Signs and Symptoms

Symptoms of Acromegaly

The changes in physical appearance and general health associated with acromegaly may occur slowly over the course of several years. Early signs and symptoms of acromegaly may be mistaken for aging or symptoms of other diseases, posing challenges for early diagnosis.¹

Because the pathological effects of increased GH production are progressive, early detection is a goal in the management of acromegaly. Early on, the signs and symptoms may be difficult to detect; however, some later changes can be more readily recognised. Comparison of current appearance to old photographs may raise suspicion of acromegaly and help identify its time of onset.^2,3

Swelling of the soft tissue of the hands and feet is an early sign of acromegaly; patients may notice changes in ring or shoe size. Bony changes gradually alter the facial features, causing enlargement of the nasal bone, protrusion of the brow and lower jaw, and increased spacing of the teeth.^1,4

Overgrowth of bone and cartilage may cause arthritis. Nerves can become trapped by thickening tissue, causing carpal tunnel syndrome, which is characterised by weakness and numbness of the hands.^5,6

Direct effects of tumour^1,4,7:

• Headache
• Visual impairment
• Hyperprolactinaemia
• Hypopituitarism
• Pituitary apoplexy

Soft tissue and skin changes^1,4:

• Acral enlargement and soft-tissue enlargement
• Increased sweating
• Skin tags and acanthosis nigricans

Cardiac features^4,8:

• Increased left ventricular mass and left ventricular hypertrophy
• Biventricular failure
• Ischaemic heart disease
• Hypertension

Carbohydrate intolerance⁴:

• Insulin resistance
• Impaired glucose tolerance
• Diabetes mellitus

Respiratory disease⁴:

• Upper airway obstruction
• Macroglossia
• Obstructive sleep apnea
• Thickening of vocal chords and enlargement of tissue

Neoplasia^4,9:

• Colonic polyps and carcinoma
• Breast, thyroid, or prostate cancer

Bone, joint, and neuromuscular disorders^1,4:

• Joint stiffness
• Arthropathy, leading to osteorarthritis
• Carpal tunnel syndrome
• Proximal myopathy
• Osteopoenia

Other endocrine dysfunction^1,4:

• Multinodular goiter
• Hypercalciuria
• Hyperparathyroidism

Other potential symptoms of acromegaly⁶:

• Headaches and visual field disturbances due to expansion of the pituitary tumour
• Skin tags
• Thick, coarse, oily skin
• Enlarged lips, nose, and tongue
• Deepening of the voice due to enlarged sinuses and vocal cords
• Snoring from upper airway obstruction
• Fatigue and weakness
• Excessive sweating and skin odour
• Impotence in men
• Abnormalities of the menstrual cycle and breast discharge in women
• Enlargement of internal organs such as the liver, spleen, kidneys, and heart

Patient with acromegaly—years before presentation (a) and at presentation (b). Wass J (ed). Handbook of Acromegaly. UK: BioScientifica Ltd, p. 9, 2001.⁸

References: 1. Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am. 1992;21:597-614. 2. Melmed S, Colao A, Barkan A, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94:1509-1517. 3. Harris AG. Diagnosis of acromegaly. In: Daly AF, ed. Acromegaly and Its Management. Philadelphia, PA: Lippincott-Raven; 1996:38-48. 4. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001;30:565-583. 5. Tierney LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis & Treatment. 43rd ed. New York, NY: Lange Medical Books/McGraw-Hill; 2004:1061-1145. 6. Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia, PA: W.B. Saunders; 2002:230-261. 7. Tanriverdi F, Karaca Z, Oner A, et al. Complete surgical resolution of bilateral total opthalmoplegia without visual field defect in an acromegalic patient presented with pituitary apoplexy. Endocr J. 2007;54:681-684. 8. Wass J, ed. Handbook of Acromegaly. Bristol, UK. BioScientifica; 2001:18-47. 9. Jenkins PJ, Besser M. Acromegaly and cancer: a problem. J Clin Endocrinol Metab. 2001;86:2935-2941.