Presentation
(See Presentation .) Growth hormone and insulinlike growth factor GH is necessary for normal linear growth. [emedicine.medscape.com]
Raynaud's disease is present in one-third of cases. [ncbi.nlm.nih.gov]
Entire Body System
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Physician
The Pituitary Patient Resource Guide a one of a kind publication intended as an invaluable source of information not only for patients but also their families, physicians, and all health care providers. [pituitary.org]
Santiago A Centurion, MD Staff Physician, Department of Dermatology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey Santiago A Centurion, MD is a member of the following medical societies: American Academy of Dermatology [emedicine.medscape.com]
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Galactorrhea
[…] and pedunculated fibromas (ie, skin tags) Hypertrichosis Oily skin (acne is not common) Hyperpigmentation (40% of patients) Acanthosis nigricans (a small percentage of patients) Excessive eccrine and apocrine sweating Breast tissue becoming atrophic; galactorrhea [emedicine.medscape.com]
Cardiovascular
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Hypertension
widely spaced teeth, bone proliferation in extremities, soft tissue thickening, hyperhidrosis, macroglossia, headache, amenorrhoea, impotence, somnolence, moodiness, glucose intolerance, cardiomegaly with heart failure (acromegalic heart disease), hypertension [medical-dictionary.thefreedictionary.com]
Insulin resistance and diabetes may also play a role in the onset of hypertension [ 20, 21 ]. Sleep apnea syndrome is likely to contribute also to the pathogenesis of hypertension. [ncbi.nlm.nih.gov]
Efficacy of 12-month treatment with the GH receptor antagonist pegvisomant in patients with acromegaly resistant to long-term, high-dose somatostatin analog treatment: effect on IGF-I levels, tumor mass, hypertension and glucose tolerance. [medigraphic.com]
[…] necessarily correct the disorder Cardiovascular complications A study by Berg et al found an increased prevalence of cardiovascular risk factors in patients with acromegaly compared with controls. [1] Cardiovascular complications include the following: Hypertension [emedicine.medscape.com]
Skin
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Hypertrichosis
Enlargement of the lower lip and nose (the nose takes on a triangular configuration) Wide spacing of the teeth and prognathism Cutis verticis gyrata (ie, furrows resembling gyri of the scalp) [6] Small sessile and pedunculated fibromas (ie, skin tags) Hypertrichosis [emedicine.medscape.com]
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Skin Thickening
Skin thickening is due to glycosaminoglycan deposition and to increased collagen production by connective tissue. Skin tags are frequent and may be a marker of colonic polyps. Raynaud's disease is present in one-third of cases. [ncbi.nlm.nih.gov]
Musculoskeletal
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Arthralgia
The arthralgia is mainly mechanical, degenerative, non-inflammatory in origin but features of osteoarthritis may develop in some patients. Joint mobility (especially of the shoulders) can be limited in the later stages of the disease. [ncbi.nlm.nih.gov]
Urogenital
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Amenorrhea
A gonadotrope deficiency will cause sexual dysfunction and decreased plasma testosterone levels in men, and menstrual disorders in women (amenorrhea in some cases) together with a decline in estradiol levels (without rise in gonadotrophin levels). [ncbi.nlm.nih.gov]
Workup
(See Presentation and Workup .) Robert Wadlow, 19 years of age, with his father (postcard photo prior to 1937). Courtesy of Wikimedia Commons (). [emedicine.medscape.com]
Treatment
Effect of different dopaminergic agents in the treatment of acromegaly. J Clin Endocrinol Metab 1997;82:518-23. Abs R, Verhelst J, Maiter D, et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. [medigraphic.com]
Currently, if surgical treatment fails to cure acromegaly, medical treatment with somatostatin analogs is recommended rather than radiotherapy. [ncbi.nlm.nih.gov]
(See Prognosis, Treatment, and Medication .) [emedicine.medscape.com]
It contains information on symptoms, proper testing, how to get a diagnosis, and the treatment options that are available. It also includes Pituitary Network Association's patient resource listings for expert medical care. [pituitary.org]
Prognosis
(See Prognosis, Treatment, and Medication .) [emedicine.medscape.com]
High GH/IGF-I concentrations, arterial hypertension, and cardiomyopathy are factors in a poor prognosis, while the duration of symptoms and other factors (diabetes, lipid disorders and cancer) are less important [ 30 ]. [ncbi.nlm.nih.gov]
Etiology
(See Pathophysiology and Etiology .) GH acts indirectly, by stimulating the formation of IGF hormones (also called somatomedins). [emedicine.medscape.com]
Etiology [ 34, 35 ] Acromegaly of pituitary origin More than 95% of patients with acromegaly have a benign monoclonal pituitary adenoma which develops from the somatotrope cells that normally produce GH in the pituitary. [ncbi.nlm.nih.gov]
Epidemiology
Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry. European Journal of Endocrinology 2004;151:439-46. Philippe C and Sylvie S. Acromegaly Orphanet. [medigraphic.com]
Systemic complications of acromegaly: epidemiology, pathogenesis, and management. [ncbi.nlm.nih.gov]
Epidemiology Gigantism is extremely rare, with approximately 100 reported cases to date. [emedicine.medscape.com]
Pathophysiology
(See Pathophysiology and Etiology .) GH acts indirectly, by stimulating the formation of IGF hormones (also called somatomedins). [emedicine.medscape.com]
Prevention
Author Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public [emedicine.medscape.com]
Treatment is aimed at correcting (or preventing) tumor compression by excising the disease-causing lesion, and at reducing GH and IGF-I levels to normal values. Transsphenoidal surgery is often the first-line treatment. [ncbi.nlm.nih.gov]