Dear Dr. Roach: In the past year and a half, I have experienced several changes in my health. My hands and feet are increasing in size. I am lightheaded, fainting on occasion.
I am gaining weight. My hormone levels are falling outside the normal ranges. After numerous blood tests, MRIs and CT scans, my endocrinologist has diagnosed me with a condition called acromegaly due to a non-cancerous growth on my pituitary gland.
He is recommending surgery to remove the tumour, with medications to follow if the surgery is not totally successful.
Can you give me any additional information on this condition and any recommendations for treatment?
L.B.
Your endocrinologist has gotten everything exactly right.
Acromegaly is caused by excess amounts of human growth hormone, normally made by the pituitary gland, and most commonly caused by a benign tumour of that gland. Diagnosis is made by laboratory testing and is confirmed by the MRI.
It affects many systems of the body, some of which you鈥檝e already noticed. Bones try to grow, but in adults, the growth plate is fused, so the only bones that can grow are in the skull and face, with prominent jaw and cheekbones, especially if 鈥� as is often the case 鈥� diagnosis is not immediate.
Changes in the cartilage and joints make the hands and feet swollen, and fractures are common. Vitamin D deficiency is also common.
Weight gain puts people with acromegaly at high risk for diabetes and sleep apnea, and these need to be looked for. Sex hormones are usually decreased in both men and women, and this also may need treatment.
Colon polyps are more likely, and a colonoscopy is recommended at diagnosis.
You mentioned lightheadedness, which can be caused by the hormonal changes, but also by several kinds of heart abnormalities that can accompany acromegaly.
An echocardiogram is likely to be recommended by your physicians.
Treatment of the tumour can be with medicines or surgery. The decision of which is best is complicated and requires more extensive knowledge about your specific situation.
Most often, I do see surgery as first-line treatment, with medicines and sometimes radiation used if the surgery isn鈥檛 completely successful, just as your endocrinologist suggests. Many of the complications I mention above get better once treatment starts, and the sooner, the better for most of them.
I found several support groups for acromegaly, including a very helpful website at acromegalycommunity.com.
