Acromegaly

Acromegaly is a rare hormonal disorder caused by chronic excess growth hormone, usually from a benign pituitary adenoma that develops after the growth plates have closed. Excess GH stimulates the liver to produce insulin-like growth factor 1 (IGF-1), leading to soft tissue and bone overgrowth.

Common features include gradual enlargement of hands and feet, facial changes such as an enlarging jaw and brow, thickened skin, and tongue enlargement. Patients may have joint pain, carpal tunnel syndrome, sleep apnea, diabetes or glucose intolerance, and high blood pressure. Long-term risks include cardiomyopathy and colorectal polyps.

Diagnosis relies on elevated IGF-1 levels and failure of GH to suppress during an oral glucose tolerance test. MRI of the pituitary identifies a GH-secreting adenoma and guides treatment.

Treatment aims to normalize GH and IGF-1 levels and manage complications. The preferred initial therapy is surgical removal of the adenoma via transsphenoidal surgery. If surgery is incomplete or unsuitable, medical therapy with somatostatin analogs (octreotide, lanreotide), a GH receptor antagonist (pegvisomant), or dopamine agonists is used. Radiotherapy may be considered in resistant cases.

Prognosis improves with early recognition and control of hormone levels. Without treatment, acromegaly is associated with increased mortality, mainly from cardiovascular and metabolic disease. Incidence is about 3–4 cases per million per year; prevalence is around 60–70 per million.