Special features

Acromegaly — clinical manifestations and diagnosis

By Anita Banerjee, MBBS, MRCP, Krishna Patel MRPharmS and Alison.M.Wren, MBBS, MRCP

Acromegaly is a clinical condition caused by the hypersecretion of growth hormone, usually as a result of a benign tumour in the pituitary gland. The first part of this special feature describes the clinical features and diagnosis of the condition

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Anita Banerjee is specialist registrar, endocrinology and diabetes mellitus
Krishna Patel is lead pharmacist, medicine, and
Alison Wren is consultant in endocrinology

all at Hammersmith Hospitals NHS Trust, London

Mehau Kulyk/SPL

Pituitary adenomas

Pituitary adenomas (seen here as the green object in the centre of the MRI image) are responsible for most cases of acromegaly

SUMMARY

Acromegaly is a condition caused by persistent hypersecretion of growth hormone (GH) and hence increased insulin-like growth factor-1 (IGF-1) secretion in adults.

The term acromegaly is derived from the Greek words akron (meaning extremity) and megas (meaning great), reflecting one of the most common symptoms of the disease, which is abnormal growth of the hands and feet.

The disease was first described in 1886 by the French neurologist Pierre Marie and his assistant, Souza-Leite. From autopsy studies Dr Marie postulated an association between the pituitary gland and the enlargement of interior organs, known as organomegaly. However, it was not until Harvey Cushing introduced the concept of hypersecretion of some type of substance from the pituitary gland being responsible for acromegaly that this idea was accepted. In 1909 Dr Cushing reported that partial removal of the pituitary gland (hypophysectomy) caused remission of the clinical symptoms of acromegaly, thereby providing further evidence for his hypothesis.

GH excess that occurs in childhood before fusion of the growth plates of the long bones is called gigantism rather than acromegaly, and is beyond the scope of this article.