Acromegaly is a hormonal disorder that results
when the pituitary gland produces excess growth hormone (GH). It
most commonly affects middle-aged adults. Once recognized, acromegaly
is treatable in most patients, but because of its slow
and often insidious onset, it frequently is not diagnosed correctly.
The name acromegaly comes from the Greek words for "extremities"
and "enlargement" and reflects one of
its most common symptoms, the abnormal growth of the hands and feet.
Symptoms of Acromegaly
Soft tissue swelling of the hands and feet is often an early feature,
with patients noticing a change in ring or shoe size. Gradually,
bony changes alter the patient's facial features: the brow and lower
jaw protrude, the nasal bone enlarges, and spacing of the teeth
Overgrowth of bone and cartilage often leads to arthritis. When
tissue thickens, it may trap nerves, causing carpal tunnel syndrome,
characterized by numbness and weakness of the hands. Other symptoms
of acromegaly include thick, coarse, oily skin; skin tags;
enlarged lips, nose and tongue; deepening of the voice due to enlarged
sinuses and vocal cords; snoring due to upper airway obstruction;
excessive sweating and skin odor; fatigue and weakness; headaches;
impaired vision; abnormalities of the menstrual cycle and sometimes
breast discharge in women; and impotence in men. There may be enlargement
of body organs, including the liver, spleen, kidneys and heart.
The most serious health consequences of acromegaly are diabetes
mellitus, hypertension, and increased risk of cardiovascular disease.
Patients with acromegaly are also at increased risk for polyps of
the colon that can develop into cancer.
When GH-producing tumors occur in childhood, the disease that
results is called gigantism rather than acromegaly.
Fusion of the growth plates of the long bones occurs after puberty
so that development of excessive Growth Hormone production in adults
does not result in increased height. Prolonged exposure to excess
Growth Hormone before fusion of the growth plates causes increased
growth of the long bones and increased height.
Cause of Acromegaly
Acromegaly is caused by prolonged overproduction of Growth Hormone
by the pituitary gland. The pituitary is a small gland at the base
of the brain that produces several important hormones to control
body functions such as growth and development, reproduction, and
metabolism. GH is part of a cascade of hormones that, as the name
implies, regulates the physical growth of the body. This cascade
begins in a part of the brain called the hypothalamus, which makes
hormones that regulate the pituitary. One of these, growth hormone-releasing
hormone (GHRH), stimulates the pituitary gland to produce GH. Another
hypothalamic hormone, somatostatin, inhibits GH production and release.
Secretion of GH by the pituitary into the bloodstream causes the
production of another hormone, called insulin-like growth factor
1 (IGF-1), in the liver. IGF-1 is the factor that actually causes
the growth of bones and other tissues of the body. IGF-1, in turn,
signals the pituitary to reduce GH production. GHRH, somatostatin,
GH, and IGF-1 levels in the body are tightly regulated by each other
and by sleep, exercise, stress, food intake and blood sugar levels.
If the pituitary continues to make GH independent of the normal
regulatory mechanisms, the level of IGF-1 continues to rise, leading
to bone growth and organ enlargement. The excess GH also causes
changes in sugar and lipid metabolism and can cause diabetes.
In over 90 percent of acromegaly patients, the overproduction
of Growth Hormone is caused by a benign tumor of the pituitary gland,
called an adenoma. These tumors produce excess Growth Hormone and,
as they expand, compress surrounding brain tissues, such as the
optic nerves. This expansion causes the headaches and visual disturbances
that are often symptoms of acromegaly. In addition, compression
of the surrounding normal pituitary tissue can alter production
of other hormones, leading to changes in menstruation and breast
discharge in women and impotence in men.
There is a marked variation in rates of GH production and the
aggressiveness of the tumor. Some adenomas grow slowly and symptoms
of GH excess are often not noticed for many years. Other adenomas
grow rapidly and invade surrounding brain areas or the sinuses,
which are located near the pituitary. In general, younger patients
tend to have more aggressive tumors. Most pituitary tumors arise
spontaneously and are not genetically inherited.
In a few patients, acromegaly is caused not by pituitary tumors
but by tumors of the pancreas, lungs, and adrenal glands. These
tumors also lead to an excess of Growth Hormone, either because
they produce Growth Hormone themselves or, more frequently, because
they produce GHRH, the hormone that stimulates the pituitary to
make Growth Hormone. In these patients, the excess GHRH can be measured
in the blood and establishes that the cause of the acromegaly is
not due to a pituitary defect. When these non-pituitary tumors are
surgically removed, Growth Hormone levels fall and the symptoms
of acromegaly improve.
Acromegaly – How it is Diagnosed?
If a doctor suspects acromegaly, he or she can measure the GH
level in the blood after a patient has fasted overnight to determine
if it is elevated. However, a single measurement of an elevated
blood Growth Hormone level is not enough to diagnose acromegaly,
because Growth Hormone is secreted by the pituitary in spurts and
its concentration in the blood can vary widely from minute to minute.
At a given moment, a patient with acromegaly may have a normal Growth
Hormone level, whereas a Growth Hormone level in a healthy person
may be five times higher.
Because of these problems, more accurate information can be obtained
when Growth Hormone is measured under conditions in which Growth
Hormone secretion is normally suppressed. Physicians often use the
oral glucose tolerance test to diagnose acromegaly, because ingestion
of 75 g of the sugar glucose lowers blood Growth Hormone levels
less than 2 ng/ml in healthy people. In patients with GH overproduction,
this reduction does not occur. The glucose tolerance test is the
most reliable method of confirming a diagnosis of acromegaly.
Physicians also can measure IGF-1 levels in patients with suspected
acromegaly. As mentioned earlier, elevated GH levels increase IGF-1
blood levels. Because IGF-1 levels are much more stable over the
course of the day, they are often a more practical and reliable
measure than GH levels. Elevated IGF-1 levels almost always indicate
acromegaly. However, a pregnant woman's IGF-1 levels are two to
three times higher than normal. In addition, physicians must be
aware that IGF-1 levels decline in aging people and may be abnormally
low in patients with poorly controlled diabetes mellitus.
After acromegaly has been diagnosed by measuring Growth Hormone
or IGF-1, imaging techniques, such as computed tomography (CT) scans
or magnetic resonance imaging (MRI) scans of the pituitary are used
to locate the tumor that causes the Growth Hormone overproduction.
Both techniques are excellent tools to visualize a tumor without
surgery. If scans fail to detect a pituitary tumor, the physician
should look for non-pituitary tumors in the chest, abdomen, or pelvis
as the cause for excess GH.
The goals of treatment are to reduce Growth Hormone production
to normal levels, to relieve the pressure that the growing pituitary
tumor exerts on the surrounding brain areas, to preserve normal
pituitary function, and to reverse or ameliorate the symptoms of
acromegaly. Currently, treatment options include surgical removal
of the tumor, drug therapy, and radiation therapy of the pituitary.
Surgery is a rapid and effective treatment. The surgeon reaches
the pituitary through an incision in the nose and, with special
tools, removes the tumor tissue in a procedure called transsphenoidal
surgery. This procedure promptly relieves the pressure on the surrounding
brain regions and leads to a lowering of GH levels. If the surgery
is successful, facial appearance and soft tissue swelling improve
within a few days. Surgery is most successful in patients with blood
GH levels below 40 ng/ml before the operation and with pituitary
tumors no larger than 10 mm in diameter. Success depends on the
skill and experience of the surgeon. Complications of surgery may
include cerebrospinal fluid leaks, meningitis, or damage to the
surrounding normal pituitary tissue, requiring lifelong pituitary
Even when surgery is successful and hormone levels return to normal,
patients must be carefully monitored for years for possible recurrence.
More commonly, hormone levels may improve, but not return completely
to normal. These patients may then require additional treatment,
usually with medications.
Conventional Drug Therapy
Two medications currently are used to treat acromegaly. These
drugs reduce both GH secretion and tumor size. Medical therapy is
sometimes used to shrink large tumors before surgery. Bromocriptine
(Parlodel®) in divided doses of about 20 mg daily reduces GH
secretion from some pituitary tumors. Side effects include gastrointestinal
upset, nausea, vomiting, light-headedness when standing, and nasal
The second medication used to treat acromegaly is octreotide (Sandostatin®).
Octreotide is a synthetic form of a brain hormone, somatostatin,
that stops GH production. This drug must be injected under the skin
every 8 hours for effective treatment.
Because octreotide inhibits gastrointestinal and pancreatic function,
long-term use causes digestive problems such as loose stools, nausea,
and gas in one third of patients. In addition, approximately 25
percent of patients develop gallstones. In rare cases, octreotide
treatment can cause diabetes.
Radiation therapy has been used both as a primary treatment and
combined with surgery or drugs. It is usually reserved for patients
who have tumor remaining after surgery. These patients often also
receive medication to lower GH levels. Radiation therapy is given
in divided doses over four to six weeks. Radiation therapy causes
a gradual loss of production of other pituitary hormones with time.
Loss of vision and brain injury, which have been reported, are very
rare complications of radiation treatments.
No single treatment is effective for all patients. Treatment should
be individualized depending on patient characteristics, such as
age and tumor size.
Homeopathic Treatment for Acromegaly
Homeopathy treats the person
as a whole. It means that homeopathic treatment focuses on the patient
as a person, as well as his pathological condition. The homeopathic
medicines are selected after a full individualizing examination
and case-analysis, which includes the medical history of the patient,
physical and mental constitution etc.
Following homeopathic medicines
have been found effective in many cases of acromegaly: Thyroidinum,
Chrysarobinum, Baryta carb, Carcinocin, Pitutrinum.