What Is Acromegaly? Understanding Causes, Symptoms, and Modern Treatment Options

Acromegaly is a rare but serious hormonal disorder that occurs when the pituitary gland produces excessive growth hormone (GH), typically in adulthood. Unlike gigantism, which happens in children before their bones stop growing, acromegaly develops gradually in adults—most commonly between the ages of 30 and 50. The condition leads to abnormal enlargement of the hands, feet, facial bones, and internal organs, significantly affecting both physical appearance and overall health.

What Causes Acromegaly?

In over 95% of cases, acromegaly is caused by a benign tumor—known as a pituitary adenoma—located in the pituitary gland at the base of the brain. This tumor secretes too much growth hormone, which then stimulates the liver to produce insulin-like growth factor 1 (IGF-1). Elevated IGF-1 levels are responsible for the progressive tissue overgrowth associated with the condition.

Risk Factors and Who Is Most Affected

While acromegaly can affect anyone, it most frequently appears in middle-aged adults, with men slightly more likely to be diagnosed than women. Due to its slow progression, symptoms may go unnoticed for years, delaying diagnosis. Early signs are often subtle, such as ring or shoe size changes, which many people dismiss as normal aging.

Common Symptoms of Acromegaly

The physical changes caused by acromegaly develop slowly, sometimes over a decade. Key symptoms include:

• Enlarged hands and feet – One of the earliest noticeable signs
• Facial changes – Protruding brow and jaw, enlarged nose, and thickened lips
• Joint pain and stiffness – Often mistaken for arthritis
• Excessive sweating – Particularly during sleep or mild activity
• Deepening voice – Due to enlarged sinuses and vocal cords
• Headaches – Caused by the tumor pressing on surrounding brain tissue

Associated Health Complications

If left untreated, acromegaly can lead to severe and potentially life-threatening complications. These include:

Osteoporosis: Weakened bones due to hormonal imbalance increase fracture risk. Sleep apnea: Enlarged tissues in the airway can obstruct breathing during sleep. Hypertension: High blood pressure affects nearly half of all patients and raises cardiovascular risks. Vision problems: A growing pituitary tumor may compress the optic nerve, leading to partial vision loss or even blindness. Additionally, long-term exposure to high GH levels increases the risk of developing type 2 diabetes and certain cancers, particularly colon polyps.

Treatment Approaches for Acromegaly

The primary goal of treatment is to normalize growth hormone and IGF-1 levels, relieve pressure from the tumor, and manage symptoms. A combination of therapies is often used depending on the severity and individual patient needs.

Surgical Intervention

Transsphenoidal surgery is the most common first-line treatment. During this minimally invasive procedure, surgeons remove the pituitary tumor through the nose and sinuses, avoiding external incisions. Success rates are high when performed early, especially for smaller tumors. Many patients experience rapid symptom relief and hormonal normalization post-surgery.

Radiation Therapy

For tumors that cannot be fully removed or recur after surgery, radiation therapy—including stereotactic radiosurgery or conventional external beam radiotherapy—may be recommended. While effective, results take longer to manifest, often requiring months to years for full hormone control.

Medical Management with Medications

Pharmacological treatments play a crucial role, especially when surgery isn't an option or doesn't fully resolve the issue. Common medications include:

• Octreotide acetate (Sandostatin) – A somatostatin analog administered via injection that suppresses GH production.
• Bromocriptine mesylate – An oral dopamine agonist that helps reduce hormone levels in some patients.
• Cabergoline – Another dopamine receptor agonist with fewer side effects than older drugs.
• Pasireotide – Used in resistant cases, though it requires careful monitoring for glucose metabolism issues.

Regular follow-up with endocrinologists, MRI scans, and hormone level testing are essential to monitor progress and adjust treatment plans. With early diagnosis and proper management, many individuals with acromegaly can achieve remission and enjoy a good quality of life.