Acromegaly: Rare Growth Hormone Disorder & How to Treat It

Acromegaly is a rare but serious medical condition that occurs due to overproduction of growth hormone, which leads to abnormal growth of bone and tissues. If left untreated, the condition can cause various complications. Surgery, drugs, and radiation are the primary treatment modalities for acromegaly. For advanced diagnosis and treatment by specialists, one can opt to get treated at one of Noida's top endocrinology hospitals, which will effectively treat the condition and ensure overall well-being.
 

Early Detection Can Prevent Complications! If you or a loved one are experiencing symptoms of acromegaly, don’t wait—Contact Us for Expert Guidance at +91 9667064100.
 

What is Acromegaly?

Acromegaly (a-krow-meh-guh-lee) is a rare but serious disease caused by an excessive growth hormone (GH) in the body. Normally, the pituitary gland—a tiny, pea-sized endocrine gland at the base of the brain—makes and controls GH. But in acromegaly, tumors on the pituitary gland or elsewhere in the body stimulate excess production of GH, causing abnormal growth.
Growth hormone, or human growth hormone (hGH) or somatotropin, is required for growth and development during childhood. After the individual has grown up and epiphyses or the bone plates have closed, GH ceases to add to height but is still useful to retain to maintain healthy bones, cartilage, organ function, and metabolism. Excess GH in adults leads to abnormal bone growth, oversized organs, high blood sugar levels (hyperglycemia), and other medical issues.

Acromegaly vs. Gigantism: What's the Difference?

Both acromegaly and gigantism are caused by too much growth hormone, just at different times of life.
Gigantism happens in children when GH levels are too high before plates close (before puberty is complete). It causes over-height and abnormal growth patterns. Gigantism is rarer than acromegaly and is also called pediatric acromegaly.
Acromegaly occurs in adults after growth plates close. Rather than growing taller, the excess GH leads to bone structure alterations, organ enlargements, and metabolic alterations.

How Does Acromegaly Affect the Body?

In adults, acromegaly results in abnormal bone growth, cartilage growth, organ growth, and soft tissue growth. The most apparent body changes are large hands, feet, ears, lips, nose, and jaw and forehead protrusion.
Growth hormone induces the liver to secrete insulin-like growth factor 1 (IGF-1), which is responsible for tissue and bone growth. Overproduction of GH results in increased IGF-1, which is responsible for:
 

• Type 2 Diabetes – Increased blood glucose levels because of the effect of GH on insulin action.
   

• Hypertension (High Blood Pressure) – GH and IGF-1 can make the heart pump harder, leading to an increase in blood pressure.
   

• Heart Disease – Enlargement of the heart (cardiomegaly) and other cardiovascular complications.

Early detection and treatment are important to effectively managing acromegaly. In case you experience symptoms or require specialized treatment, visit an endocrinology hospital in Noida for expert evaluation and treatment.

Symptoms of Acromegaly

Acromegaly may result in slow changes in physical appearance, involving different parts of the body over a period of time. Some of the most obvious changes are:
 

• Thickened ears and lips
   

• A prominent nose
   

• Enlarged feet and hands
   

• Prominent jaw or brow
   

• Increased interdental spacing
   

• Tongue enlargement
   

• Enlargement of the rib cage, which causes a rounded chest contour
   

• Skin Changes of Acromegaly
   

• Acromegaly can cause skin changes, such as:
   

• Acne
   

• Development of benign skin tumors known as skin tags
   

• Coarse, oily thickened skin
   

• Swelling of tissues under the skin

Because these changes occur gradually over a period of many years, they typically are not noticeable at first. Often, people find that their rings do not fit or that they have a larger shoe size. Differences sometimes become apparent only upon comparing old and new photographs.

Other Symptoms of Acromegaly

In addition to physical change, acromegaly can lead to a variety of other symptoms, including:

• Loss of vision, including peripheral vision loss
   

• Inappropriate sweating and body odor
   

• Severe weakness
   

• Chronic headache
   

• Joint pain and stiffness
   

• Deeper voice because of changes in the vocal cords

Causes of Acromegaly

The main cause of acromegaly is a pituitary adenoma, a benign tumor of the pituitary gland. The tumor secretes excessive growth hormone (GH) over many years.
The excess GH causes most of the symptoms of acromegaly. Some, such as headaches and vision disturbances, are due to the tumor compressing adjacent brain structures.
Occasionally, tumors outside the pituitary gland—e.g., in the pancreas or lungs—can lead to acromegaly. The tumors can:

• Produce growth hormone directly

• Release growth hormone-releasing hormone (GHRH), which stimulates the pituitary to secrete too much GHRH.

Growth Hormone and Its Role

The growth hormone is secreted by the pituitary gland, which is situated at the back of the bridge of the nose at the base of the brain. Development and growth of the body are major roles carried out by GH.
When GH is released into the bloodstream, it makes the liver release another hormone called insulin-like growth factor-1 (IGF-1). It is IGF-1 and not GH itself that induces bone and tissue growth directly.
Excess GH results in excess IGF-1, which produces symptoms and complications of acromegaly.

Risk Factors for Acromegaly

Although uncommon, certain people have a higher chance of developing acromegaly due to their genetic predisposition. One such condition is Multiple Endocrine Neoplasia Type 1, or MEN1.
MEN1 is a hereditary disorder that can lead to tumors of the pituitary gland, pancreas, and parathyroid glands. The tumors can secrete excess hormones, leading to a multitude of medical problems:

• An overactive pituitary gland tumor can lead to acromegaly due to excessive release of GH

• A pancreatic tumor can secrete insulin, resulting in less than normal blood glucose levels

• Excessively active parathyroid glands can cause softening of bones and kidney stones

Though acromegaly is not usually hereditary, patients with a family history of MEN1 or other endocrine diseases are at risk of developing it.
If you or your friend is suffering from the symptoms of acromegaly, go to a specialty endocrinology hospital in Noida for early diagnosis and treatment.

Complications of Acromegaly

Untreated acromegaly can cause a range of health complications, which affect different organs and systems of the body. Complications are as follows:

1. Cardiovascular Conditions

Acromegaly highly predisposes a person to heart and blood vessel diseases, including:

• High blood pressure (Hypertension) – Overload on the heart and arteries

• Narrowed arteries (Atherosclerosis) – Can cause heart attack or stroke

• Cardiomyopathy – A disease of the heart muscle that can lead to heart failure

2. Cancer and Pre-Cancerous Conditions

Patients with acromegaly are also at higher risk of developing certain cancers, which are:

• Colon cancer – Acromegaly can lead to abnormal colon polyps, which, if left untreated, can become cancerous

• Other cancers – Elevated growth hormone (GH) and IGF-1 can lead to cancer

3. Sexual and Reproductive Problems

Disturbances of the hormones in acromegaly can cause:

• Irregular or absent menstrual periods in females
   

• Impotence in males
   

• Lack of libido (sex drive)

4. Other Serious Diseases
 

• Osteoarthritis – A condition of progressive arthritis of the joints that is causing pain and stiffness
   

• Type 2 Diabetes – Because of resistance to insulin
   

• Goiter – An enlarged thyroid gland of irregular size
   

• Sleep Apnea – Stops and resumes breathing numerous times during sleep, causing fatigue
   

• Carpal Tunnel Syndrome – Triggers numbness, tingling, and weakness in the arms and hands
   

• Spinal Cord Compression or Fractures – May be caused by abnormal bone growth
   

• Vision Changes or Vision Loss – Caused by pressure from tumors on optic nerves

Diagnosis of Acromegaly

Acromegaly is diagnosed by detailed medical history, physical examination, and certain tests to establish excess production of growth hormone (GH). These are:

1. IGF-1 Blood Test

• It measures insulin-like growth factor-1 (IGF-1) level
   

• Increased levels of IGF-1 suggest excess GH production

2. Growth Hormone Suppression Test

• The patient is asked to drink a glucose solution
   

• Normally, GH levels would decrease after taking glucose
   

• In acromegaly, the GH levels remain elevated, which is a test confirmation of the condition

3. Imaging Tests (MRI and X-Rays)
 

• MRI Scan – Establishes the size and location of a pituitary tumor
   

• X-Rays of hands and feet – Detects abnormal bone growth
   

• If the pituitary tumor is not identified, further imaging scans would be needed to locate tumors in other parts of the body, like the pancreas or lungs.

Treatment of Acromegaly

The prime aim of the treatment of acromegaly is to normalize growth hormone (GH) and insulin-like growth factor 1 (IGF-1), along with controlling symptoms and avoiding complications. Depending upon individual conditions like size, location, and severity of symptoms, and general health, the treatment varies.

Treatment Modes

In successful treatment of acromegaly, the following modes of treatment are usually followed:

1. Surgery

Surgical removal of the tumor is usually the initial treatment, especially if a pituitary gland tumor is the cause. The most common surgery, transsphenoidal surgery, is to enter the pituitary gland via the nose to remove the tumor. It can lower GH levels considerably, especially if the tumor is small. If the tumor is not in the pituitary gland, another type of surgery will be suggested.
Where the tumor is not fully removed, other forms of treatment like a redo surgery, drugs, or irradiation are used to keep regulating hormone levels. Surgery also corrects headaches and visual abnormalities brought about by tumor pressure on adjacent tissues.

2. Drugs

Where surgery is not sufficient to decrease levels of GH and IGF-1, drugs are used to control hormone secretion or to inhibit their activity. Frequently used drugs are:
 

• Somatostatin Analogues

These medications are copies of somatostatin, a hormone that normally is made by the body and prevents GH release. Octreotide (Mycapssa, Sandostatin) and lanreotide (Somatuline Depot) decrease GH production and even shrink tumors in the pituitary gland. They are taken by mouth or through monthly injections.
 

• Dopamine Agonists

Cabergoline and bromocriptine (Cycloset, Parlodel) may decrease GH and IGF-1 in some individuals and, in occasional cases, also reduce the size of tumors. High doses, however, are usually needed, and these carry a greater likelihood of side effects such as nausea, dizziness, sleepiness, nasal congestion, changes in mood, and insomnia.
 

• Growth Hormone Antagonist

Pegvisomant (Somavert) acts by inhibiting the action of GH on body tissues, which in turn reduces the level of IGF-1. It does not reduce GH levels or reduce tumor size. Pegvisomant can affect the liver and therefore patients need to be monitored regularly with a blood test. Pegvisomant is given daily as an injection and can be combined with other treatments.

3. Radiation Therapy

Radiotherapy is a choice when surgery is not possible, when it is not possible to remove the tumor completely, or when medication is inadequate. Radiotherapy slowly decreases the size of the tumor, gradually reducing GH levels.
 

• Effectiveness of Treatment

Although treatment can greatly enhance symptoms and general health, certain physical changes resulting from acromegaly will not be altered. Soft tissue edema usually resolves, and the skin is less oily and rough. But bone overgrowth usually does not reverse.
Furthermore, if other medical conditions have arisen as a result of acromegaly, including diabetes, hypertension, or joint disease, other treatments may be required to control these conditions best.
Through the synergy of surgical, medical, and radiation therapy on a as-needed basis, health practitioners attempt to restore endocrine equilibrium, alleviate symptoms, and improve quality of life in patients with acromegaly.

• Acromegaly Radiation Therapy

Radiation is employed to ablate remaining tumor tissue from surgery and reduce growth hormone levels over time. Months or years are often needed, however, before the effects of radiation become apparent in a response of symptoms.
As radiation impinges not just on GH production but on other pituitary hormones as well, patients being treated need follow-ups periodically. The follow-ups enable doctors to keep track of hormone levels and optimal functioning of the pituitary gland. Follow-up may extend throughout a person's lifetime to deal with long-term impact.

Types of Radiation Therapy

There are various forms of radiation therapy for acromegaly treatment, and the extent of tumor control and impact on adjacent tissues varies:

1. Stereotactic Radiosurgery
 

• Uses 3D imaging to direct a focused beam of high-dose radiation at the tumor and reduce damage to nearby healthy tissue.
   

• Usually given in one sitting.
   

• May take 5 to 10 years to achieve a normal level of GH levels.

2. Proton Beam Radiation
 

• Uses protons rather than conventional radiation beams, and tumors can thus be destroyed selectively.
   

• Causes fewer effects of damage to the adjacent pituitary gland and other tissues than conventional radiation.
   

• Is simpler and safer with fewer late complications.

3. Conventional Radiation Therapy
 

• Involves small doses of radiation delivered over a period of 4 to 6 weeks.
   

• Has a higher risk of damaging the pituitary gland than stereotactic radiosurgery or proton beam radiation.
   

• The full therapeutic effect may take 10 or more years to be realized.

Long-Term Considerations

Patients receiving radiation therapy for acromegaly must undergo lifelong hormone monitoring due to the potential impact on overall pituitary function. In some cases, additional hormone replacement therapy may be required to manage deficiencies caused by radiation treatment.
By selecting the most suitable type of radiation therapy, healthcare professionals aim to control GH levels, shrink the tumor, and improve the patient’s quality of life while minimizing potential risks.

Meet Our Expert Endocrinologist for uncommon growth hormone disorder

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Dr. Vimal Gupta is a highly experienced endocrinologist in Noida, specializing in diabetes, thyroid disorders, and metabolic conditions. He is committed to providing compassionate and evidence-based care, helping patients achieve optimal hormonal balance and improved overall health.

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Conclusion

Acromegaly is a rare but potentially harmful endocrine disorder due to excess secretion of the growth hormone, typically secondary to tumors of the pituitary gland. It has disastrous consequences in its untreated form consisting of cardiovascular disease, diabetes, arthritis, and even blindness. It needs early diagnosis and treatment if the disease is to be well controlled.
Medical therapy, surgery, and radiation therapy normalize the hormone level and reduce symptoms, thereby enhancing the quality of life of the patient. Physical changes in all cases turn out to be permanent, but complete medical treatment can avoid complications and normalize hormones.

FAQs on Acromegaly

1. Do acromegaly symptoms improve after treatment?
Ans: While treatment can remove some of the symptoms like swelling of soft tissues and thickening of the skin, change of the bones and organ enlargement is irreversible in most instances.

2. How long does it take for GH to normalize after treatment?
Ans: It depends on the treatment—surgery will immediately lower the GH, while radiation will take years to completely normalize the level of the hormone.

3. Is acromegaly always due to a pituitary tumor?
Ans: No, but in a minority of situations tumors in other parts of lung tissue, pancreas, or adrenal glands also result in increased production of GH.

4. What diet changes can regulate symptoms of acromegaly?
Ans: Normal nutrition, regulation of blood sugar levels, mild exercise, and frequent follow-up check on heart functioning can regulate the symptoms and complications.

5. Does acromegaly have any effect on fertility and pregnancy?
Ans: Yes, acromegaly does have an effect on the reproductive hormones, leading to irregular periods of infertility in women and decreased sperm counts in men. Fertility can be restored in some patients with treatment, however.

6. Is there anything else if surgery isn't an option?
Ans: Yes, a number of other drugs including somatostatin analogues, dopamine agonists, or GH antagonists exist as options to control the hormone level, and the tumor can be shrunk over time with radiation therapy.

7. Acromegaly should be monitored in how often in a patient?
Ans: They need long-term follow-up with endocrinologists to monitor GH and IGF-1 levels, pituitary status, and comorbidities such as diabetes or cardiovascular disease.