The underdiagnosed Acromegaly!
Acromegaly is a rare non-cancerous tumor (Adenoma) disorder where the pituitary gland produces too much growth hormone, causing body tissues and bones to grow. It can affect people at any age but usually, it diagnosed in adults that range from 30 to 50 years old. In case the same condition was diagnosed at any age below 18, it is called gigantism.
In rare cases, acromegaly is caused by a tumor in another part of the body, such as the lungs, pancreas, or another part of the brain and it is known as neuroendocrine tumors (NETs)
Several cases may be misdiagnosed due to the insidious nature of the disease and lack of awareness.
Acromegaly has the following symptoms:
- Abnormally enlarged hands and feet
- Prominent and large facial features.
- Enlarged tongue
- Thick, coarse, and oily skin
- Sweating
- Voice deepening as a result of enlarged sinuses and vocal cords
- Joints pain
- Tiredness and weakness
- Headaches as a result of the tumor pressing on nearby tissues
- Blurred or reduced vision as a result of the tumor pressing on nearby tissues
- loss of sex drive
- Carpel tunnel syndrome
- Abnormal periods in women
- Erection problems in men
In case acromegaly was not treated well there is a high risk of developing:
- Heart disease
- Hypertension
- Type 2 diabetes
- Disease of the heart muscle (cardiomyopathy)
- Arthritis
- Bowel polyps that may develop further to bowel cancer
Several factors impact the treating physician decision including the size of the adenoma whether it is micro or macroadenoma, the patient status and availability of medication, and skilled surgeons.
Transsphenoidal surgery is used to remove the tumor. The surgery is done through the sphenoid sinus, hollow space in the skull behind the nasal passages, and below the brain. Sometimes patients are advised to take somatostatin analogues before the surgery to reduce the tumor size and soften the tissue. In other cases, the treating physician may start the intramuscular or subcutaneous somatostatin analogues directly like Octreotide and Lanreotide. In 2020, the FDA approved the first oral Octreotide dosage form for Acromegaly, which is considered as a breakthrough for acromegaly patients.
Despite being a rare disease, several cases are still misdiagnosed.
