Growing Hands or Feet? Why You Should Check Your Growth Hormone

1. Etiology (Causes)

Acromegaly is caused by excessive growth hormone (GH) production, typically from:

• Pituitary adenoma (benign tumor) – 95% of cases
• Ectopic GH secretion (rare, from lung/pancreatic tumors)
• Genetic syndromes (MEN-1, Carney complex)

Key Mechanism: GH overproduction → Increased IGF-1 → Abnormal tissue growth

2. Symptoms

Early Signs (Often Overlooked):

• Gradual enlargement of hands/feet (ring/watch no longer fits)
• Coarsening facial features (prominent brow/nose, jaw protrusion)
• Increased shoe/hat size

Advanced Symptoms:

• Physical Changes:
  • Thickened skin/oily complexion
  • Macroglossia (enlarged tongue)
  • Widened tooth spacing
• Systemic Effects:
  • Joint pain/arthritis
  • Carpal tunnel syndrome
  • Hypertension (50% of patients)
  • Sleep apnea (60% of cases)
  • Glucose intolerance (25-45%)

3. Diagnosis

Diagnostic Triad:

1. IGF-1 blood test (elevated)
2. Oral glucose tolerance test (GH fails to suppress)
3. Pituitary MRI (identifies adenoma size/location)

Additional Tests:

• Visual field testing (for tumor compression)
• Colonoscopy (increased cancer risk)
• Echocardiogram (cardiomegaly screening)

4. Treatment

First-Line Options:

• Transsphenoidal surgery (cures 80% of microadenomas)
• Medical Therapy:
  • Somatostatin analogs (octreotide/lanreotide)
  • GH receptor antagonists (pegvisomant)
  • Dopamine agonists (cabergoline)

Radiation Therapy (if surgery/meds fail):

• Gamma knife radiosurgery
• Conventional radiation

5. Prevention

No Primary Prevention, but early detection helps:

• Monitor if you have:
  • Family history of pituitary tumors
  • MEN-1 syndrome
  • Unexplained growth changes

6. When to See a Doctor?

Seek evaluation for:

• Progressive enlargement of extremities
• New-onset sleep apnea/snoring
• Unexplained hypertension/diabetes
• Change in facial appearance over years
• Ring/watch no longer fitting

7. Disease Management

Critical Monitoring:

• Annual:
  • IGF-1 levels
  • Pituitary MRI (if residual tumor)
  • Colonoscopy (every 3-5 years)
  • Cardiac echo

Key Statistics:

• Diagnosis delay: Average 7-10 years
• Mortality: 2-3x higher if untreated
• Surgical cure rates:
  • Microadenomas: 80-90%
  • Macroadenomas: 40-60%

Visual Diagnosis Clues

Characteristic Facial Features:

• Prominent supraorbital ridge
• Thickened nasal cartilage
• Prognathism (jaw protrusion)
• Deepened skin folds

Hand Findings:

• Spade-like appearance
• Thickened fingers
• Positive “ring sign” (can’t remove wedding ring)