What happens in the body
Growth hormone is produced by the pituitary gland and acts primarily through insulin-like growth factor produced in the liver. In an adult, an excess of these substances causes cartilage, bones and soft tissues to grow. The skin and subcutaneous structures thicken, and internal organs enlarge, including the heart and tongue. Growth hormone counteracts insulin, so carbohydrate metabolism disorders often develop. If the tumor grows upward, it puts pressure on the optic chiasm and impairs lateral vision.
- Excess growth hormone and insulin-like growth factor
- Overgrowth of bones, cartilage and soft tissues
- Enlargement of internal organs
- Decreased insulin sensitivity
- Tumor pressure on the visual pathways
How to suspect: early and late signs
The most reliable guides are not appearance, but everyday observations: rings stop fitting, you have to buy shoes a size or two larger, the hat becomes tight. Increased sweating, oily skin, snoring and breathing pauses during sleep, numbness of the fingers due to compression of the nerve in the wrist, pain in the joints and back, and fatigue appear. Facial features change gradually, and this is best seen when compared with photographs from ten years ago - doctors also use this technique during appointments.
- Increasing the size of rings, shoes, hats
- Enlargement of the nose, lips, brow ridges, lower jaw
- Gaps between teeth, changes in bite
- Increased sweating and oily skin
- Snoring and sleep apnea
- Numbness of hands, pain in joints
- Fatigue and headache
Why is acromegaly dangerous?
The disease affects not only appearance. Over time, the heart enlarges and copes worse with the load, blood pressure rises, and the rhythm is disturbed. Disorders of carbohydrate metabolism often develop, including diabetes mellitus. Changes in the joints lead to persistent pain and limited mobility, and nighttime breathing pauses increase the load on the heart. The risk of intestinal polyps increases, so doctors recommend appropriate examination. All this makes early treatment especially important.
- Enlarged heart and heart failure
- Arterial hypertension and rhythm disturbances
- Diabetes mellitus and prediabetes
- Sleep apnea
- Arthrosis of large joints and spine
- Increased risk of colon polyps
Diagnostics
A one-time measurement of growth hormone is not very informative, because it is released in spurts throughout the day. Therefore, the level of insulin-like growth factor is first determined, which reflects the average level over the days, and then the diagnosis is confirmed by a test with a glucose load: normally, sugar suppresses the production of growth hormone, but with acromegaly this does not happen. Once confirmed, an MRI of the pituitary gland is performed to locate and measure the tumor. Additionally, visual fields, heart condition, carbohydrate metabolism and other pituitary hormones are assessed.
- Insulin-like growth factor
- Glucose load test
- MRI of the pituitary gland with contrast
- Assessment of visual fields by an ophthalmologist
- ECG and echocardiography
- Glucose tolerance test and glycated hemoglobin
- Evaluation of other pituitary hormones
Treatment
The main method is surgical removal of the adenoma, most often through the nose using endoscopic access. When the tumor is completely removed, hormone levels normalize and many complaints decrease. If surgery is impossible or not effective enough, drug therapy is prescribed with drugs that suppress the production or action of growth hormone; The endocrinologist selects a specific regimen. In some cases, radiation therapy is used, the effect of which develops gradually. Skeletal changes that have formed over the years of illness do not go back, but further progression stops.
- Endoscopic surgery through the nose
- Drug therapy for residual activity
- Radiation therapy in selected cases
- Treatment of diabetes, blood pressure and sleep apnea
- Lifelong observation by an endocrinologist
- Monitoring hormones and MRI according to schedule
