What are the symptoms and problems of acromegaly?
Acromegaly literally means 'enlarged extremities' or 'enlarged hands and feet'. This is a typical feature, but there are many other symptoms. The symptoms develop gradually. Some people have symptoms which develop over 10-15 years before the diagnosis is made.
It is useful to divide the symptoms into two types: those caused by too much growth hormone, and those caused by the enlarging tumour (adenoma) in the pituitary.
Symptoms caused by too much growth hormone
The excess of growth hormone in your bloodstream can affect various tissues in your body which can make them 'thicken' or 'grow'. So, over time one or more of the following may develop:
- Hands and feet become larger and broader. Your glove and shoe size may increase over the years. You may not be able to get a wedding ring off.
- The skin may thicken (particularly on the face) and become more greasy and sweaty.
- Changes to the face which may include: thickened lips and nose, thickening of the scalp, the jaw becoming more prominent. As the changes develop slowly, they may not be recognised by family or friends. However, looking back at old photographs may suggest your facial appearance has 'thickened' or changed.
- The vocal cords thicken which may cause your voice to deepen.
- Your tongue may enlarge so you may often 'bite your tongue'.
- Thickening of cartilage may cause arthritis in various joints.
- Thickening of the nasal passages can make you snore loudly and may cause obstruction in airflow when you are asleep (sleep apnoea). This can make you have a poor nights sleep with daytime drowsiness.
- 'Carpel tunnel syndrome'. This is where a nerve going through the wrist is squashed by thickened tissue. It can cause pain, tingling and weakness in parts of the hands.
Other effects of too much growth hormone include
- General tiredness and some muscle weakness.
- About 1 in 5 people with acromegaly also develop diabetes as growth hormone counters the effects of insulin.
- High blood pressure develops in about 1 in 3 cases.
- Increase risk of heart disease and stroke. This is probably because of the increase risk of developing high blood pressure and diabetes.
- People with acromegaly have an increased chance of developing polyps (small benign growths) in the bowel and an increased chance of developing bowel cancer. For example, in one study people with acromegaly were routinely checked for bowel problems. In this study it was found that about 1 in 4 people with acromegaly had a benign bowel polyp and about 1 in 20 had bowel cancer (before it had caused any symptoms). People with acromegaly are now routinely screened for these conditions (see below).
Also, in about 1 in 3 cases, the adenoma also makes too much of another hormone called prolactin. This can cause sexual and menstrual problems, and a milky discharge from the nipple. Many men with acromegaly also develop erectile dysfunction (impotence).
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