Acromegaly is a hormonal disorder characterized by excessive growth of the extremities, a protruding jaw, a flattened nose, swollen ears, thickened skin, separated teeth, and an enlarged rib cage. Acromegaly results from a pituitary tumor occurring after puberty. The tumor induces production of excessive quantities of growth hormone (somatotropin) which, in turn, causes a disproportionate growth of the end (acral) parts of the skeleton—the hands, feet, elbows, knees, and jaw, When this same tumor occurs in children, it causes’ a generalized but proportionate growth of the skeleton and soft tissues.
Onset of symptoms in acromegaly occurs between the ages of 20 and 50. Generally, the changes are so gradual that no one notices them. However, photographs taken over a period of years usually reveal a progressive enlargement of facial features. And sometimes, increases in hat, shoe, and glove sizes alert the patient to the fact that something is wrong.
During the active period of the disease, the patient may complain of poor eyesight due to pressure of the pituitary tumor on the optic nerve, headaches, sweating, an unpleasant odor due to oiliness of the skin, and a decrease in sex
Heart size increases, along with that of the liver and other internal organs. Muscle weakness and abnormal sensations such as a burning feeling may be due to entrapment of nerves in bony and soft tissue overgrowth. Psychological problems often develop as a result of concern over the changes in appearance.
Diagnosis is confirmed by x-ray studies of the skull and skeleton. The x-rays will show enlargement of the bones and soft tissue and of the depression in the skull bone (the sella turcica) where the pituitary gland lies. The basal metabolism rate (BMR) may be high. The presence of active disease is determined by watching for continued
evidence of soft tissue and skeletal growth and by measuring increased quantities of growth hormone in the blood that are not suppressed by glucose.
Treatment in the past generally has consisted of either radiation therapy or surgery. The aim is to reduce production of growth hormone and to relieve the headache or visual problems caused by pressure from the tumor.
Recently, more success has been achieved in arresting acromegaly by the use of heavy particle radiation (proton or alpha particle beam) or by the use of two new surgical techniques: a freezing technique called cryosurgery, or a radio-frequency heat method.
However, if the tumor has enlarged beyond the sella turcica, it must be removed by an open surgical method. The patient’s future depends on the nature and the size of the tumor. Because of the permanent disfigurement that the condition produces, the progress of the disease must be watched closely. If radiation does not seem to be successful in arresting the disease, surgery may be used at an early stage to minimize the undesirable cosmetic effects, Although therapy will not reverse the bony changes, it does decrease the amount of soft tissue growth and softens the characteristic coarse, leathery skin.