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Symptoms |
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Acromegaly can cause changes in physical appearance and general health that 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, which can make the early diagnosis of this disease challenging.
Early detection is a goal in the management of acromegaly because the pathological effects of increased growth hormone (GH) production are progressive. Early on, the signs and symptoms may not be recognizable; however, some of the later changes can be easier to recognize. Comparing current appearance to old photographs is sometimes what leads to suspicion of this disease and helps to identify its time of onset.
An early sign of acromegaly is swelling of the soft tissue of the hands and feet. Patients may notice a change in ring size or shoe size. Bony changes gradually alter the facial features, causing protrusion of the brow and lower jaw, enlargement of the nasal bone, and increased spacing of the teeth.
Arthritis can occur because of the overgrowth of bone and cartilage. Nerves can become trapped because of the thickening tissue, causing carpal tunnel syndrome, which is characterized by weakness and numbness of the hands.
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Direct effects of tumour:
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Headache |
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Visual impairment |
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Hyperprolactinaemia |
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Hypopituitarism |
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Pituitary apoplexy |
Soft tissue and skin changes:
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Acral enlargement and
soft-tissue enlargement |
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Increased sweating |
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Skin tags and acanthosis
nigricans |
Cardiac features:
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Increased left ventricular
mass and left ventricular hypertrophy |
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Biventricular failure |
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Ischaemic heart disease |
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Hypertension |
Carbohydrate intolerance:
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Insulin resistance |
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Impaired glucose tolerance |
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Diabetes mellitus |
Respiratory disease:
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Upper airway obstruction |
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Macroglossia |
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Obstructive sleep apena |
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Thickening of vocal chords
and enlargement of tissue |
Neoplasia:
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Colonic polyps and carcinoma |
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Breast, thyroid, or prostate
cancer |
Bone, joint and neuromuscular disorders:
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Joint stiffness |
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Arthropathy, leading
to osterarthritis |
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Carpal tunnel syndrome |
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Proximal myopathy |
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Osteopenia |
Other endocrine dysfunction:
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Multinodular goiter |
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Hypercalciuria |
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Hyperparathroidism |
Other symptoms of acromegaly may include:
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Headaches and vision
disturbances due to expansion of the pituitary tumour |
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Skin tags |
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Thick, coarse, oily skin
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Enlarged lips, nose,
and tongue |
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Deepening of the voice
due to enlarged sinuses and vocal cords |
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Snoring from upper airway
obstruction |
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Fatigue and weakness |
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Excessive sweating and
skin odour |
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Impotence in men |
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Abnormalities of the
menstrual cycle and breast discharge in women |
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Enlargement of internal
organs such as the liver, spleen, kidneys, and heart |
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Patient with acromegaly-years before presentation
(a) and at presentation (b). Wass J (ed). Handbook of Acromegaly.
UK: BioScientifica Ltd, p. 9, 2001.
Hand of a patient without acromegaly (left) compared with hands
of a patient with acromegaly (centre and right). Wass J (ed).
Handbook of Acromegaly. UK: BioScientifica Ltd, p. 23,
2001.
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