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  Sep 26, 2018

Acromegaly Complications

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Acromegaly can cause several complications if left untreated. These complications, like the symptoms of the disease, are gradual in onset and may take months or years to develop.

Vigilance regarding these complications is part of management of acromegaly. Some of the complications include:-

  • Heart disease – acromegaly increases the risk of ischemic heart disease leading to a worsening of risk of heart attacks and angina. Risk of heart failure also rises with enlargement of the heart and imbalance between demands of the body to the capacity of the heart to pump blood.
  • Stroke risk is also raised in persons with acromegaly.
  • The risk of diabetes mellitus rises to a great extent among those with acromegaly.
  • Pregnant women with acromegaly have a heightened risk of developing gestational diabetes and pregnancy induced hypertension or high blood pressure. This may raise the risk of preterm birth or still birth.
  • Those with acromegaly are at risk of arthritis and joint pains as well. This is called Acromegalic arthropathy and affects up to 70% of patients. Both the axial and peripheral skeleton may be affected. This involves the spine as well as the joints of the limbs. Due to compression of nerves of the hand, patient may develop Carpal tunnel syndrome.
  • Due to overgrowth of structures of the back of the throat and tongue there may be development of Obstructive sleep apnoea and this leads to interrupted sleep.
  • There is a high risk of development of colonic polyps. These polyps, if not detected early and removed, may go on to form adenocarcinoma of the colon or bowel cancer. Those with acromegaly thus require early and regular screening for bowel cancer.
  • A pituitary tumor may cause increase in secretion of the hormone prolactin by the pituitary gland. There may be additional deficiencies of cortisol, thyroid hormone production and sex steroids due to the defects in pituitary hormone production.
  • As the pituitary tumor grows, it may press upon the optic chiasm. This optic chiasm is a junction point where the optic nerves from both eyes converge. As the chiasm is pressed, there may be severe impairment of vision. The loss of vision typically affects the outer visual fields and is called bitemporal hemianopia.
  • Severe headache may be seen as a complication of acromegaly.
  • As a complication of surgery or radiation therapy, acromegaly patients may develop hypopituitarism. This leads to severe decline in hormones secreted by the pituitary. These may require replacement usually for life.
  • There is a risk of developing kidney failure.

Sources

  1. http://www.nhs.uk/conditions/acromegaly/Pages/Introduction.aspx
  2. http://www.endocrine.niddk.nih.gov/pubs/acro/acromegaly.pdf
  3. https://www.aace.com/files/acromegaly-guidelines.pdf
  4. http://jcem.endojournals.org/content/94/5/1509.full