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Acromegaly Treatment to Regulate Growth Hormone
The word "Acromegaly" is derived from a Greek word “acro” meaning extremities and “megaly” means great. It is one of the hormonal disorders characterized by the overproduction of growth hormone by the pituitary gland in the brain. When the pituitary gland secretes excessive growth hormone, there is an increase in bone size, causing excessive growth in the extremities and face. This condition is often seen in adolescents, although it may affect people of any age.
If left untreated, acromegaly can cause severe illness and even death. In children and teens who are still growing, acromegaly can cause gigantism, meaning they will have abnormal or unusual increase in height due to an exaggerated bone growth. Acromegaly is quite rare and physical features grow gradually, which is why it takes time to identify the symptoms and diagnose the condition.
What are the signs and symptoms of acromegaly?
As mentioned above, the characteristic symptom of acromegaly is enlarged extremities. People who have this condition notice that their fingers are way too big to insert a ring and their feet are way too big to fit a shoe. Gradually, acromegaly may cause facial changes, such as an enlarged nose, protruding jaw, thickened lips, along with wider spaces between teeth.
The symptoms of acromegaly may vary from one individual to another, such as:
- Enlarged extremities
- Engorged facial features
- Enlarged tongue
- Thick skin
- Excessive perspiration with foul body odor
- Deep, husky voice
- Fatigue and generalized weakness
- Vision problem
- Limited mobility in joints
- Menstrual issues in women
- Sexual issues in both sexes
What are the causes if acromegaly?
Acromegaly can be caused by an overproduction of growth hormone by the pituitary gland, a small gland located in the brain, which also secretes other important hormones. Growth hormone plays a vital role in developing and maintaining your physical growth. It has been found that acromegaly is caused by a benign tumors that make the gland to secrete more amount of growth hormone.
Usually, the condition is not inherited. However, studies have shown a small group of families that may draw us to the conclusion that acromegaly can be inherited. Research has been able to find that acromegaly can be inherited in a condition known as "familial isolated pituitary adenoma" or "endocrine neoplasia". If anyone has the gene for any of these conditions, they are at risk of developing the pituitary tumor that may release excess growth hormone, causing acromegaly.
Excessive secretion of growth hormone triggers the liver to secrete a hormone known as "insulin-like growth factor-1" (IGF-1), which in turn, accelerates the growth and development of bones as well as other tissues of the body. Excessive secretion of IGF-1 can lead to abnormal growth and development of bones and soft tissues, which are the characteristic symptoms of acromegaly or gigantism.
How is acromegaly detected?
Depending on the above signs and symptoms, your doctor will advise you to get some blood work. In acromegaly, the growth hormone levels and IGF-1 are elevated. An endocrinologist will be able to diagnose your condition after ensuring that all your hormones secreted by your pituitary gland are normal. Additionally, you have to undergo a scan called magnetic resonance imaging (MRI) scan for visual assessment of your gland and its tumor.
To confirm acromegaly diagnosis, your doctor will advise a test known as "oral glucose tolerance test" in which you are given a glucose drink. If your blood growth hormone level does not fall, you have acromegaly. If the level falls, you do not have acromegaly.
What are the complications of acromegaly?
If the condition is detected in early stages where the tumors are small, the secretion of growth hormone can be normalized in many cases. In such people, the possibility of developing acromegaly complications is low. However, they need regular medical checkup and follow-up to check for any recurrence in later life.
In people with full-blown acromegaly, the condition is irreversible, such as those who have major changes in the shape of bones, along with the development of other features characteristic to acromegaly, such as diabetes, high blood pressure, or arthritis. One of the major complications of acromegaly is arthritis, which is progressive even after undergoing treatment. Others include heart disease and bowel tumors, which is why people with acromegaly need regular medical checkup for possible heart disease and bowel tumors.
How is acromegaly treated?
When it comes to acromegaly treatment, the goal is to reduce the production of growth hormone and lower the impact of the benign tumor in the gland. Your doctor may advise you to undergo a combination of treatments, which may include surgery, medications, and radiation.
Your doctors may advise you to undergo surgical removal of pituitary tumor. Extracting the tumor through nasal passages may normalize growth hormone production, eliminating the pressure around the surrounding tissues and relieving the signs and symptoms of acromegaly. However, in a few cases, your doctor may not advise undergoing surgery to remove the whole tumor, resulting in an elevated growth hormone level after surgery and requiring others treatments.
There are medications available to reduce the secretion of growth hormone, such as somatostatin analogues – octreotide and lanreotide – which are nothing but the synthetic forms of somatostatin, the brain hormone. These drugs may inhibit the excessive production of growth hormone. The route of administration of these medications is intramuscular, which is to be taken once a month under the supervision of a doctor.
Other medications that are prescribed to treat acromegaly include dopamine agonists, such as bromocriptine (Parlodel) and cabergoline (Cabanex), which lower the levels of growth hormone and IGF-1. Another medication called pegvisomant (Somavert) is effective at blocking the effect of growth hormone, which is recommended to people who failed to respond to other treatments. It is to be taken daily.
Radiotherapy is recommend when the tumor remains even after undergoing surgery. Radiation destroys any tumor cells and reduces the levels of growth hormone. Please note that it can take a few years for radiotherapy to work and improve the symptoms of acromegaly. Radiation therapy for acromegaly include conventional radiotherapy, proton beam therapy, and stereotactic radiosurgery.