Symptoms

The symptoms of acromegaly appear very gradually over time, which is partly why it can be difficult for some doctors to diagnose. The changes are gradual because it takes time for the cells of the body to respond to growth hormone (GH) and the increase in IGF-1 (insulin-like growth factor-1) hormone that results from it.

Symptoms caused by too much GH and IGF-1

The IGF-1 hormone affects bone growth by causing the bones of the hands, arms, feet, legs, head and jaw to thicken and grow too much. You may notice that your rings, shoes and hats no longer fit well.

Some symptoms are the result of soft tissue growth caused by too much GH and IGF-1. The lips and tongue can increase in size, and the palms of the hands and soles of the feet can become noticeably thickened.

GH also affects the body’s metabolism of macronutrients, which are sugars, fats and proteins. GH causes the release of fats and sugar into the bloodstream. Too much GH can cause high triglycerides (fats) and high blood sugar, which can increase the risk for heart disease and diabetes. GH and IGF-1 cause muscles and other tissues to grow. Muscles are made of protein. If the muscles and other tissues become too large, they can pinch a nerve resulting in pain and weakness.

Other symptoms of acromegaly

Other symptoms of acromegaly are the result of the tumour, or adenoma, pressing against different parts of the brain near the pituitary gland. If the adenoma presses against the part of the brain involved in vision, you might have double vision or trouble seeing out of one or both eyes.

Summary of signs and symptoms of acromegaly*:

  • Increased sweating

  • Oily skin and acne

  • Enlarged thyroid gland (goiter)

  • High blood pressure

  • Sleep apnea

  • Compression of nerves (e.g., carpal tunnel syndrome)

  • Joint pain (arthritis)

  • Skin tags

  • Prominent jaw, nose and forehead

  • Widening of the spaces between the teeth

  • Bony enlargement of the hands, arms, feet and legs

  • Enlargement of the lips and tongue

  • Headaches

  • Emotional symptoms/mood changes

If these and other symptoms go untreated for a long period of time, serious illness and complications may occur. Please speak with your doctor about any symptoms you may be experiencing as this information is for educational purposes only and not intended to be used for the purpose of diagnosis.

Hypopituitarism

The pituitary adenoma can also cause an imbalance of the other hormones that are made and released by the pituitary gland. This can cause symptoms of underproduction of the other pituitary gland hormones, called hypopituitarism.

The signs and symptoms of hypopituitarism depend on which pituitary hormones are affected1:

Pituitary hormone

Signs and symptoms of deficiency

Adrenocorticotropic hormone (ACTH)

Fatigue, poor appetite, nausea, vomiting, low blood pressure, weight loss, pale skin

Thyroid-stimulating hormone (TSH)

Fatigue, weight gain, dry skin, sensitivity to cold, constipation, heavy periods in women

Gonadotropins (LH and FSH)

Women: loss of periods, loss of sex drive, infertility
Men: loss of sex drive, erectile dysfunction, impotence, infertility

Prolactin

Inability to breastfeed

Oxytocin

Difficulty with breastfeeding

Antidiuretic hormone

Excessive urination and thirst, dilute urine

Complications

Some signs and symptoms of acromegaly can lead to complications that may require more treatment and monitoring such as:

Heart disease occurs when the blood vessels that nourish the heart become very narrow. When the blood vessels have become narrowed, the heart cannot receive enough blood and oxygen. Symptoms of heart disease include chest pain/angina, fatigue and shortness of breath.

Heart failure occurs when the heart is not able to pump enough blood to the body. Symptoms of heart failure include trouble breathing, exercise intolerance and swollen ankles and feet.

High blood pressure occurs when your blood pressure is consistently elevated over time. Blood pressure is the pressure of the blood on the inside walls of the arteries when the heart contracts and relaxes. The symptoms of high blood pressure are not always noticeable, but complications from it include, kidney damage, heart disease, heart failure and stroke.

Diabetes mellitus occurs when the body stops producing insulin or becomes less responsive to insulin. Insulin helps your body use sugar as a source of energy from your diet. Symptoms of diabetes mellitus include fatigue, and excessive thirst and urination. Uncontrolled diabetes can lead to long-term health complications such as heart disease, vision trouble, kidney problems and nerve damage.

Sleep apnea occurs when you stop breathing for short periods of time while you are sleeping. The main symptoms of sleep apnea are feeling tired during the day and snoring with short pauses in breathing while sleeping. Uncontrolled sleep apnea can lead to high blood pressure, heart attack, stroke and diabetes.

Colon polyps are tissue growths inside the large intestine. The symptoms of colon polyps are not always noticeable but may include blood in the stool, and diarrhea or constipation that lasts for more than a week. If colon polyps go undetected, they may develop into cancer.

During diagnosis and follow-up visits, your doctor will monitor you for the development of these symptoms and their complications. If you have any of these symptoms or notice any new ones develop, please speak with your doctor.

Check out the true-2-me guest editorial on treatment Considerations for Acromegaly


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