An excess of growth hormone causes the bones to keep growing, which can lead to a number of serious complications if left untreated.
Acromegaly is a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood.
When you have too much growth hormone, your bones increase in size. In childhood, this leads to increased height and is called gigantism. But in adulthood, a change in height doesn't occur. Instead, the increase in bone size is limited to the bones of your hands, feet and face, and is called acromegaly.
Because acromegaly is uncommon and the physical changes occur slowly over many years, the condition sometimes takes a long time to recognize. Untreated, high levels of growth hormone can affect other parts of the body, in addition to your bones. This can lead to serious — sometimes even life-threatening — health problems. But treatment can reduce your risk of complications and significantly improve your symptoms, including the enlargement of your features.
Symptoms of acromegaly include an enlarged face and hands. Changes to the face may cause the brow bone and lower jawbone to protrude, and the nose and lips to get larger.
A common sign of acromegaly is enlarged hands and feet. For example, you may notice that you aren't able to put on rings that used to fit, and that your shoe size has progressively increased.
Acromegaly may also cause gradual changes in your face's shape, such as a protruding lower jaw and brow bone, an enlarged nose, thickened lips, and wider spacing between your teeth.
Because acromegaly tends to progress slowly, early signs may not be obvious for years. Sometimes, people notice the physical changes only by comparing old photos with newer ones.
Overall, acromegaly signs and symptoms tend to vary from one person to another, and may include any of the following:
If you have signs and symptoms associated with acromegaly, contact your doctor for an exam.
Acromegaly usually develops slowly. Even your family members may not notice the gradual physical changes that occur with this disorder at first. But early diagnosis is important so that you can start getting proper care. Acromegaly can lead to serious health problems if it's not treated.
Acromegaly occurs when the pituitary gland produces too much growth hormone (GH) over a long period of time.
The pituitary gland is a small gland at the base of your brain, behind the bridge of your nose. It produces GH and a number of other hormones. GH plays an important role in managing your physical growth.
When the pituitary gland releases GH into your bloodstream, it triggers your liver to produce a hormone called insulin-like growth factor-1 (IGF-1) — sometimes also called insulin-like growth factor-I, or IGF-I. IGF-1 is what causes your bones and other tissues to grow. Too much GH leads to too much IGF-1, which can cause acromegaly signs, symptoms and complications.
In adults, a tumor is the most common cause of too much GH production:
The pituitary gland and the hypothalamus are located within the brain and control hormone production.
If left untreated, acromegaly can lead to major health problems. Complications may include:
Early treatment of acromegaly can prevent these complications from developing or becoming worse. Untreated, acromegaly and its complications can lead to premature death.
Your doctor will ask about your medical history and conduct a physical exam. Then he or she may recommend the following steps:
Acromegaly treatment varies by person. Your treatment plan will likely depend on the location and size of your tumor, the severity of your symptoms, and your age and overall health.
To help lower your GH and IGF-1 levels, treatment options typically include surgery or radiation to remove or reduce the size of the tumor that is causing your symptoms, and medication to help normalize your hormone levels.
If you're experiencing health problems as a result of acromegaly, your doctor may recommend additional treatments to help manage your complications.
Doctors can remove most pituitary tumors using a method called transsphenoidal surgery. During this procedure, your surgeon works through your nose to remove the tumor from your pituitary gland. If the tumor causing your symptoms isn't located on your pituitary gland, your doctor will recommend another type of surgery to remove the tumor.
In many cases — especially if your tumor is small — removal of the tumor returns your GH levels to normal. If the tumor was putting pressure on the tissues around your pituitary gland, removing the tumor also helps relieve headaches and vision changes.
In some cases, your surgeon may not be able to remove the entire tumor. If this is the case, you may still have elevated GH levels after surgery. Your doctor may recommend another surgery, medications or radiation treatments.
Your doctor may recommend one of the following medications — or a combination of medications — to help your hormone levels return to normal:
If your surgeon wasn't able to remove the whole tumor during surgery, your doctor may recommend radiation treatment. Radiation therapy destroys any lingering tumor cells and slowly reduces GH levels. It may take years for this treatment to noticeably improve acromegaly symptoms.
Radiation treatment often lowers levels of other pituitary hormones, too — not just GH. If you receive radiation treatment, you'll likely need regular follow-up visits with your doctor to make sure that your pituitary gland is working properly, and to check your hormone levels. This follow-up care may last for the rest of your life.
Types of radiation therapy include:
In transnasal transsphenoidal endoscopic surgery, a surgical instrument is placed through the nostril and alongside the nasal septum to access a pituitary tumor.
You'll probably first see your family doctor or a general doctor. However, in some cases, you may be referred immediately to a doctor who specializes in hormonal disorders (endocrinologist).
It's good to prepare for your appointment. Here's some information to help you get ready for your appointment and to know what to expect from your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For acromegaly, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions you have.
Your doctor is likely to ask you a number of questions, including: