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What is Acromegaly/GIgantism?

Acromegaly or Gigantism is a condition in which there is too much growth hormone production in the body and the bone/soft tissues gradually enlarge.

When the bones enlarge (happens in children), it is considered as “Gigantism”.

When the soft tissues enlarge (happens in adults), it is considered as “Acromegaly”.

What are the causes?

Most of the times, increased growth hormone release is usually a noncancerous (benign) tumor of the pituitary gland. Very rarely ectopic sources like pancreas or lungs can release GHRH (Growth Hormone Releasing Hormone) and can produce Acromegaly.

How Adrenal Glands are relevant to our body ?

Addison’s disease results from damage to the adrenal cortex.
This damage may be caused by the following:

 Infections such as tuberculosis, HIV, or fungal infections (TB is one of the common cause of Addisons disease in India)

 Autoimmune disease (Immune system mistakenly attacking the gland)

 Hemorrhage

 Tumors (Metastasis from other cancers such as lung)

 Use of blood-thinning drugs (anticoagulants)

What are the symptoms?

  • Easy fatiguability
  • Enlarged bones of the face
  • Enlarged feet and hands
  • Enlarged jaw (prognathism) and tongue
  • Excessive height (when excess growth hormone production begins in childhood)
  • Headache
  • Hoarseness
  • Joint pains, limited joint movement
  • Excessive snoring
  • Paresthesia/tingling of the extremities
  • Widely spaced teeth
  • Widened fingers or toes due to skin overgrowth with swelling, redness, and pain

What are the tests which will help?

  • Post glucose growth hormone level: High
  • Insulin-like growth factor 1 (IGF-1): High
  • Spine x-rays: shows abnormal bone growth
  • Pituitary MRI: may show a pituitary tumor
  • Echocardiogram may show an enlarged heart, leaky mitral valve, or leaky aortic valve.
  • Blood glucose and blood pressure might increase.

What is the treatment?

Surgery to remove the pituitary tumor causing this condition corrects the abnormal growth hormone secretion in most patients.

Radiation of the pituitary gland is used for people who do not respond to the surgical treatment. However, the reduction in growth hormone levels after radiation is very slow.

The following medications may be used to treat acromegaly:

  • Long acting Octreotide or Cabergoline may control growth hormone release in some people.
  • Pegvisomant directly blocks the effects of growth hormone, and has been shown to improve symptoms of acromegaly.

These medications may be used before surgery, or when surgery is not possible; but they are very expensive.

After treatment, periodic evaluation is necessary to ensure that the pituitary gland is working normally. Yearly evaluations are recommended.

What is the Prognosis?

Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon.

Without treatment the symptoms will get worse, and the risk of cardiovascular disease increases.

What are the possible complications?

  • Arthritis
  • Cardiovascular disease
  • Carpal tunnel syndrome
  • Colonic polyps
  • Glucose intolerance or diabetes
  • High blood pressure
  • Hypopituitarism
  • Sleep apnea
  • Spinal cord compression
  • Vision abnormalities

When to Contact an Endocrinologist?

If you have symptoms/signs of acromegaly, or if you feel like jaws, hands and feet are enlarging better to consult an Endocrinologists, as they are well versed in the long term management (even after surgery).

Acromegaly presents as enlargement of jaw, hands & feet (Adults)
Gigantism will have tall stature (Children)
High Growth hormone & IGF1 levels
Trans sphenoidal surgery: Initial treatment of choice
Radiotherapy & long acting somatostatin analogs: in case of relapse

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