Acromegaly

Acromegaly results from chronic growth hormone excess, most commonly from a growth hormone-secreting pituitary adenoma. Elevated growth hormone stimulates insulin-like growth factor 1 (IGF-1) production, which mediates most systemic effects. The gradual onset makes early recognition difficult—family members often notice changes in appearance before the patient does. Characteristic features include progressive growth of hands and feet, coarsening of facial features with prognathism (jaw protrusion), increased nose size, lip thickening, and increased spacing between teeth. Systemic complications are severe: cardiovascular disease (hypertension, cardiomyopathy, arrhythmias) occurs in 30-60%, type 2 diabetes in 20-35%, and arthritis in 25%. Sleep apnea develops in 40-70% due to upper airway obstruction from soft tissue overgrowth. Malignancy risk is increased, particularly colon and thyroid cancer. Neurologic complications can result from mass effect of the adenoma (vision loss from optic chiasm compression, headaches). Diagnosis requires demonstration of non-suppressed growth hormone and elevated IGF-1. Without treatment, life expectancy is reduced by 10 years.