Acromegaly is a disease that results from excessive secretion of growth hormone (GH) from the pituitary gland, usually caused by an adenoma (an excessive growth of normal cells, usually non-cancerous in nature).
In a child or adolescent, excessive GH is called pituitary gigantism. For adults, excess GH will stimulate the growth of bone, cartilage, organs and skin; patients will not, however, become taller.
MANIFESTATIONS OF THE DISEASE
Key things to remember about the manifestation of the disease:
- GH can impact each patient differently.
- Each individual can present with different symptoms and there is not one symptom that impacts all patients.
- A single patient with several symptoms represents only a small portion of those diagnosed with acromegaly.
- Family doctors often only identify the disease when they notice several symptoms associated with acromegaly.
- With the manifestation of only a few symptoms, doctors often treat the symptom(s) and the possibility of acromegaly is not investigated. This leads to further disease progression without detection, and patients often suffer for years before a diagnosis is made. The damage to the body is irreversible.
- Based on discussion between ourselves, there are five broad sets of symptoms:
1. Morphological changes
The most noticeable characteristics of GH are:
- swollen and/or larger hands and feet, which result in increasing shoe and glove size and the need to enlarge rings;
- facial modifications, such as enlargement of the frontal bone (brow), the nose, the jaw (the teeth become spread apart), and the tongue; and
- enlargement of the soft tissues of the pharynx and larynx that lead to snoring, and sometimes, obstructive sleep apnea.
2. Metabolic complications
The main metabolic complications are related to the production of the sexual hormones by the pituitary gland. Women might notice the absence of menstruation, vaginal dryness, and excess hair growth. Men might notice a severely reduced libido.
Other “metabolic” symptoms are thyroid nodules, excessive sweating, skin tags, carpal tunnel syndrome, and hypertension.
3. Symptoms related to the size of the tumour mass
Sometimes, the size of the tumour attached to the pituitary gland will fill the cavity where the pituitary gland sits and will compress the optic nerve which leads to vision problems. The increased size of the tumour could also compress the pituitary gland and impact the production of several hormones. It could also lead to constant headaches (by compressing the brain).
4. Symptoms associated with a comorbidity
A number of symptoms will have a very significant and irreversible impacts on the quality of life for the person down the road. Among them are:
- The heart will continue to grow, leading to the possibility of different defects such as shortness of breath and heart failure.
- Cartilage between joints will enlarge and will eventually cause arthropathy of the knees, ankles, hips, and spine. Back problems might also occur.
- A number of patients become insulin resistant and will eventually have difficulty controlling their glucose.
- If the excess of growth hormone is not controlled over time, there is an increased risk of colon polys and colon cancer. In three studies with colon cancer data, the frequency of cancer was increased more than fourfold in acromegaly patients.
5. Fatigue and weight gain
A cluster of symptoms described above could lead to chronic fatigue and weight gain.
THE ROAD TO TREATMENT
Unfortunately, awareness of the disease is lacking among the general population. As such, those who are developing the disease do not really know what is happening, or they mistake some symptoms with general aging issues. They are generally able to identify typical, but often isolated, signs of acromegaly long before a doctor is able to pinpoint the disease and many fail to mention these symptoms during visits to the doctor. Because many symptoms also appear in the general population, and the fact that acromegaly is a rare disease, family doctors are more likely to refer patients to a specialist to deal with the isolated symptoms as opposed to an endocrinologist. The endocrinologist, through a clinical interview and blood work, will determine if the patient has pituitary disease and is able to provide treatment options.
Treatments are not as effective when disease has progressed untreated for several years. Way too many of us have a significant lower quality of life. This can manifest as reduced self-esteem, chronic comorbidities, chronic pain, chronic fatigue, depression, and impaired relationships with family and others.
Acromegaly is a serious disease that needs to be diagnosed early and treated in a timely manner. Awareness and knowledge are key to quality and longevity of life for patients.
REFERENCE
For more information about the patients’ perspective on acromegaly, please read this paper.
Acromegaly Ottawa 