Acromegaly history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

History and Symptoms

Mandibular overgrowth leads to prognathism, maxillary widening, teeth separation and jaw malocclusion.

Features that result from high level of hGH or expanding tumor include:

• Soft tissue swelling of the hands and feet
• Brow and lower jaw protrusion
• Enlarging hands
• Enlarging feet
• Arthritis and carpal tunnel syndrome
• Teeth spacing increase
• Macroglossia [enlarged tongue]
• Heart failure
• Kidney failure
• Compression of the optic chiasm leading to loss of vision in the outer visual fields (typically bitemporal hemianopia)
• Headache
• Diabetes mellitus
• Hypertension
• Enlarging heart
• Increased palmar sweating and sebum production over the face (seborrhea) are clinical indicators of active growth hormone (GH) producing pituitary tumours. These symptoms can also be used to monitor the activity of the tumour after surgery although biochemical monitoring is confirmatory.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

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  Facial changes secondary to elevated growth hormone levels. Note in particular prominent supra-orbital ridge, jaw, and generally enlarged facial features.

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  Markedly enlarged hand resulting from excess growth hormone. For reference purposes, the comparison hand is size 6 1/2.

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  Facial changes secondary to elevated growth hormone levels. Note in particular prominent supra-orbital ridge, jaw, and generally enlarged facial features.

Facial aspect of a patient with acromegaly. The nose is widened and thickened, the cheekbones are obvious, the forehead bulges, the lips are thick and the facial lines are marked. The forehead and overlying skin is thickened, sometimes leading to frontal bossing.

As compared with the hand of a typical person (left), the hand of a patient with acromegaly (right) is enlarged, the fingers are widened, thickened and stubby, and the soft tissue is thickened.

Pituitary gigantism in children

This condition of growth hormone excess is rare in children and is referred to as pituitary gigantism, because the excessive growth hormone produces excessive growth of bones and the child can achieve excessive height. As an affected child becomes an adult, many of the adult problems can gradually develop. The distinction between gigantism (occurring in children) and acromegaly (occurring in adults) can be made by the occurrence of the adenoma in relation to the closure of the epiphyses. If elevated growth hormone levels occur before the closure of the epiphyses (i.e. in prepubertal children), then gigantism ensues. If it occurs after the closure of the epiphyses (i.e., in adults) then acromegaly ensues.