Acromegaly Treatment in Delhi, India

Acromegaly is a rare hormonal disorder that occurs when the pituitary gland produces excessive growth hormone, leading to an overgrowth of bones and tissues in the body. This condition usually develops slowly over several years, with symptoms often going unnoticed or misattributed to other causes. It affects both men and women equally, usually appearing in adulthood.

Acromegaly is often mistaken for normal ageing or other conditions due to its slow progression and varied symptoms. Delayed diagnosis can significantly impact a person's quality of life and increase the risk of complications. It is vital for individuals experiencing any characteristic symptoms - such as enlarged hands or feet, facial changes, joint pain, or unexplained fatigue - to seek medical attention promptly.

Acromegaly Symptoms

It's important to be aware of the signs and symptoms associated with acromegaly so that it can be diagnosed and managed appropriately. Here are some common symptoms of acromegaly:

• Enlargement of hands, feet and facial features: One of the hallmark signs of acromegaly is the gradual enlargement of certain body parts. This can include the hands, feet, jaw, nose, forehead, and other facial features. Individuals may notice that their rings no longer fit or that their shoe size has increased.

• Thickening of the skin and soft tissues: Over time, people with acromegaly may experience thickening and swelling of the skin and soft tissues throughout their body. This can lead to a coarser appearance and changes in facial contours.

• Joint pain and increased size of internal organs: As excess growth hormone affects bone and cartilage, individuals with acromegaly may experience joint pain and stiffness. Additionally, the internal organs can become enlarged, which may contribute to various health issues.

• Coarsening of facial features and voice deepening: The excessive growth hormone can cause changes in facial features such as a protruding jaw or an enlarged nose. In some cases, individuals may also notice a deepening of their voice due to changes in the vocal cords.

• Headaches and vision changes due to tumour pressure on nerves: Acromegaly is often caused by a non-cancerous tumour in the pituitary gland called an adenoma. As this tumour grows, it can put pressure on nearby structures, leading to headaches and vision changes.

Acromegaly Causes

Acromegaly occurs when the pituitary gland produces excessive amounts of growth hormone (GH). This excess GH is usually caused by a benign tumour in the pituitary gland, known as a pituitary adenoma.

Here are the primary causes of acromegaly:

• Pituitary tumour: The most common cause of acromegaly is the presence of a pituitary tumour. This tumour stimulates the overproduction of growth hormone, leading to the development of acromegaly.

• Excess growth hormone: The overproduction of growth hormone by the pituitary tumour results in elevated levels of insulin-like growth factor 1 (IGF-1). IGF-1 plays a crucial role in the growth and development of various tissues and organs in the body.

Acromegaly Diagnosis

Early detection and treatment for acromegaly can greatly improve outcomes for individuals. Here are the common methods used to diagnose acromegaly:

Blood Tests

The first step in diagnosing acromegaly is to measure the levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in the blood. Elevated levels of these hormones can indicate the presence of acromegaly.

Imaging Studies

To identify any possible pituitary tumours, doctors may recommend imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans. These tests can provide detailed images of the pituitary gland and help determine the size and location of any tumours.

Oral Glucose Tolerance Test (OGTT)

The OGTT is an essential test used to confirm GH overproduction. During this test, blood samples are taken before and after consuming a glucose drink to evaluate how the body responds to changes in blood sugar levels. In individuals with acromegaly, GH levels remain high even after glucose intake.

Acromegaly Treatment

The goal of treatment for acromegaly is to reduce GH levels and control symptoms to improve patients' quality of life. Several treatment options are available, including surgery, medications and radiation therapy.

Surgery

Transsphenoidal surgery is the primary treatment for acromegaly. It involves removing the pituitary tumour responsible for excess GH production. This procedure is performed through the nose or mouth, minimising scarring and reducing recovery time. Surgery often leads to a significant reduction in GH levels and alleviation of symptoms.

Medications

In cases where surgery is not feasible or unsuccessful, medications are used to control GH levels. Somatostatin analogues, such as octreotide or lanreotide, are commonly prescribed. These medications mimic the action of somatostatin, a hormone that inhibits GH secretion. Another option is growth hormone receptor antagonists (GHRA), such as pegvisomant, which block the effects of GH on target tissues.

Radiation Therapy

If surgery and medication fail to adequately control GH levels or if the tumour cannot be completely removed surgically, radiation therapy may be recommended. This treatment for acromegaly involves using high-energy X-rays or other forms of radiation to destroy or shrink the tumour cells. While radiation therapy is effective in reducing GH secretion, its effects may take several years to become apparent.

It's important to note that each treatment option has its benefits and potential side effects. The choice of treatment for acromegaly depends on various factors like tumour size, location, and individual patient needs.

Types of Acromegaly

Acromegaly can be classified into different types based on tumour size or hormone secretion patterns. Understanding the various types can help in determining the appropriate treatment for acromegaly for each individual.

Tumour Size Classification

• Microadenomas: These are small tumours measuring less than 1 centimetre in diameter. They are often detected incidentally during brain imaging for other reasons.

• Macroadenomas: These are larger tumours measuring more than 1 centimetre in diameter. Macroadenomas can cause compression of surrounding structures, leading to symptoms such as headaches and visual disturbances.

Hormone Secretion Pattern Classification

• GH-secreting adenomas: This is the most common type of acromegaly. These tumours produce excessive amounts of GH, leading to the characteristic symptoms of acromegaly.

• Prolactin-secreting adenomas: In some cases, acromegaly may be associated with concomitant prolactin secretion. This can result in symptoms related to hyperprolactinemia, such as menstrual irregularities and galactorrhea.

• Plurihormonal adenomas: Rarely, tumours may secrete multiple hormones, including GH and other pituitary hormones like prolactin or adrenocorticotropic hormone (ACTH). This can lead to a complex clinical presentation requiring tailored treatment approaches.

Complications Associated with Acromegaly

While this condition may seem uncommon, it can lead to several complications that affect various systems in the body. In this section, let's discuss some of the complications associated with acromegaly:

• Cardiovascular issues: Acromegaly can have a profound impact on the cardiovascular system, leading to an increased risk of hypertension (high blood pressure), heart disease, and an elevated risk of stroke. Excessive growth hormone can cause the walls of the blood vessels to thicken, making them less flexible and increasing the workload on the heart.

• Metabolic problems: Acromegaly can also disrupt metabolic processes in the body. It is not uncommon for individuals with acromegaly to develop diabetes or experience glucose intolerance and lipid abnormalities. These metabolic changes can have long-term effects on overall health and well-being.

• Increased risk of certain cancers: Unfortunately, acromegaly has been linked to an increased risk of certain types of cancers. Research has shown that individuals with acromegaly may have higher rates of colorectal cancer, thyroid cancer, and breast cancer compared to the general population. Individuals with acromegaly need to undergo regular screenings for these types of cancers.

• Impairment of the respiratory system: The excessive growth hormone in acromegaly can affect the respiratory system, leading to conditions such as sleep apnea. Sleep apnea is a disorder in which breathing pauses repeatedly during sleep, causing disrupted sleep patterns and potential long-term health consequences.

Risk Factors for Acromegaly

While anyone can develop acromegaly, certain risk factors may increase the likelihood of developing this condition. Let's take a closer look at some of these risk factors:

• Age: Acromegaly is commonly diagnosed in middle-aged adults, typically at an average age of 40 years. However, it can also occur in individuals of any age.

• Gender: Although acromegaly affects both men and women, studies have shown that it is slightly more prevalent in women. The reasons behind this gender difference are still being researched.

• Genetic predisposition or family history: In some cases, acromegaly may be linked to a genetic predisposition or a family history of pituitary tumours. If one has a close relative, such as a parent or sibling, who has been diagnosed with acromegaly or had a pituitary tumour, he/she may have an increased risk of developing the condition.

Prevention Strategies for Acromegaly

Acromegaly can be challenging to prevent. However, regular health check-ups and early detection can significantly improve treatment outcomes. Here are some prevention strategies for acromegaly:

• Regular health check-ups: Make it a priority to schedule routine health check-ups with the doctor. During these visits, the doctor can monitor hormone levels and perform tests to detect any abnormalities in the pituitary gland.

• Awareness of symptoms: Educate oneself about the symptoms of acromegaly, such as enlarged hands and feet, facial changes, joint pain and excessive sweating. Being aware of these signs can prompt one to seek medical attention promptly.

• Hormone level monitoring: If one has a family history of pituitary tumours or has previously been diagnosed with a pituitary condition, it is essential to regularly monitor hormone levels. This proactive approach can help detect any early hormonal imbalances.

• Treatment for pituitary tumours: Seeking immediate treatment if a person has been diagnosed with a pituitary tumour. Early intervention can prevent the tumour from growing larger and causing excess hormone production.

Frequently Asked Questions

1. How does acromegaly differ from gigantism?

While both conditions involve excessive growth hormone production, gigantism occurs during childhood or adolescence before the bones have stopped growing, leading to abnormal height and stature. Acromegaly, on the other hand, typically develops in adulthood and causes gradual enlargement of bones and tissues.

2. Can acromegaly be cured?

Although there is no cure for acromegaly, it can be effectively managed with proper treatment. The goals of treatment for acromegaly are to reduce growth hormone levels, alleviate symptoms, and prevent complications.

3. How common is acromegaly?

Acromegaly is a rare condition, affecting approximately 3 to 14 in every 100,000 people. However, due to its slow onset and nonspecific symptoms, it often goes undiagnosed or misdiagnosed.

4. What are the long-term health risks associated with acromegaly?

If left untreated or poorly controlled, acromegaly can lead to several health risks, including cardiovascular disease, diabetes mellitus, hypertension, arthritis, sleep apnea, and an increased risk of certain cancers.

5. Is acromegaly hereditary?

In most cases, acromegaly is not inherited and occurs sporadically. However, rarely it can be caused by an inherited genetic condition known as multiple endocrine neoplasia type 1 (MEN1).

6. Can acromegaly affect facial appearance?

Yes, acromegaly can affect facial appearance over time. Common facial changes include an enlarged nose, protruding jaw, thickened lips, and enlarged tongue.

7. Are there lifestyle changes that can help manage acromegaly?

While lifestyle changes alone cannot cure acromegaly, they can help manage the symptoms and improve overall well-being. Maintaining a healthy weight, eating a balanced diet, exercising regularly, managing stress, and getting enough sleep are important aspects of managing acromegaly.

8. What role does the pituitary gland play in acromegaly?

The pituitary gland is responsible for regulating the production and release of growth hormones. In acromegaly, a benign tumour called an adenoma develops in the pituitary gland, causing it to secrete excessive amounts of growth hormone.

9. Are there support groups for individuals with acromegaly?

Yes, there are support groups and online communities available for individuals living with acromegaly. These groups offer a platform for sharing experiences, providing emotional support and exchanging information.

10. Can acromegaly be detected early, and why is early detection important?

Acromegaly can be challenging to diagnose in its early stages due to its slow progression and nonspecific symptoms. However, early detection is crucial as it allows for timely intervention and treatment for acromegaly to prevent complications and improve long-term outcomes.

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