Acromegaly

Acromegaly is a rare endocrine condition in which the body produces an excess of growth hormone over a period of years. In adults the growth plates of the bones have already closed, so the body does not get taller but changes shape: hands, feet and facial features enlarge. The cause is almost always a benign tumour of the pituitary gland. It responds well to treatment, and the earlier that starts, the fewer irreversible changes are left behind.

Symptoms

The main difficulty is that the changes accumulate over years and are invisible to people who see you every day. Often the first clue is something mundane: a ring that no longer fits, shoes that need to be a size larger.

• hands and feet enlarge, with a change in ring and shoe size;
• facial features coarsen: brow ridges, nose and lips; the lower jaw comes forward and gaps open between the teeth;
• skin becomes thicker and oilier, with increased sweating;
• the voice deepens and roughens;
• headaches, joint pain, numbness and weakness in the hands;
• snoring with pauses in breathing during sleep, daytime sleepiness, fatigue;
• in women the menstrual cycle is disrupted; in men, erectile function declines.

The condition is most often identified between 30 and 50. If the excess of growth hormone begins in childhood, before the growth plates close, a different condition develops — gigantism.

When to see a clinician

• you have noticed that over a few years your shoe size, ring size or facial features have changed;
• sweating, headaches, joint pain and numbness in the hands occur together;
• people around you comment on changes in your appearance that you cannot see;
• sleep apnoea and constant fatigue have appeared without clear cause.

A useful thing to bring to the appointment is old photographs from the last 5 to 10 years. Comparing images frequently reveals what the mirror does not.

How it is diagnosed

The starting point is a blood test for insulin-like growth factor (IGF-1), which reflects the average level of growth hormone and is therefore more informative than a single measurement of the hormone itself. If it is abnormal, a glucose loading test follows: normally glucose suppresses growth hormone production, but in acromegaly it does not.

Once the excess is confirmed, an MRI of the pituitary locates the tumour and assesses its size. Visual fields, the function of the other pituitary hormones, and the conditions that commonly accompany the disease are checked too: blood sugar, blood pressure, the heart, sleep apnoea and bowel polyps.

Treatment

The aim is to return growth hormone to normal levels and relieve pressure from the tumour on surrounding structures.

• Surgery. The main approach: the adenoma is removed endoscopically through the nose, with no external incisions. For many people this is enough.
• Medication. Somatostatin analogues, growth hormone receptor blockers and dopamine agonists are used when surgery is not possible, has not achieved a complete effect, or when preparation is needed beforehand.
• Radiotherapy. Held in reserve for cases where hormone excess persists after surgery and medication.

Follow-up continues after treatment: hormone levels are monitored, replacement therapy prescribed if required, and blood pressure, blood sugar and heart function kept under review.

Why delay costs

A prolonged excess of growth hormone raises the risk of type 2 diabetes, high blood pressure, heart disease, sleep apnoea and bowel polyps. Changes to bone and cartilage do not reverse once the hormone is normalised — which is why early diagnosis matters beyond how you feel.

Common questions

Is it inherited? As a rule, no. Inherited forms exist but account for a small proportion.

Is a pituitary tumour cancer? Almost always it is a benign adenoma, and it does not spread.

Will my appearance return to how it was? Soft-tissue swelling reduces and the skin becomes thinner. Bone changes remain.

Online consultation

In an online appointment a doctor can go through your symptoms, judge whether there are grounds to test growth hormone levels, explain which blood tests to start with and advise which specialist to see in person.

This article is for general information and does not replace a consultation with a doctor.