Definition
Acromegaly refers to a pathological change in growth due to chronic somatotropin excess. The condition occurs primarily in individuals aged 40-50 years. If acromegaly is not adequately treated, life expectancy is shortened by approximately 10 years due to secondary diseases.
Symptoms
The symptoms of acromegaly initially remain inconspicuous. The symptoms are nonspecific and develop only slowly. Therefore, the disease is usually discovered late. Several years often pass from the onset of the first symptoms until the diagnosis is made. Excess somatotropin leads to gigantism in children with still open epiphyseal joints (normal body proportions are largely preserved) and to acromegaly in adulthood (closed epiphyseal joints).
- Pituitary enlargement
- Compression of cranial nerves
- Visual disturbances/loss of vision
- Headache
- Excessive growth of the acra (fingers, hands, toes, nose, chin, jaw, eye bulges and the zygomatic arches).
- Coarsening of the facial features
- Tooth gaps
- Gigantism
- Articular cartilage growths (arthroses)
- Carpal tunnel syndrome
- Tingling in the hands and feet
- Joint and muscle pain
- Heavy sweating (hyperhydrosis)
- Increase in skin thickness
- Acne and oily skin
- Fibroma (mesenchymal tumor)
- Colonic polyp
- Hypertension
- Ventricular hypertrophy
- Cardiomyopathy
- Heart failure
- Enlargement of the heart (cardiomegaly)
- Sleep disturbances
- Nocturnal pauses in breathing (sleep apnea syndrome)
- Visceromegaly (enlargement of the thyroid gland, tongue, salivary glands, liver, kidney, prostate and spleen).
- Decrease in libido and potency
- Amenorrhea and galactorrhea
- Decreased glucose tolerance, insulin resistance or diabetes mellitus.
- Hypertriglyceridemia
- Hypercalciuria
- Increased aldosterone levels
- Decreased renin levels
- Hypertrichosis
- Euthyroid struma diffusa
- Water retention
- Weight gain
- Psychological changes (fatigue, mood lability).
Views
Causes of acromegaly: acromegaly therapy:
Causes
The most common cause is a pituitary tumor (adenoma).
- Tumors of the hypothalamus with excessive somatotropin-releasing hormone secretion.
- Ectopic production of somatotropin-releasing hormone or somoatotropin by hormone-forming tumors.
Complications
- Hypertension
- Circulatory disorders of the heart and brain.
- Diabetes mellitus
- Nocturnal pauses in breathing (sleep apnea syndrome)
Non-drug therapy
Surgical tumor removal: surgery is performed through the nose and sphenoid sinus under general anesthesia. The chances of cure depend mainly on the size of the tumor. In the case of tumors that can only be partially removed or cannot be removed by surgery, radiotherapy is used. Success takes years to be achieved. A complete cure is usually not achieved, which is why additional medication must be taken. A common complication of radiation is hypopituitarism, which necessitates hormone replacement therapy.
Drug therapy
Somatostatin analogs (octreotide, lanreotide):
- Suppress somatotropin secretion by binding to the somatostatin receptor. Somatostatin analogues are used after surgery or radiotherapy
Growth hormone receptor antagonists (pegvisomant):
- By binding to the somatotropin receptor, the effects of STH are blocked.
Dopamine agonists (bromocriptine, cabergoline):
- Reduction of somatotropin secretion. Therapy with dopamine agonists in combination with somatostatin analogs shows beneficial effects in treatment of acromegaly
