Acromegaly

Acromegaly is a rare hormonal disease caused by excess growth hormone (GH), in over 95% of cases from a benign tumour (adenoma) of the pituitary gland. GH drives the liver to make IGF-1, and it is the sustained high IGF-1 that produces the effects. In adults — after the growth plates have fused — the changes are not height but thickening: gradual enlargement of the hands and feet (rings and shoes stop fitting), coarsening of facial features, a larger jaw and spacing of the teeth, and enlargement of internal organs. Because it evolves over many years, it is frequently diagnosed a decade after it begins, often when a photograph comparison or a complication draws attention. Untreated it raises the risk of diabetes, high blood pressure, heart disease, sleep apnoea and certain cancers, so recognising it matters.

• IGF-1 — the primary screening test; a single raised, age-matched IGF-1 is a reliable signal because it does not swing like GH.
• Growth hormone during an oral glucose tolerance test — the confirmatory test; in acromegaly GH fails to suppress after glucose.
• Fasting glucose / HbA1c — often raised; GH opposes insulin.
• Prolactin — some pituitary tumours co-secrete it.
• Pituitary MRI — locates and sizes the adenoma once biochemistry confirms.
• Other pituitary hormones — checked because a large tumour can compress the gland.

• Gradually enlarging hands and feet — rings, gloves and shoes no longer fit
• Coarsening facial features, larger jaw, gaps opening between teeth
• Deepening voice, enlarging tongue
• Excessive sweating and oily skin
• Joint pain
• Headaches and, if the tumour presses on the optic nerves, visual field loss
• Carpal tunnel syndrome, numbness in the hands
• Snoring / sleep apnoea
• New diabetes or high blood pressure