akromegalian

Akromegalian is an adjective describing anything related to acromegaly, a chronic endocrine disorder most often caused by a growth hormone–secreting pituitary adenoma. The term derives from Greek akros, meaning extreme or top, and megas, meaning large. In adults, excess growth hormone after the growth plates close leads to acromegaly; in children, the same excess causes gigantism.

The condition arises when growth hormone–producing pituitary adenomas, or less commonly ectopic GH- or GHRH-secreting tumors, raise GH and subsequently insulin-like growth factor 1 (IGF-1) production in the liver. IGF-1 mediates many tissue effects; GH excess promotes bone and soft tissue growth and metabolic changes.

Clinical features include gradual enlargement of the hands and feet, facial feature changes such as enlarged jaw and brow, prognathism, spacing of teeth, thickened skin, sweating, and arthropathy. Other consequences include sleep apnea, hypertension, glucose intolerance or diabetes, cardiomyopathy, and colon polyps. The onset is insidious; when occurring in childhood before epiphyseal closure, it is gigantism rather than acromegaly.

Diagnosis requires biochemical and imaging evidence: elevated IGF-1 levels, failure of GH suppression with an oral glucose tolerance test, and imaging (usually MRI) showing a pituitary adenoma. Differential diagnosis includes other causes of GH/IGF-1 elevation, and treatment-related changes.

Management is multidisciplinary and aims to reduce GH to normal levels and control comorbidities: transsphenoidal surgery to remove the tumor is first line when feasible; medical therapy with somatostatin analogs or GH receptor antagonists; dopamine agonists in select cases; and radiotherapy as needed. With treatment, life expectancy improves, though cardiovascular and metabolic risks persist. Pierre Marie first described acromegaly in 1886.