dramatic changes, such as the growth of the skull bones (causing changes in facial features and wide spaces between the teeth), growth of the hands, and feet, growth of tissue in the tongue and throat (causing sleep apnea), changes in joints and ligaments throughout the body (which often cause joint pain and swelling, and, in some cases, carpal tunnel syndrome).

These are the changes that patients may notice, and some of them, like sleep apnea, can be life-threatening. Unfortunately, the most dangerous changes are not obvious to patients and include changes in the heart that can lead to heart disease or sudden death and changes in the colon that can lead to colon polyps that can degenerate into colon cancer.

If left untreated, acromegaly can lead to serious illness and death, but it's important to note that almost all pituitary adenomas are benign tumors and not cancer.

In addition to the effects of having too much growth hormone, these tumors can eventually grow large enough to compress the normal pituitary gland, leading to the loss of normal hormones that are important for normal life and reproduction.

If the tumor becomes very large, it can cause compression of other nerves or arteries near the pituitary gland, especially the optic nerves that connect the eyes to the brain; this can cause slow but progressive vision loss.

WHICH IS THE TREATMENT?

Acromegaly is traditionally treated by transsphenoidal surgery, in which the adenoma is removed through a small incision made in the back of the nose.

The intervention requires a short hospital stay and also recovery time. Between 80% and 85% of patients with tumors smaller than 1 cm (microadenomas) are usually cured in the long term, compared to 50% or 60% of patients with larger tumors (macroadenomas).

Patients whose symptoms persist after surgery are treated with drugs that block the action of growth hormone. These include somatostatin analogs, which are effective in 50 to 70 percent of patients; in dopamine agonists, which are effective in up to 90 percent of patients; and growth hormone antagonists, which are not as effective as the previous two drugs and may be prescribed in addition to somatostatin analogs.

All patients with acromegaly should be seen by an endocrinologist, who can make sure that treatment is effective and that all other hormonal functions are working well.

CAN ACROMEGALY SHORTEN LIFE?

Patients with uncontrolled acromegaly are at increased risk of dying earlier than expected. Lowering the excess level of the hormone to its normal level reduces this risk. Complications associated with acromegaly that can affect your life include heart failure, high blood pressure, abnormal cholesterol, diabetes, snoring, and other sleep-related breathing problems, and joint disease.

TREATMENT AFTER THE OPERATION

Unfortunately, when most patients are diagnosed with acromegaly (usually a delay of many years after the onset of symptoms), the pituitary tumor is large and may invade areas not easily accessible by the surgeon or the tumor has invaded. surrounding structures.

Surgical referral rates depend on the size of the tumor and the experience of the surgeon. Surgery is usually effective in removing most of the tumor, relieving headaches, and improving vision problems, but it may not be possible to remove the entire tumor. Additional treatments are often necessary to reduce serum levels of GH and IGF-I to normal, in order to reduce the risk of complications from continued excessive production of growth hormone.

 

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