Chapter 15 – Acromegaly

Acromegaly is caused by excess growth hormone (GH) secretion emanating from a somatotroph adenoma. High GH and Insulin-like growth factor-1 (IGF-1) levels lead to acral changes and bony disfigurement, as well as soft tissue overgrowth with characteristic facial and peripheral features, headache, joint pains, and soft tissue swelling. Common comorbidities include hypertension, glucose intolerance, arthritis, and sleep apnea, all leading to increased mortality if left untreated. Management includes transsphenoidal surgical resection of the GH-secreting adenoma, radiation, and medical therapies. Somatostatin receptor ligands suppress GH and IGF-1 levels, and may also shrink the tumor mass. GH-receptor antagonist blocks peripheral GH action and leads to lowered IGF-1 levels. Long-term follow-up is required to maintain biochemical control, treat comorbidities, and reverse adverse mortality outcomes.