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Acromegaly

Acromegaly is a chronic endocrine disorder caused by excess secretion of growth hormone (GH) after closure of
the epiphyseal growth plates, leading to increased production of insulin-like growth factor-1 (IGF-1) and abnormal
enlargement of bones and soft tissues.

Also called

Growth hormone excess disorder

ICD-10

E22.0

Specialty

Endocrine

Onset

Chronic

Reviewed

August 2026

On This Page

Overview

  • Acromegaly is usually caused by a growth hormone–secreting pituitary adenoma. Because it develops slowly,
  • physical changes may occur gradually over many years. Common features include enlarged hands and feet, facial
    changes, excessive sweating, headaches, and metabolic complications such as diabetes mellitus.

Etiology & Risk Factors

-Etiology

-The main cause of Acromegaly is:

Growth Hormone-Secreting Pituitary Adenoma
• Benign tumor of anterior pituitary somatotroph cells.
• Produces excessive growth hormone (GH).
• GH stimulates the liver and other tissues to produce IGF-1.
• IGF-1 causes growth of bones and soft tissues.
Rare causes include:
• Ectopic secretion of growth hormone–releasing hormone (GHRH)
• Ectopic GH production from non-pituitary tumors

-Inheritance
• Most cases are sporadic.
Rare genetic causes include:
• Multiple Endocrine Neoplasia type 1 (MEN 1)

-Risk Factors
• Family history of pituitary tumors
• Genetic endocrine tumor syndromes
• Previous history of pituitary disease
• Middle adulthood (commonly diagnosed between 30–50 years)

Pathophysiology

Pituitary somatotroph adenoma
→ ↑ Growth hormone (GH) secretion
→ GH stimulates liver and tissues
→ ↑ Insulin-like growth factor-1 (IGF-1) production
→ ↑ Bone and soft tissue growth after epiphyseal closure
→ Enlargement of hands, feet, jaw, and facial features
→ Organ enlargement + metabolic dysfunction
→ Cardiovascular complications + diabetes mellitus + sleep apnea

Clinical Presentation

-Symptoms:

• Gradual enlargement of hands and feet
• Increase in shoe or ring size
• Headaches
• Excessive sweating
• Joint pain
• Snoring
• Sleep disturbance
• Visual problems
• Menstrual irregularities
• Reduced libido

-Signs:

Characteristic physical changes:
• Enlarged hands and feet
• Coarse facial features
• Prominent jaw (prognathism)
• Enlarged nose
• Increased spacing between teeth
• Enlarged tongue (macroglossia)
• Deepened voice


-Other findings:
• Hypertension
• Carpal tunnel syndrome

Untreated Acromegaly may lead to:
• Cardiomyopathy
• Heart failure
• Severe hypertension
• Diabetes mellitus

History Taking

-Ask about:

• Changes in shoe or ring size
• Facial appearance changes noticed by patient or family
• Headaches
• Visual symptoms:
• Loss of peripheral vision
• Blurred vision
• Excessive sweating
• Joint pain
• Muscle weakness
• Snoring and daytime sleepiness

Physical Examination

-General Examination
• Measure height and weight
• Assess body habitus
• Check blood pressure
• Look for characteristic facial changes
• Assess skin thickness and sweating

-System-Specific Examination:

-Head and Face:
• Coarse facial features
• Enlarged nose
• Thick lips
• Prominent jaw
• Increased ring size
• Increased shoe size

-Neurological Examination:

• Visual field testing for bitemporal hemianopia
• Assessment of headaches or cranial nerve abnormalities

-Cardiovascular Examination:
• Hypertension
• Signs of cardiomyopathy or heart failure

-Musculoskeletal Examination:
• Joint tenderness
• Reduced mobility

Investigations

-Biochemistry / Specific Tests
Serum Insulin-Like Growth Factor-1 (IGF-1)
Initial screening test.
Findings:
• Elevated IGF-1 level supports diagnosis.
Growth Hormone (GH)

-Measurement:
Random GH levels are unreliable because GH secretion is pulsatile.
Oral Glucose Tolerance Test (OGTT)

Confirmatory test.
Normal response:
• Glucose suppresses GH secretion.

Acromegaly:
• Failure of GH suppression after glucose administration.

-Glucose Metabolism Assessment
May show:
• Impaired glucose tolerance
• Diabetes mellitus
Other Hormonal Tests

Assess pituitary function:
• Prolactin
• Thyroid function tests
• Cortisol assessment
• Gonadal hormones

Imaging
Magnetic Resonance Imaging (MRI) of Pituitary
Investigation of choice after biochemical confirmation.
Findings:
• Pituitary adenoma
• Tumor size assessment

Diagnosis

-Diagnosis is established by:

1. Elevated age-adjusted IGF-1 level.
2. Failure of GH suppression during oral glucose tolerance testing.
3. Pituitary MRI to identify the source.

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Management

1. First-Line / Emergency Management

Acromegaly is usually not an emergency.
Initial management includes:
• Confirm biochemical diagnosis.
• Perform pituitary imaging.
• Assess tumor size and complications.
• Refer to endocrinology and neurosurgical teams.

2. Definitive Treatment

Transsphenoidal Pituitary Surgery
First-line treatment for most patients with a resectable pituitary adenoma.
Goals:
• Remove tumor
• Reduce GH secretion
• Normalize IGF-1 levels

3. Medical Treatment

Somatostatin Analogues
Examples:
• Octreotide
• Lanreotide
Effects:
• Reduce GH secretion
• Lower IGF-1 levels

GH Receptor Antagonist
Example:
• Pegvisomant
Effect:
• Blocks GH action at tissues.
• Reduces IGF-1 production.

Dopamine Agonists
Example:
• Cabergoline
May be used in selected patients, especially with mild disease or mixed hormone-secreting tumors.

4. Surgical / Procedural Treatment
Transsphenoidal Surgery
Performed through the nasal route to remove pituitary adenomas.
Radiotherapy

Complications

-Cardiovascular
• Hypertension
• Cardiomyopathy
• Heart failure

-Metabolic
• Insulin resistance
• Diabetes mellitus

-Respiratory
• Obstructive sleep apnea
Neurological
• Headaches
• Carpal tunnel syndrome

-Musculoskeletal
• Osteoarthritis
• Joint pain

Prognosis

Without treatment, Acromegaly is associated with increased morbidity and mortality, mainly due to cardiovascular
complications.
With early diagnosis and effective treatment, prognosis improves significantly.

Key Points / Clinical Pearls

• Acromegaly is caused by excessive growth hormone secretion after epiphyseal closure.
• The most common cause is a GH-secreting pituitary adenoma.
• Excess GH increases IGF-1 production.
• Common features include enlarged hands, feet, jaw, and facial changes.
• Symptoms develop slowly and may be missed for years.
• IGF-1 is the best initial screening test.
• Failure of GH suppression during OGTT confirms diagnosis.
• Pituitary MRI identifies the tumor source.
• Transsphenoidal surgery is the main definitive treatment.
• Somatostatin analogues reduce GH secretion.

  • Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(11):3933-3951. Journal of Clinical Endocrinology & Metabolism .
  • Giustina A, Barkan A, Casanueva FF, et al. Criteria for Cure of Acromegaly: A Consensus Statement. J Clin Endocrinol Metab. 2000;85(2):526-529.
  • Melmed S, Bronstein MD, Chanson P, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Complications. Pituitary. 2013;16(3):294-302.
  • Colao A, Grasso LFS, Giustina A, Melmed S, Chanson P, Pereira AM. Acromegaly. Nat Rev Dis Primers. 2019;5:20. Nature Reviews Disease Primers .
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Acromegaly . National Institutes of Health.