Acromegaly By Kelsie Bonow

Acromegaly Greek words “extremities” and “enlargement” Hormonal disorder – excess growth hormone (after puberty) Results in enlargement of body tissues Genetic alteration, not present at birth After growth plates have fused, does not affect height Brow and lower jaw protrude, nasal bone enlarges, teeth space out Spontaneous, not inherited

Etiology Benign tumor of pituitary gland (adenoma) Body continues to produce growth hormone (GH) IGH-I levels rise Bone overgrowth, tissue enlargement Non-pituitary tumors Genetic alteration in pituitary cell, increased cell division, tumor Can affect production of other hormones, location of tumor Pancreas or lungs, produce GH or growth hormone-releasing hormone Maurice Tillet – aspiring actor, fled France, professional wrestler in America

Signs and Symptoms - VISIBLE Abnormal growth of hands and feet Swelling – change in ring or shoe size Enlarged jaw, tongue, and facial bones Widely spaced teeth Skin tags, skin and body odor, and thickening of skin Skin and body odor, excessive sweating Hoarseness

Signs and Symptoms – NOT VISIBLE Headache Fatigue and weakness Carpal tunnel Joint pain Abnormal menstrual cycle and erectile dysfunction Deepening of voice Sleep apnea Impaired vision Enlarged sinuses and vocal cords

Diagnostics Blood tests Imaging GH level Oral glucose tolerance test IGF-I levels Imaging Magnetic resonance imaging (MRI) Computerized tomography (CT) GH level not enough, secreted in spurts, level varies often Oral glucose – drink glucose, lowers GH, not w/ acromegaly Elevated IGF-I almost always indicate acromegaly MRI most sensitive CT if unable to have MRI

Treatment Surgery Medical Therapy Radio Therapy 1st option Rapid and effective Experience of surgeon Medical Therapy Used if surgery is not a cure Shrinks tumor before surgery Somatostatin, GHRAs, dopamine agonists Radio Therapy Tumor remaining after surgery Do not respond to medication If surgery successful, improvement with a few days Risk of damage to surrounding tissue, rarely meningitis Somatostatin slows GH production GHRAs normalize IGF-I levels

Prognosis Surgery successful in most patients 55 – 80% overall remission rate after surgery If left untreated.. Symptoms worsen Arthritis Cardiovascular disease Diabetes High blood pressure Vision abnormalities

Prevention There are no methods to prevent this condition, it is spontaneous. Early treatment may prevent further complications.