akromegalii

Akromegalii, also known as acromegaly, is a rare hormonal disorder caused by excessive secretion of growth hormone (GH) in adulthood. In most cases the excess GH results from a benign pituitary adenoma. Less commonly, non-pituitary tumors that secrete GH or growth hormone–releasing hormone (GHRH) can cause the condition. The elevated GH stimulates the liver to produce insulin-like growth factor 1 (IGF-1), which mediates many clinical features.

The condition typically develops gradually, with peak effects appearing years after onset. The most characteristic signs are enlargement of the hands and feet, and gradual coarsening of facial features, including a protruding jaw and spaced teeth. Other common features include thickened skin, excessive sweating, sleep apnea, joint pain, and fatigue. Patients may also develop impaired glucose tolerance or diabetes. Longstanding disease is associated with increased risk of cardiovascular disease, hypertension, colon polyps and cancer, osteoarthritis, and pituitary dysfunction.

Diagnosis is based on biochemical and imaging studies. Elevated IGF-1 levels adjusted for age and sex, together with insufficient suppression of GH during an oral glucose tolerance test, support the diagnosis. MRI of the pituitary typically identifies a adenoma. Comprehensive evaluation often includes screening for cardiovascular disease, diabetes, sleep apnea, and colon neoplasia.

Treatment usually begins with surgical removal of the pituitary tumor via transsphenoidal surgery. Medical therapies include somatostatin analogs (eg, octreotide, lanreotide), GH receptor antagonists (pegvisomant), and dopamine agonists (cabergoline). Radiotherapy may be used when surgery or medications do not achieve control. Regular follow-up aims to normalize GH/IGF-1 levels and manage comorbidities. With effective treatment, life expectancy improves substantially compared with untreated disease.