Common Causes And Risk Factors Of Acromegaly

Acromegaly is a disorder involving the hormones where an individual's pituitary gland makes an excessive amount of growth hormone during their adulthood years. Patients who have acromegaly often present with enlarged feet, enlarged hands, enlarged and coarsened facial features, oily and thickened skin, excessive sweating, excessive body odor, skin tags, muscle weakness, deepened voice, snoring, impaired vision, enlarged tongue, joint pain, enlarged organs, and headaches. An acromegaly diagnosis is made with the help of blood GH and IGF-I measurement tests, growth hormone suppression test, and MRI scans. Treatment for acromegaly aims to decrease a patient's production of growth hormone and reducing the adverse effects of any tumor that may be affecting the pituitary gland and its neighboring tissues. Treatment methods include pituitary tumor excision surgery, medications, and radiation therapy.

There are several risk factors and causes of acromegaly. Get familiar with some of them now.

Too Much Growth Hormone

An individual who has too much growth hormone in their body is at a higher risk of developing acromegaly than someone who has normal amounts of growth hormone. The growth hormone in an individual's blood is a signal to their liver that tells it to produce a hormone called insulin-like growth factor-I or IGF-I. When there is an excess of growth hormone in the blood, it results in the excessive production of IGF-I. IGF-I causes the stimulation of growth in an individual's bones and other types of tissues. Excessive amounts of IGF-l can cause abnormal skeletal and soft tissue growth, which can result in the development of gigantism or acromegaly. Too much growth hormone that causes acromegaly is mostly seen in middle-aged adults. An excessive amount of growth hormone in the body due to any mechanism can have long-lasting effects that may even cause premature death. The most serious complications that occur as a result of too much growth hormone include high blood pressure, arthritis, type 2 diabetes, and an increased risk of cardiovascular disease.

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Pituitary Adenoma

Over ninety-five percent of all individuals who develop acromegaly have a benign tumor in their pituitary gland that secretes an excessive amount of growth hormone. The majority of pituitary adenomas are considered macro-adenomas, which are tumors larger than one centimeter. A pituitary adenoma may secrete too much of other pituitary hormones in addition to the excessive amounts of growth hormone. The amount of hormones produced depends on the size of a patient's pituitary adenoma and how quickly it grows. Most individuals who develop pituitary adenomas do not develop them due to a genetically inherited factor, but spontaneously instead. Around seventeen percent of the population is affected by a pituitary adenoma, even though most are small and do not produce symptoms. Pituitary adenomas that do end up causing acromegaly by producing a problematic quantity of growth hormone take years to develop, so a patient has the tumor long before they realize it. An MRI scan of a patient's brain can help determine the size of their pituitary adenoma, and a CT scan may be used for those who are unable to have an MRI.

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Other Tumors

While most cases of acromegaly are caused by an adenoma in the pituitary gland, some rare cases are the result of a tumor that develops in another tissue. These other tumors may develop in a different part of the brain, pancreas, and lungs. Excess amounts of growth hormone can occur if these other tumors produce growth hormone directly, or when they produce a different hormone referred to as growth hormone-releasing hormone that tells the pituitary gland to produce more growth hormone. Individuals affected by a non-pituitary tumor that makes growth hormone-releasing hormone may have an enlarged pituitary gland that is visible on imaging tests because the gland is working in overdrive. The enlargement of the pituitary gland and the various possible origination points of a tumor that secretes growth hormone-releasing hormone can make it challenging for physicians to identify this tumor as the problem. However, once the growth hormone-releasing tumor is located and surgically removed, the acromegaly symptoms should subside.

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Middle Age

Middle-aged individuals are at a higher risk of developing acromegaly than those in other age groups. The most specific reason for the existence of this risk factor is that any form of increased growth hormone production in the body that occurs in an individual who is seventeen years old or younger is referred to as a different disease called gigantism. It is called gigantism because an excess amount of growth hormone in the body of an individual in this age group has different effects than it does on the body of an individual who is fully grown and developed. The average age of a male when they are diagnosed with acromegaly is forty years old. The average age of females who are diagnosed with acromegaly is forty-five old. There is a long delay in the time between when subtle symptoms manifest and when an individual gets diagnosed with acromegaly. On average, symptoms are present in a patient for a minimum of between four and fifteen years at the time of diagnosis. The mean amount of time between when symptoms start and when an individual is diagnosed with acromegaly is 8.7 years. The risk factor of being a middle-aged adult should be considered in context because only three to four new cases of acromegaly per every one million individuals are diagnosed annually.

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History Of Pituitary Tumors

An individual who has a personal or familial history of pituitary tumors is at a greater risk of developing acromegaly than those who do not. The development of a tumor in the pituitary gland is influenced by a blend of epigenetic, environmental, tumor microenvironment, and genetic factors. An individual who has a familial genetic disease characterized by the development of endocrine tumors would be a good example of someone at a higher risk of developing acromegaly. Genetic mutations that occur on the AIP, MEN1, MEN4, CDKN1B, PRKAR1A, SDHx, GPR101, and GNAS genes are associated with an increased risk of developing acromegaly. A personal history of pituitary tumors or other endocrine tumors indicates a genetic mutation that lowers the effectiveness of tumor suppressor genes. These mutations can occur spontaneously without any inheritance, or they can be passed down from an individual's parents. A personal history of other forms of pituitary adenomas can cause an individual to be at higher risk of developing acromegaly. Studies have shown preexisting prolactinomas have a positive correlation with the development of growth hormone-producing adenomas.