Acromegaly: Symptoms, Complaints, Signs

In childhood, excess STH before the closure of the epiphyseal joints (growth plates) leads to proportioned gigantism (pituitary gigantism; marked tall stature; patients often reach a height of >2 m). In adults, i.e., after completion of physiological growth, excessive STH production manifests exclusively in the head, acras (protruding parts of the body such as hands and feet, chin and lower jaw, ears, nose, over-eye bulges, and genitals) and visceral organs (organs in the abdomen). The following symptoms and complaints may indicate acromegaly:

  • Enlargement of the acra – ends of the body such as the nose, chin, ears, hands (wedding ring no longer fits), feet (shoe size ↑).
  • Thickened facial / scalp skin, increased wrinkled (pronounced forehead wrinkles, deep wrinkles around the mouth) → coarsening of facial features.
  • Growth of the upper and lower jaw (prognathism (protrusion of the upper jaw), malocclusion (malocclusion), gaps between teeth).
  • Enlargement of cartilaginous joint parts.
  • Thickened, hardened nails
  • Arterial hypertension (high blood pressure)
  • Arthropathy (joint disease), unspecified (arthritis).
  • Arthralgia, diffuse
  • Pain in the limbs
  • Visual disturbances/facial field restrictions/visual loss (compression of the optic chiasm).
  • Increased intraocular pressure
  • Muscle weakness
  • Macroglossia (enlargement of the tongue) → speech (slurred speech), swallowing and occlusion disorders.
  • Deep voice
  • Water retention (water retention)
  • Weight gain

Skin

  • Acne
  • Diffuse hyperpigmentation
  • Hyperhidrosis (unphysiologically strong sweating).
  • Hypertrichosis (a hair density exceeding the usual degree of sex-specific hair or a hairiness in otherwise always hairless areas).
  • Seborrhea (increased sebum secretion).
  • Thickened, sweaty, oily skin (enlarged skin pores), unpleasant body odor.
  • Other skin changes include:
    • Numerous fibromata pendulantia (pedunculated fibromas; “skin tag”).
    • Seborrheic warts (age warts), in large numbers (Leser-Trelat sign).
    • Pyoderma gangraenosum (painful disease of the skin in which ulceration or ulceration (ulceration or ulcer) and gangrene (tissue death due to reduced blood flow or other damage) occurs over a large area, usually in one place)
    • Psoriasis (psoriasis)

Organs

  • Hepatomegaly (enlargement).
  • Cardiomegaly (enlargement of the heart)
  • Splanchno-/Visceromegaly (abnormal enlargement of internal organs).
  • Goiter (enlargement of the thyroid gland)

Endocrine functions and metabolism

  • Alopecia (hair loss)
  • Lipid metabolism disorders
  • Galactorrhea (abnormal breast milk discharge) (in the presence of an adenoma that simultaneously secretes GH and prolactin).
  • Gynecomastia (enlargement of the male mammary gland).
  • Hirsutism – increased terminal hair (long hair) in women, according to the male distribution pattern.
  • Tall growth (gigantism) – when acromegaly occurs in childhood, ie before epiphyseal closure.
  • Hyperinsulinemia (insulin resistance) → Pathological glucose tolerance, diabetes mellitus type 2.
  • Pituitary (“concerning the pituitary gland (hypophysis)”) failure symptoms (due tointracranial space).
  • Loss of libido
  • Oligo-/amenorrhea; other cycle disorders.
  • Loss of potency/libido disorders

Nervous system and psyche

  • Cephalgia (headache)
  • Carpal tunnel syndrome – nerve compression syndrome affecting the median nerve at the wrist (causing paresthesias in the first three and a half fingers of the hand) [common].
  • Tarsal tunnel syndrome – compression syndrome (bottleneck syndrome) in the course of the N. tibialis (“tibial nerve”) in the posterior tarsal tunnel; compression under the retinaculum flexorum (relatively rare); clinical picture: in the foreground are pain, paresthesias (sensory disturbances; partly burning) in the area of the forefoot at (Nn.plantaris medialis and lateralis), sometimes with radiation into the medial heel (R. calcaneus); but may also cause hypesthesia (numbness) in the innervation area of the tibial nerve and, in rare cases, paresis (paralysis) of the toe spreaders and short toe flexors; diagnosis: sonography and magnetic resonance imaging (MRI) [common].
  • Mood lability, loss of motivation, depressed mood.
  • Lack of concentration
  • Rapid fatigability, lethargy
  • Pain in the facial area
  • Snoring and sleep apnea syndrome

It usually takes many years before a diagnosis of acromegaly is made. Most commonly, acromegaly is diagnosed between the 3rd and 5th decade of life.