Related articles: Acromegaly
Definition
Acromegaly is a syndrome related to an excessive secretion of growth hormone (Growth Hormone, GH) in adulthood. In fact, it is often diagnosed between the ages of 20 and 50, while before the arrest of growth the hypersecretion of GH leads to gigantism.
Almost always, acromegaly is caused by the presence of a GH-secreting pituitary adenoma (a tumor that secretes GH even in the absence of hypothalamic GHRH). Abuse perpetuated over time by exogenous GH, often used for doping purposes, can also lead to a clinical picture of acromegaly.
Most common symptoms and signs *
- Changes in the menstrual cycle
- Amenorrhea
- Asthenia
- Increased appetite
- Weight gain
- Cardiomegaly
- Erectile dysfunction
- Articolar pains
- Muscle pains
- Hepatomegaly
- Galactorrhea
- Glycosuria
- Joint swelling
- insulin Resistance
- Hyperglycemia
- Hyperhidrosis
- hyperprolactinaemia
- Hypertension
- Hirsutism
- Swollen lips
- Inflated tongue
- macroglossia
- Headache
- Dental malocclusion
- Paresthesia
- Oily skin
- Dark skin
- Overshot
- Hoarseness
- Joint stiffness
- seborrhea
- Drowsiness
- splenomegaly
- steatorrhea
- Barrel chest
Further indications
Acromegaly is characterized by slow and progressive physical alterations, associated with systemic symptoms and metabolic complications. It is manifested by an enlargement of the bones and the soft parts, at the beginning more evident at the extremities of the hands, feet and face. Characteristics are the somatic alterations of the face, whose features become marked and coarse. The orbital arches and the cheekbones become protruding, the nose becomes larger, while the excessive growth of the jaw bone leads to the protrusion of the jaw (prognathism) and to the dental malocclusion. Over time, the face takes on a completely different appearance from the original one. The tongue is often swollen and fissured. The proliferation of laryngeal cartilages, on the other hand, leads to a modification of the voice, which becomes hoarse and deep. Hands and feet increase in size and become squat, so much so that rings, gloves and shoes of larger sizes are needed. Deformities appear in the distal parts and are frequent joint symptoms (arthritis, joint pain, reduced joint mobility, etc.). Peripheral neuropathies (eg, paresthesia and carpal tunnel syndrome) are also frequent. At skin level, a thickening and hyperpigmentation of the skin is observed. The sebaceous and sweat glands undergo hyperfunction, so patients frequently complain of excessive sweating and an unpleasant smell. Also internal organs, including heart, liver, kidneys, spleen, thyroid, parathyroid and pancreas, increase in volume (visceromegaly). Headache is frequent due to the presence of a pituitary tumor (local symptom of mass effect). It also increases the risk of developing visual disturbances, cardiac and rheumatic complications, hypertension and cancer of the gastro-intestinal tract. There are also other metabolic alterations, such as reduced glucose tolerance and diabetes. In some women, galactorrhea, menstrual irregularities or amenorrhea are observed, while about one third of men with acromegaly develop erectile dysfunction.
The diagnosis is based on the finding of high levels of growth hormone (GH) and on performing an MRI of the skull to identify the site and characteristics of the adenoma. Furthermore, in patients with suspected acromegaly, the basal pituitary function and serum IGF-1 concentration, which acts as a mediator for the effects of GH, must be evaluated.
Treatment consists of surgical removal or destruction of the pituitary adenoma.
