ACROMEGALY

growth and metabolic disorder characterized by enlargement of the skeletal extremities. It is the result of overproduction of pituitary growth hormone (somatotropin) after maturity, caused by a tumour of the pituitary gland. Acromegaly is often associated with the abnormal growth in stature known as pituitary gigantism (see gigantism). The onset of acromegaly is gradual. Hands and feet become enlarged; facial features are exaggerated as the jaw lengthens and the nose and brow ridge grow thicker; the skin thickens; and most internal organs enlarge. Headache, excessive sweating, and high blood pressure are other manifestations. Acromegalic individuals are likely to develop congestive heart failure, particularly when blood pressure becomes high. Muscle weakness is frequent because muscle overgrowth produced by growth hormone decreases their capacity for work. At times, excessive overgrowth of bone edges involves the joints and produces pain. The bones may become thin and porous-a condition known as osteoporosis. Diabetes mellitus appears in 20 to 40 percent of acromegalic individuals because excesses of growth hormone block the action of insulin. If the pituitary tumour enlarges, it can produce visual-field defects, blindness or paralysis of the eye muscles, and can injure the posterior pituitary gland or the hypothalamus. Also, hemorrhage into the tumour can produce sudden loss of vision. Acromegaly may be treated by surgical removal of the pituitary tumour or destruction of it by X-ray irradiation or liquid nitrogen. Rarely, the pituitary tumour will cease to secrete growth hormone because of a spontaneous hemorrhage or a blockage of the blood supply. Decreases in acromegalic manifestations and amelioration of diabetes mellitus have followed therapy with female hormones-estrogen or medroxyprogesterone-which reduce the secretion of growth hormone. For those treated by pituitary surgery, irradiation, or other measures and for those who spontaneously develop deficits of gonadal, thyroidal, or adrenocortical hormones, replacement-hormone therapy is necessary.