What Is Acromegaly? What Are Its Symptoms?

If you've noticed that your long-worn ring is gradually tightening on your finger, your shoe size keeps increasing, your watch is becoming too snug for your wrist, be warned! If this picture is accompanied by joint pain, excessive sweating, coarsening of facial features, numbness and weakness in the hands, treatment success is quite high and you may be facing a rare disease known as acromegaly. Acromegaly is a disease that manifests itself through enlargement of the hands and feet and coarsening of facial features, resulting from excessive amounts of growth hormone in the body. It occurs in 3 to 14 people per 100,000 worldwide, but its frequency in our country is still not known with certainty.

Prof. Dr. Sema Yarman, Specialist in Endocrinology and Metabolic Diseases at Acıbadem Maslak Hospital, provided the following comments on the subject:

"Acromegaly, which can rarely have genetic transmission, is most commonly caused by a benign, non-cancerous tumor originating from growth hormone-secreting cells of the pituitary gland. Excessive growth hormone secreted from this tumor can lead to diabetes, high blood pressure, heart failure, sleep-apnea syndrome, joint pain, numbness and weakness in the hands, polyps in the colon, thyroid tumors and many other rarer tumor formations."

Enlargement of the hands and feet due to soft tissue increase is the earliest sign detected

Acromegaly has many symptoms. Among the earliest signs detected is "enlargement of the hands and feet due to soft tissue increase." Other symptoms include prominent forward projection of the eyebrow ridges, coarsening of facial features such as forward projection of the lower jaw, separation of the teeth, fullness of the lips, enlargement of the nose and tongue, numbness and weakness in the hands, skin thickening and increased oiliness, excessive sweating, galactorrhea and joint pain. If the tumor grows and exerts pressure on surrounding tissues, it can cause headaches; if it presses on the optic nerve, it can cause visual impairment. If the tumor grows very large and exerts pressure on the healthy hormone-secreting cells of the pituitary gland, it can lead to conditions such as fatigue and malaise due to these hormone deficiencies, infertility, irregular menstruation, decreased sexual function and lack of interest in men.  

Can be discovered by chance

Easily observable growth symptoms have implications for the patient's daily life. For example, the patient's ring size and shoe size gradually increase, watches they have worn for years become tight on their wrist, their helmet becomes too small for their head, dentures are frequently replaced because they become tight, and snoring and nasal congestion continue despite surgery. Endocrinologist Prof. Dr. Sema Yarman explained how patients decide to seek medical attention beyond these symptoms: "The patient may notice this problem when an acquaintance they haven't seen in a long time tells them they have changed and become much larger. In this case, it can help if the patient compares their current photos with those from 7-8 years ago. Sometimes, after hearing from an acromegaly patient they happen to encounter, they may suspect they also have this disease. Or they may learn that there are people in their family who similarly became larger over time and underwent brain surgery."  

Diagnosis can be made easily

Acromegaly, which is more common between the ages of 30 and 50, presents clinical findings that vary from patient to patient, and because it develops very slowly, the disease may go unnoticed for years. However, if typical features are present, diagnosis can be made easily by an endocrinologist. After examination, certain hormonal tests are performed, starting with growth hormone levels, and pituitary MRI imaging is used to visualize the tumor.  

Quality of life improves with treatment

Both the quality of life and life expectancy of acromegaly patients, whose treatment process is usually successful, return to normal as in healthy individuals. The first step in treatment is removal of the tumor found by an experienced neurosurgeon through the nose via transsphenoidal surgery. Prof. Dr. Sema Yarman, Specialist in Endocrinology and Metabolic Diseases, noted that the success of surgery depends on the size of the tumor and the neurosurgeon's experience, and continued: "Generally, removal of small tumors is more successful than larger ones. In large tumors, surgery is quite effective in relieving headaches and eliminating visual disturbances. However, in very large tumors where complete removal is not possible, additional treatments such as medication or radiation may be required after surgery." Often, within the first few days after surgery, the patient feels facial thinning and reduction in hand and foot size due to soft tissue regression. Treatment aims to achieve hormonal control to prevent disease activity and thus improve other accompanying conditions. The endocrinologist experienced in this field determines the most appropriate treatment method for the patient.  

A healthy pregnancy is possible

"As long as tumor cells secreting reproductive hormones do not prevent hormone secretion, the patient can have children. There are also patients who had children after surgery. However, surgery or radiation therapy may reduce the chance of having children. Although there are changes in growth hormone levels during pregnancy, generally a normal pregnancy and healthy delivery occur," she stated.