acromegali

Acromegaly, sometimes spelled acromegali in some languages, is a hormonal disorder characterized by excess growth hormone (GH) secretion after the growth plates have closed. It is most often caused by a benign pituitary adenoma that stimulates somatotroph cells to produce excess GH. If GH excess occurs before the end of puberty, it can cause gigantism; in adults, it leads to progressive enlargement of bones in the hands, feet, and face, along with thickening of soft tissues.

Common features include enlargement of the hands and feet, coarse facial features (jaw protrusion, spacing of teeth), increased skin thickness, sweating, and joint pain. Soft tissue swelling can contribute to sleep apnea, headaches, and vision problems if a pituitary mass compresses nearby structures. Metabolic complications such as hypertension, glucose intolerance or diabetes, and an increased risk of cardiovascular disease may occur if the condition remains untreated.

Diagnosis relies on biochemical testing and imaging. Serum insulin-like growth factor 1 (IGF-1) levels are typically elevated and reflect GH activity. A lack of suppression of GH during an oral glucose tolerance test (GH remains above about 1 μg/L) supports the diagnosis. Magnetic resonance imaging (MRI) identifies the pituitary tumor.

Treatment aims to normalize GH/IGF-1 and control tumor growth. It often starts with surgical removal of the pituitary adenoma via transsphenoidal surgery. If surgery is incomplete or unsuitable, medical therapies such as somatostatin analogs (octreotide, lanreotide), GH receptor antagonist (pegvisomant), or, in some cases, dopamine agonists (cabergoline) are used. Radiotherapy may be considered for residual disease. Regular follow-up focuses on hormone levels and management of comorbidities. Acromegaly is rare; incidence is about 3–4 cases per million per year, with a prevalence around 60–70 per million.