however, IGF-1 (made mostly in the liver) is released more evenly than GH, and
IGF-1 levels remain higher longer. When both of these levels are elevated together,
they can also cause many of the signs and symptoms of acromegaly.
Somatostatin - One of the main effects of somatostatin is its ability to control
the amount of GH in the body. Researchers have taken advantage of this knowledge
in developing treatments for acromegaly.
GH is produced by the pituitary. IGF-1 is produced primarily by the liver in
response to GH. Somatostatin is produced by the hypothalamus, a part of the
brain that influences the pituitary.
Possible Signs and Symptoms of Acromegaly
Symptoms caused by the tumor:
Headaches
Visual problems
Symptoms caused by GH oversecretion:
Hypertension (high blood pressure) or other heart-related problems
Diabetes
Sleep apnea
Excessive sweating
Joint pains
Enlargement of hands and feet
Swelling of soft tissue
Other signs and symptoms of acromegaly:
Carpal tunnel syndrome
Skin tags
Menstrual cycle disturbances/impotence
Goiter (enlargement of the thyroid gland)
Sinus congestion
Skin changes, including thickening, oiliness, acne
Coarsening of facial features, including forehead, nose, lips, tongue, jaw.
Diagnosing and Monitoring Acromegaly
Several tests are useful in diagnosing and monitoring acromegaly. The most
important are laboratory tests that measure the levels of growth hormone (GH)
in the blood. Because these levels vary naturally depending on factors such as
your age, the time of day, and when you last ate, there are two main approaches
to measuring your GH.
Random GH testing. To compensate for the variation in levels, your doctor may
average the values from a series of "random" blood tests.
Oral glucose tolerance test (OGTT). Alternatively, a way to get an accurate
reading in a single measurement is to take the blood sample after you do an
overnight fast, followed by an early morning drink of concentrated glucose solution.
Additionally, insulin-like growth factor-1 (IGF-1) levels can be measured, as
acromegaly in the absence of elevated IGF-1 levels is rare. These levels vary
by age and gender and need to be adjusted accordingly. The test for IGF-1 levels
is a blood test.
Blood test for IGF-1 levels. Because IGF-1 is released more evenly than GH, and
these levels remain higher longer, IGF-1 levels can be taken at any time, with a
blood test.
Normal GH Levels
Normal GH levels vary, depending on when the measurement is taken:
After an OGTT, GH levels should be
<1 ng/mL.
Without an OGTT, an average level of <2.5 ng/mL from multiple random samples is
considered normal.
Normal IGF-1 Levels
Normal IGF-1 levels depend on your age and gender, and the reference numbers may
vary slightly depending on which laboratory provides the results.
Levels of GH and IGF-1 are often measured in ng/mL, which stands for nanograms
per milliliter. The reference numbers can be slightly different depending on the
assays used for testing and on the laboratory your healthcare professional uses.
Please talk to your healthcare professional about your test results and what they
mean for you.
Tests for Acromegaly Diagnosis
After acromegaly has been diagnosed, other tests, such as head scans with magnetic
resonance imaging (MRI) or computed tomography (CT), are designed to look for a
pituitary growth or tumor, the most likely source of the excessive GH secretion.
Normally, these tests are performed on an outpatient basis inside a hospital or
clinic and involve no special preparation on your part. Head scans are a way to
provide your healthcare provider with "photographs" of the inside of your head.
Additional Tests for Acromegaly Diagnosis
Still other tests, such as an electrocardiogram (ECG), chest X-ray, eye and visual
field examination will help your doctor check your overall health. These tests
also usually do not require hospitalization and are performed by healthcare
specialists in different fields. These specialists and/or technicians will send
all test results directly to your healthcare provider. Your healthcare professional
will then provide you with your test results, as well as specific information
regarding your current levels of GH and IGF-1. It's important to understand the
results of all of your tests and learn your GH and IGF-1 levels so that you can
become a more knowledgeable patient.
KNOW YOUR TREATMENT OPTIONS
When treating acromegaly, your healthcare professional is most concerned with
managing the disease to preserve your overall health.
Surgery – The goal of surgical treatment for acromegaly is to remove the pituitary
tumor, reducing the associated symptoms such as headache, and normalize GH and
IGF-1 levels. This type of surgery is called transsphenoidal. With this type of
procedure, the surgeon reaches the pituitary through the nose (transnasal) or
through an incision in the upper lip (translabial) and is able to remove the
tumor, relieving pressure and immediately reducing GH levels.
Medical Therapy – There are different medical treatments used to treat acromegaly.
Your doctor can tell you about how each of them works.
Radiation Therapy – Radiation is most commonly used as adjuvant therapy (following
surgery) in those cases where some tumor is still present and medications are not
working. The full effect of this therapy may not occur for many years.
Everyone responds to treatment differently, so you and your healthcare professional
should work together to determine which treatment option or combination of
approaches is right for you.
ADAPTING TO LIFE WITH ACROMEGALY
Acromegaly affects not only your physical body, but it may also impact your
self-image and emotional well-being. It's useful to acknowledge the impact that
acromegaly has on your life.
This page highlights the emotional impact of living with a chronic disease, and
suggests how you can adapt to living with acromegaly. Topics covered include:
Responding to the Diagnosis
Dealing with Setbacks
Giving Back
Responding to the Diagnosis
A diagnosis of acromegaly is a serious event. However, for many people, it may
actually come as a relief; having lived for a long time with the symptoms, you
finally have an explanation for what's been causing them.
In general, people who have been diagnosed with a chronic illness respond in one
of three ways: resignation, denial, or adaptation.
Resignation. Resigning yourself to having an illness is part of the process of
coming to terms with your diagnosis and admitting that you have to adapt your life.
Resignation isn't the same as acceptance, as it can be somewhat dispiriting,
especially in the beginning, but it is a start towards dealing with the situation
and finding a sense of emotional well-being. It's normal to feel a certain amount
of helplessness when we're confronted by difficult facts. But by acknowledging
these feelings, and understanding that they're natural, you can begin to move
from resignation towards true acceptance.
Denial. Some people react to illness by refusing to acknowledge that anything is
wrong. Denial is usually based on fear or anger, and these are emotions that can
be especially difficult or feel inappropriate to express. To overcome the emotions
behind denial, many people find that connecting with others who have acromegaly,
or another chronic illness, can be of immense value. It's important to understand
that these feelings are natural. By expressing them in a supportive environment,
you gain energy, humor, and a sense of peace. Even if you don't have access to a
support group, simply recognizing that it is normal to have unpleasant feelings
can help make you feel better.
Adaptation. As you are able to recognize and deal with your disease and the impact
it has on your life, you can move toward a healthier emotional state. Instead of
"surrendering" to your disease, you can take an active role in managing it.
Adaptation is a process, but the reward is a sense of living more fully, and the
possibility that, by taking charge of your emotional life, you may have more
energy to do the things that may help improve your symptoms and prognosis.
