What Is Acromegaly?
Acromegaly is a rare and slowly progressive hormonal disorder caused by an overactive production of growth hormone (GH) from cells in the pituitary gland. The most common cause is a benign tumor (adenoma) that develops in the pituitary gland. Excessive secretion of growth hormone leads to noticeable physical changes such as the thickening of bones in the hands, feet, and face. If left untreated, acromegaly can result in serious health problems like heart, joint, and metabolic disorders. The average age of diagnosis for acromegaly is 40–47 years, with men being diagnosed on average 4.5 years earlier than women. The prevalence is reported to be 28–137 per million, and the incidence is 2–11 cases per year. The proportion of patients diagnosed before the age of nineteen is between 2.5% and 22%. The average time between the onset of disease symptoms and diagnosis is 5 years, although this period can extend up to 15 years.
Sleep apnea syndrome, which occurs in 20–80% of patients, is associated with hypoventilation and hypoxemia. In acromegaly, enlargements of synovial tissue and joints lead to hypertrophic arthropathy. The risk of vertebral fractures is increased in the presence of active disease. The development of a nodular goiter is elevated in acromegaly patients and is correlated with the disease duration. There are data showing both an increased and an unchanged risk of thyroid cancer in acromegaly compared to the general population.
Furthermore, an increased incidence of hyperplastic colon adenomas, colorectal polyps, and colon cancer has been demonstrated in patients. Untreated acromegaly negatively affects quality of life (QoL) and also leads to neurocognitive and neuropsychiatric disorders.
Why Does Acromegaly Develop?
The most common cause of the disease is adenomas in the pituitary gland that uncontrollably secrete growth hormone. In rare cases, an excessive secretion of GHRH (Growth Hormone-Releasing Hormone) from the hypothalamus or a hormone excess originating from tumors in other organs like the pancreas and lungs can be observed.
What Are The Symptoms And Diagnostic Methods For Acromegaly?
Acromegaly typically progresses insidiously, and its symptoms develop over time. Physical findings such as enlargement of the hands and feet, prominent facial features, increased protrusion of the chin and forehead, and widening of tooth gaps are common. Additionally, excessive sweating, headaches, joint pain, sleep apnea, visual disturbances, and menstrual irregularities may occur.
Uzm. Dr. Burcu Meryem Atak Sançmış assesses the patient’s complaints and examines hormone levels. First, the IGF-1 (insulin-like growth factor 1) level is measured. Subsequently, it is checked whether the GH level is suppressed by an oral glucose tolerance test. To confirm the diagnosis, a brain MRI is performed to evaluate the pituitary gland.
What Are The Treatment Methods For Acromegaly?
The primary goal of treatment is to normalize growth hormone levels and reduce tumor-related pressure. For this purpose, methods such as surgery, medication therapy, and radiation therapy are used.
The first choice is typically transsphenoidal surgery to remove the adenoma. If hormone levels do not reach the desired level after surgery, medication therapies such as somatostatin analogs, dopamine agonists, or GH receptor antagonists are used. In cases where surgery and medication therapy are insufficient, radiation therapy may be applied.
Our expert doctor develops an individualized approach for each patient, regularly monitors hormone levels, integrates lifestyle changes into the treatment process, and implements a multidisciplinary treatment plan.
Frequently Asked Questions
Is Acromegaly And Gigantism The Same Thing?
No. Acromegaly develops in adults, and since the bone growth plates have closed, there is no increase in height; instead, hands, feet, and the face grow larger. Gigantism begins in childhood and leads to abnormal height growth.
What Should Acromegaly Patients Be Aware Of? Regular follow-up, consistent medication intake, salt and sugar balance, sleep patterns, control of cardiovascular risks, and a healthy diet are important. All recommended systemic imaging and screening examinations must be performed at the appropriate time. What are these?
- All acromegaly patients should be monitored for diabetes mellitus, hypertension, cardiovascular diseases, osteoarthritis, sleep apnea, nodular goiter, and colon polyps, as well as potential cancers.
- In acromegaly patients with hypertension and diabetes mellitus, standard nutritional therapies and medical treatments should be used to control blood pressure, blood sugar, and lipid levels.
- Acromegaly patients whose cardiac function does not improve after biochemical remission should routinely undergo echocardiography.
- Since the risk of developing colorectal cancer and colon polyps is increased, acromegaly patients should be regularly monitored with colonoscopy at the time of diagnosis or from the age of 40 onwards. The frequency of colonoscopy varies depending on the findings of the first colonoscopy and acromegaly activity. Patients with adenomatous polyps detected during the initial screening or whose serum IGF-1 levels remain high should be recommended screening every three years. Patients with a normal first colonoscopy, hyperplastic polyps, or normal GH and IGF-1 levels should undergo colonoscopy every five years.
- The risk of thyroid cancer in acromegaly patients is debatable; in cases with thyroid nodules on examination, USG follow-ups and, if necessary, fine-needle aspiration biopsies of the thyroid should be performed. Female patients should undergo regular mammography screenings for breast cancer.
Does Acromegaly Affect Fertility?
Yes. Women may experience menstrual irregularities, and men may have low testosterone levels. If hormonal balance is restored through treatment, fertility may return. It is recommended to discontinue long-acting medication formulations and pegvisomant approximately 2 months before attempting to conceive. However, the latest guidelines published by the European Society of Endocrinology state that the use of long-acting SRL analogs can be continued until pregnancy is confirmed.
What Is The Relationship Between Acromegaly And Pregnancy?
Changes in the growth hormone axis are also reflected in the course of acromegaly during pregnancy. In the first trimester, a decrease in IGF-1 and a reduction in acromegaly symptoms may be observed due to the anti-GH effect of estrogen, while IGF-1 levels increase again from the second trimester onwards. Literature data show that the risk of tumor growth is not very high.
In an acromegaly patient with a desire for fertility, acromegaly should be treated first. If an unplanned pregnancy occurs or pregnancy occurs with medical treatment, medications should be discontinued and the patient monitored. If compressive symptoms appear, treatment should be considered. If acromegaly is suspected during pregnancy and there are no compressive symptoms, diagnostic tests should be performed after birth due to the low accuracy of tests during pregnancy.
How Should Postnatal Follow-Up Of Acromegaly Patients During Lactation Be Conducted?
Breastfeeding is permitted in patients without compressive symptoms or aggressive tumors. However, it should be noted that an increase in disease activity is common immediately after birth and early treatment may be necessary.
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