Acromegaly is a disorder that occurs when high levels of growth hormone make bones and soft tissues grow excessively. The disorder usually is caused by a pituitary adenoma, which is a tumor in the pituitary gland. The pituitary gland is located at the base of the skull and produces many hormones.
The preferred surgical treatment at UPMC for acromegaly is the Endoscopic Endonasal Approach (EEA) to remove the pituitary tumor. This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time.
Symptoms of acromegaly usually develop over time, and the condition is not typically diagnosed for years. The average age for people to be diagnosed is around 40 or 45.
Your doctor will ask you about your symptoms and medical history, and will perform a physical exam.
Symptoms may include:
- large growth in the hands and feet (rings or shoes may no longer fit)
- severe acne and thickening skin
- deepening voice
- protrusion of forehead and jaw
- excessive sweating
- fatigue
Complications may include:
- sleep apnea
- diabetes
- high blood pressure
- heart disease
- irregular menstrual cycles (in women)
- erectile dysfunction (in men)
To make the diagnosis, your doctor will order blood and imaging tests.
Lab and Imaging Tests
Blood tests will measure the hormones that are produced by the pituitary gland, such as growth hormone (GH), insulin-like growth factor (IGF-I), and other pituitary hormones.
You also may have a glucose tolerance test to see if the level of growth hormone drops. This hormone will not drop in patients with acromegaly.
Your doctor may want you to receive an MRI or CT scan of your head. The scan will look for a tumor in your pituitary gland.
Goals of treatment include:
- removing or reducing the size of the pituitary tumor
- reducing the production of growth hormone so that it is at a normal level
- stopping and reversing the symptoms caused by the excess growth hormone
- correcting other abnormalities to the thyroid, adrenal, and sex organs
If not treated, acromegaly can cause serious complications and may be fatal.
Surgery
For most cases of acromegaly, the best treatment is to remove the pituitary adenoma (tumor) that is causing the excessive growth hormone. At UPMC, the preferred method for this surgery is the Endoscopic Endonasal Approach (EEA). This approach allows surgeons to see the pituitary gland well without making an open incision. The pituitary tumor is removed through the nose and nasal cavities, and recovery time is faster than with a traditional approach. The remaining pituitary gland is explored carefully to check for other lesions, and all abnormal tissue is removed.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient's brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical and non-surgical approaches to maximize the benefits of surgery while minimizing risks.
Stereotactic Radiosurgery
Stereotactic radiosurgery (Gamma Knife, CyberKnife) uses highly focused beams of radiation to shrink the tumor. This method is used in patients whose tumors do not respond to surgery or to medication.
Medication
Medications may be used to reduce the level of growth hormone that the pituitary gland produces. You may receive medication after surgery if surgery was not curative.
