Acromegaly

Acromegaly is a hormonal disorder caused by excess growth hormone (GH) secretion from the pituitary gland over a prolonged period. More than 95% of cases are caused by a benign pituitary adenoma — a non-cancerous tumour that secretes GH continuously. The excess GH drives the liver to produce insulin-like growth factor 1 (IGF-1), which stimulates growth in bones and soft tissue throughout the body.

Because the condition develops gradually, signs often go unnoticed for years and are frequently identified only by comparing old photographs with current appearance.

**Common symptoms include:** - Enlarged hands and feet — rings no longer fit, shoe size increases gradually - Coarsening of facial features: protruding jaw and brow ridges, enlarged nose, thickened lips, widened tooth gaps - Thick, oily, coarse skin; skin tags - Excessive sweating and body odour - Deep, husky voice (enlarged vocal cords and sinuses) - Loud snoring (upper airway obstruction) - Joint pain and limited range of motion - Headaches and visual disturbances (from tumour pressure) - Enlarged tongue - Fatigue and muscle weakness - Irregular menstrual cycles in women; erectile dysfunction in men - Enlarged heart and other organs - Reduced libido

**Complications** if untreated include hypertension, cardiomyopathy, osteoarthritis, diabetes mellitus, thyroid enlargement, colonic polyps, sleep apnoea, carpal tunnel syndrome, spinal cord compression, and vision loss. Untreated acromegaly can lead to premature death.

**Treatment** targets reducing GH production and shrinking the tumour:

- **Surgery** — endoscopic transnasal transsphenoidal surgery removes the pituitary adenoma through the nose. Normalises GH in most cases; some patients need additional treatment if the tumour cannot be fully removed. - **Somatostatin analogues** (octreotide, lanreotide) — monthly injections that suppress GH secretion. - **Dopamine agonists** (cabergoline, bromocriptine) — oral medications that lower GH and IGF-1 and may shrink the tumour. - **GH receptor antagonist** (pegvisomant) — daily injection that blocks GH action on tissues; normalises IGF-1 without reducing GH or tumour size. - **Radiosurgery** — used when tumour cells remain after surgery; slowly reduces GH over years.