Acromegaly

The symptoms of Acromegaly are due to either:

Compression on the surrounding structures of the brain due to the enlarged pituitary tumor:

1. Headache
2. Impaired vision (partial or completed vision loss in one of both eyes). This might be gradual or sudden.
3. Cranial nerve palsies
4. Symptoms related to pituitary hormone deficiencies caused by the tumor – the most common being hypogonadism (symptoms due to low testosterone in males or estrogen in females). (insert a link to hypopituitarism)

Excess of production of growth hormone resulting from overgrowth of tissues:

1. Coarse facial features include a prominently enlarged forehead, nose, enlarged tongue, widely spaced teeth, and a deep voice.
2. Thick skin
3. Enlarged and swollen hands and feet
4. Carpal tunnel syndrome
5. Peripheral neuropathy
6. Gigantism – if this condition occurs before puberty
7. Enlargement of different organs in the body – thyroid, heart, liver, lungs and kidneys
8. Heart disease – coronary artery disease, cardiac failure
9. Sleep apnea
10. Metabolic abnormalities – increased risk for diabetes mellitus
11. Tumors in other parts of the body – colon polyps – are both benign (non-cancerous) and malignant (cancerous), as well as in the stomach, esophagus, and skin.

Diagnosing Acromegaly can be challenging due to the gradual onset of symptoms over a long period. Having a high degree of clinical suspicion is important to diagnose and successfully treat this condition. Dr Thomas will do a comprehensive medical evaluation, eliciting all the different symptoms and signs of the condition and a thorough physical examination. She will order the relevant blood tests (GH, serum IGF-1, and oral glucose tolerance test) to help diagnose this condition. A prompt, successful diagnosis is important for early diagnosis, treatment, and prevention of complications due to the disease.

Following the above tests, she will arrange for you to have the appropriate radiology imaging studies, like an MRI of the pituitary gland, for localization of the pituitary gland tumor. Additional imaging, like specialized nuclear medicine scans, may be needed.

The goals of treatment of patients with Acromegaly are to lower the serum IGF-1 concentration to within the normal range for the patient’s age and gender, control/reduce the pituitary tumor size, and reduce the mass effects/compression of the surrounding structures in the brain, improve symptoms and control or reverse the metabolic complications like diabetes mellitus. Dr Thomas will review all the results of the blood tests and the relevant imaging. She will educate you on the condition, explain all the results of the tests, and formulate an individualized treatment plan for you.

The different modalities of treatment of Cushing disease are:

Surgery

Dr Thomas will refer you to an experienced neurosurgeon for evaluation and surgical management of the pituitary tumor.

Postoperatively, Dr Thomas will monitor your clinical symptoms and arrange for you to have blood tests to monitor the reduction in serum IGF-1, the biochemical parameter used to monitor the resolution and recurrence of the tumor. She will also arrange for you to have additional imaging with an MRI of the pituitary gland approximately 12 weeks post-surgery.

You may need additional surgery if the entire tumor is not removed or if the tumor recurs.

Medications

Oral medications are required when surgery has not normalized the serum IGF-1. The medications include long-acting somatostatin analogs that block the cells producing GH or pegvisomant, a medication that blocks the action of GH.

Radiation therapy

If the tumor is large and is incompletely removed by surgery but is still producing either excess GH or causing pressure on the surrounding structures in the brain, then you may need radiation therapy. Radiation therapy helps with tumor growth control as well as in controlling the production of excess hormones from the pituitary gland.

Lifelong follow-up is required to monitor the complete resolution of the GH excess and the recurrence of the tumor. Dr Reena Thomas will do a comprehensive evaluation, and appropriate tests and imaging will be needed to optimally monitor any tumor recurrence. You will also need to be screened for cardiovascular disease, metabolic diseases, and tumors in other parts of the body due to Acromegaly.