Acromegaly is characterized by enlarged feet, hands, and face as well as ears, lips, tongue, nose, skin, and internal organs. The most common cause of acromegaly is a benign pituitary adenoma. This can arise sporadically, through genetic mutation, or in familial association with multiple endocrine neoplasia type 1, McCune-Albright syndrome, and Carney complex.
Gigantism, on the contrary, is found in children with hyperpituitarism prior to completing ossification of the growth plates. Its onset is rapid and quickly recognized due to the growth of long bones and conspicuously enlarging stature.
Acromegaly can progress slowly over a period of years to decades, going unrecognized until multiple organ complications become evident at the average age of 40. Among these serious complications are hypertension, cardiovascular disorders, type 2 diabetes, and arthritis.
The common signs and symptoms of acromegaly include enlarged hands and feet. Especially prominent are changed facial features (widening spaces between teeth, enlarging lips, jaw, brow, tongue, and nose) and skin overgrowth (thickened skin). Headaches, profuse sweating, and sleep apnea are common.
The effects caused by excessive GH include a wide array of clinical findings.
- Skin and soft tissue changes can include oily, course skin, enlarged pores, acrochordons (skin tags), hyperpigmentation, doughy skin with deepened forehead creases, and thickened nails and eyelids.
- Cardiovascular effects include hypertension, cardiomyopathy, arrhythmias, left ventricular hypertrophy, and other cerebrovascular and respiratory events.
- Joint and bone effects can include joint aches or pain, limited joint mobility, and progress to arthritis.
- Enlarged organs may include the thyroid, spleen, kidneys, liver, colon, and heart. Patients may be likely to develop recurring colonic polyps.
- Metabolism and other hormones can be affected. Pituitary dysfunction can cause an imbalance in glucose and lipid metabolism. Other hormonal manifestations include excessive sweating (apocrine and eccrine) and body odor. There may be interruption of the menstrual cycle, virilization, hirsutism, ovarian cysts, multiple uterine leiomyomas, breast discharge, and infertility in women. Approximately half of acromegaly patients have hypogonadism, which can lead to erectile dysfunction in men and decreased libido. The presence of hypercalciuria, urolithiasis, and hyperphosphatemia also affects bone metabolism, and around 30% of patients have vertebral fractures at presentation.
- Enlarged vocal cords and sinuses cause voice deepening and can contribute to airway obstruction during sleep, including the onset of heavy snoring.
