Acromegaly is a rare hormonal disorder caused by the pituitary gland producing excessive growth hormone (GH) over time. This overproduction is almost always due to a benign tumor on the pituitary gland, known as a pituitary adenoma. The condition leads to gradual enlargement and disfigurement of various body parts, along with other health complications. Surgical intervention is often the primary treatment.
Recognizing Acromegaly
The physical changes associated with acromegaly develop slowly, often over years, making early diagnosis challenging. Patients may notice their hands and feet becoming larger, requiring changes in shoe or ring sizes. Facial features also gradually alter, including an enlarged jaw and forehead, a broadened nose, and thicker lips. The skin may become thicker and oilier, and skin tags can appear.
Beyond these visible changes, acromegaly presents internal symptoms. Persistent headaches are common, and the growing pituitary tumor can press on optic nerves, leading to vision problems or loss of peripheral vision. Individuals may experience joint pain, limited joint movement, and carpal tunnel syndrome due to nerve compression. Internal organs, such as the heart, can enlarge, and sleep apnea is a common complication. Fatigue is also common, along with metabolic issues like type 2 diabetes and high blood pressure, due to excess growth hormone and insulin-like growth factor-1 (IGF-1) affecting metabolism.
Surgical Treatment
The primary treatment for acromegaly involves surgical removal of the pituitary tumor, often performed via transsphenoidal surgery. This minimally invasive technique involves accessing the pituitary gland through the nasal cavity or an incision under the upper lip, avoiding external facial incisions. The surgeon uses specialized instruments to remove the adenoma while minimizing disruption to healthy brain tissue.
The objective of transsphenoidal surgery is to resect the tumor and restore normal levels of growth hormone and IGF-1. The success of the surgery depends on several factors, including the size of the tumor and whether it has invaded surrounding structures. Smaller, well-contained tumors often have a higher chance of complete removal and hormone normalization.
Post-Surgical Outcomes
Following successful surgical intervention, patients can anticipate improvements in their symptoms and overall health. The normalization of growth hormone and IGF-1 levels is a key outcome, halting disease progression. Many physical features may show reversal or improvement, such as a reduction in hand and foot size, and a softening of facial features over time. While some long-standing physical changes may not fully disappear, their progression ceases, and improvements often occur.
Associated symptoms often improve after surgery. Headaches often lessen or resolve, and joint pain may decrease. Sleep apnea can improve or resolve, and symptoms like carpal tunnel syndrome often subside. Patients commonly report increased energy levels and improvement in their quality of life as hormone levels normalize and symptoms alleviate.
Recovery and Long-Term Management
Immediately following transsphenoidal surgery, patients usually stay in the hospital for a few days. Initial discomfort, like nasal congestion or mild headache, is common. Some patients may have nasal packing to manage bleeding. Potential short-term complications include a cerebrospinal fluid (CSF) leak or temporary diabetes insipidus, a condition affecting water balance.
Long-term management of acromegaly involves ongoing monitoring to ensure hormone levels remain normal and detect tumor recurrence. Regular follow-up appointments with an endocrinologist are necessary, including blood tests to measure growth hormone and IGF-1 levels. If surgery does not achieve a cure or if the tumor recurs, additional treatments such as medication or radiation therapy may be considered. Managing residual hormonal deficiencies, such as those affecting thyroid function or cortisol production, is also important for continued care.