34-year-old diagnosed with acromegaly on admission for diabetic ketoacidosis
A 34-year-old male patient with diabetic ketoacidosis was taken to the hospital with coarse facial features. He had no known medical history but had noticed a three-size increase in shoe size over the previous ten years and hazy eyesight over the previous three years. Physical examination revealed a broadened nose, frontal bossing, prominent lower jaw, and upper incisor malocclusion (Panel A), which were not seen in an image taken 15 years earlier (Panel B). Bitemporal hemianopsia was discovered through visual-field testing. Based on the clinical features, the patient was suspected of having acromegaly. The diagnosis was confirmed with further testing.
A glycated haemoglobin level of 12.3% (reference range, 5 to 14), an insulin-like growth factor 1 (IGF-1) level of 478 ng per millilitre (reference range, 53 to 331), and a growth hormone level of more than 65 ng per millilitre (reference value, 7.1) were found in laboratory research. Acromegaly was determined to be the cause of the problem. A pituitary macroadenoma measuring 6.0 cm by 3.4 cm by 2.8 cm (Panel C, asterisk) and macroglossia were discovered using magnetic resonance imaging of the head. A partial transsphenoidal tumour excision was undertaken.
Histopathological examination revealed a somatotroph adenoma (Panel D, hematoxylin and eosin staining) that was also growth hormone positive. The patient was discharged with instructions to receive monthly octreotide to treat remaining tumour and diabetic and hypertension drugs. The patient’s IGF-1 level had decreased after one month of follow-up, but the mass gradually reexpanded, necessitating a second resection 8 months later.
Acromegaly is caused by an excess amount of growth hormone
Acromegaly occurs when the body produces an excessive amount of growth hormone (GH). GH, which is mostly produced in the pituitary gland, regulates physical growth in the body. Too much of this hormone in adults causes bone, cartilage, bodily organs, and other tissues to grow in size. Common physical changes include an enlarged or swollen nose, ears, hands, and feet.
Acromegaly is uncommon. According to scientists, between 3 to 14 people out of every 100,000 have acromegaly. Acromegaly is most commonly diagnosed in adults in their forties and fifties, but symptoms can arise at any age. In youngsters, excessive growth hormone produces gigantism NIH external link rather than acromegaly. Gigantism develops when children’s growth plates merge or close before the end of adolescence. Children who receive too much GH before the growth plates close become tall.
Acromegaly often presents with other symptoms before the illness is detected and addressed
Most persons with acromegaly can be treated. However, because symptoms appear gradually, health concerns might arise before the illness is detected and addressed. The health problems may include, high blood pressure, type 2 diabetes, heart disease, sleep apnoea, arthritis, carpal tunnel syndrome and other conditions that affect the bones and muscles. Acromegaly patients are also more likely to develop colon polyps, which can lead to colon cancer if not removed.
Some acromegaly patients may have a hereditary disease that causes tumours to form in various places of their bodies. These additional tumours can grow as GH levels rise. Acromegaly, if left untreated, can cause major health complications and premature mortality. However, when symptoms are adequately treated, they normally improve and may even disappear. Life expectancy may eventually revert to normal.
Aetiology
Acromegaly occurs when the pituitary gland produces excessive amounts of GH into the body over time. When GH enters the bloodstream, the liver is signalled to generate another hormone known as insulin-like growth factor I (IGF-I). IGF-I is the hormone that stimulates bone and tissue growth. High levels of this hormone also alter how the body processes blood glucose (blood sugar) and lipids (fats), potentially leading to type 2 diabetes, high blood pressure, and heart disease. A pituitary adenoma, a tumour in the pituitary gland, causes acromegaly in more than 9 out of 10 instances. A tumour in another part of the body may be the culprit in rare cases.
Although researchers are unsure what causes these tumours to form, genetic factors may be involved. Acromegaly in young adults has been linked to gene abnormalities.
Source: NEJM
