Acromegaly

Acromegaly is a rare hormonal disorder that causes the feet, hands, and bones to grow excessively. In fact, the term acromegaly means enlargement of the extremities.

This condition typically affects adults, but it can occur anytime after puberty. If left untreated, acromegaly can lead to life-threatening health complications. However, if treated early on, individuals diagnosed with acromegaly can expect to lead a healthy life.

Causes of Acromegaly

Growth hormone (GH) is a chemical substance that is made in the pituitary gland. This hormone is essential for growth and development in children and in adults, helping to maintain healthy bones and muscles. Sometimes, an individual may produce too much growth hormone, due to:

  • A tumor in the pituitary gland (roughly 95% of acromegaly diagnoses)
  • A tumor located in another area of the body, such as the lungs (this constitutes a smaller percentage of acromegaly diagnoses). These tumors may produce GH themselves or may produce a hormone called growth hormone-releasing hormone that then stimulates the pituitary gland to produce more GH.

Symptoms of Acromegaly

The most common symptom of acromegaly is enlargement of the feet and/or hands. Individuals may notice the need for a larger shoe size or that a ring no longer fits. Some individuals may even notice a change in facial features due to bone enlargement, such as an enlarged nose or a protruding jaw.

Symptoms can vary from person to person and may include the following:

  • Achy joints
  • Carpal tunnel syndrome
  • Sleep apnea due to airway obstruction
  • Sweating more than usual and excessive body odor
  • Headaches
  • Fatigue
  • Skin that begins to take on a rough texture and becomes more oily than usual
  • Enlarged sinuses and vocal chords, which can lead to a deepening of the voice
  • In men, erectile dysfunction
  • In women, abnormalities in the menstrual cycle

Symptoms of acromegaly may develop slowly, making them difficult to detect. For this reason, signs of acromegaly may go unnoticed for a long time. It’s very important to treat acromegaly early in order to receive proper care. If you notice any symptoms of acromegaly, make an appointment with your doctor.

What to Expect at Your Appointment

During your appointment, your doctor will ask you questions about your symptoms and your medical history before performing a physical examination. In order to confirm a diagnosis of acromegaly, your doctor will want to perform the following tests:

  • GH and IGF-I hormone test - For this test, you will be asked not to eat for at least eight hours, overnight. In the morning, your doctor will collect a blood sample, which will be used to measure the levels of growth hormone and insulin-like growth factor 1 (IGF-1) in your system. High levels of these hormones can be an indication of acromegaly.
  • Growth hormone suppression test - You will be asked to not eat or drink for at least 10 hours before the test. Your doctor will then give you a sugar solution to drink, which must be consumed within five minutes. Your doctor will take a blood sample before and after drinking the solution. Consistent levels of growth hormone after drinking the solution can be an indication of acromegaly.
  • MRI scan - Your doctor may prescribe an MRI scan in order to locate and measure the size of a tumor in the pituitary gland. If no tumor is found in the pituitary gland, then doctors will know to look for a tumor in other areas of the body that might be responsible for the overproduction of growth hormone.

Non-surgical Treatments for Acromegaly

The goals of acromegaly treatment are to:

  • Decrease the production of growth hormone
  • Limit the effects of the pituitary tumor

Successful treatment of acromegaly requires a dedicated team of experienced specialists. At MedStar Washington Hospital Center, our acromegaly experts are part of the only multidisciplinary team of its kind in the Washington, DC, area. Patients have access to neurosurgeons experienced with pituitary disorders, a pituitary endocrinologist, a neuro ophthalmologist, otolaryngology, office visits, diagnostic testing, and surgery - all in the same location.

“The ability to see all treating doctors in one facility, usually on the same day, [allows for] collaboration between the treating staff in real-time.” - Dr. Edward Fiore Aulisi, Chairman of the Department of Neurosurgery & Medical Director of the MedStar Neuroscience Intermediate Care Unit

As treatments for acromegaly have advanced, it has become more common that medication may be prescribed before surgery is recommended. Medication may be used to either significantly reduce the amount of growth hormone production or to block the effects of growth hormone. However, some patients may benefit significantly from a combination of medication and surgical intervention.

If the patient does not respond to medications, and/or the tumor is invasive, complete surgical removal of the tumor may not be possible. In this case, patients will undergo radiation therapy to target remaining tumor cells and to slow the production of growth hormone. Radiation may cause a decrease in the production of other hormones produced by the pituitary gland. If this happens, patients may be prescribed hormone replacements.

There is no one treatment for acromegaly that will benefit every patient. Treatment plans should be tailored to each individual patient, depending on his/her symptoms and the unique diagnosis.

Surgical Treatment for Acromegaly and Post-Treatment

The type of surgery performed will depend on the size, extent, and location of the tumor. The tumor can be removed using one of two techniques:

  • Transsphenoidal surgery - The tumor is removed through the nasal cavity using endoscopic techniques.
  • Transcranial surgery - The tumor is removed through the skull using open surgical techniques.

Outlook and Prognosis for Individuals With Acromegaly

If acromegaly is diagnosed and treated early, individuals may lead normal, healthy lives. When diagnosed late, individuals may suffer from health complications such as respiratory disorder, cardiovascular disease, and malignant (cancerous) tumors. Due to the nature of acromegaly, it may be necessary to follow up indefinitely with the physician to monitor the function of the pituitary gland.

Coping with the symptoms of acromegaly may prove challenging for some individuals. It is recommended that these individuals seek out support groups in order to talk through the challenges of acromegaly treatment and post-treatment.

Pituitary Tumors: Symptoms You Should Look For

Did you know that up to 20 percent of people have pituitary tumors, but many of them cause no problems, if they are ever even diagnosed? While this may be considered good news for many people, pituitary tumors are not always benign.

If you develop a pituitary tumor that interferes with your hormones or presses on the surrounding nerves, you could experience a broad range of health issues that should be addressed. Read on to learn about pituitary tumors so you can spot the signs and seek the treatment you need.

First, What Is the Pituitary Gland?

Before you can understand the symptoms, you first need to understand the purpose of the pituitary gland. It is a tiny gland located at the base of the brain, which makes several important hormones, including:

  • TSH (thyroid stimulating hormone), which controls the thyroid gland;
  • ACTH (adrenocorticotropic hormone), which affects the production of cortisol (the body’s stress hormone) from the adrenal gland;
  • FSH (follicle stimulating hormone) and LH (Luteinizing hormone) that regulate male and female sex organs and fertility;
  • Growth hormone, which regulates growth, particularly in children; and
  • Prolactin, which controls breast growth and lactation.

You can think of the pituitary gland as the conductor of the endocrine orchestra. It regulates the production of hormones by other glands in the body, just like a conductor controls the production of sound by individual musicians.

Symptoms of Pituitary Tumors

Pituitary tumors can be functional (overproduction of one or more hormones by the tumor cells) or non-functional.  Symptoms of pituitary tumors therefore fall into two categories: those related to hormonal excess and those related to mass effect of the tumor on surrounding structures.

Tumors that do not increase hormone production can press on important structures around them, such as the nerves connecting the eyes to the brain. These tumors can cause headaches and vision problems. On the other hand, tumors that raise hormone levels can create health issues tied to the hormone they produce.

For example, a tumor that secretes too much ACTH which then stimulates the adrenal glands to make cortisol can cause Cushing's disease, a state of cortisol excess associated with  weight gain, muscle weakness, depression, high blood pressure, diabetes, and an increased risk of heart disease, osteoporosis, fractures and blood clots in the blood vessels of legs and lungs. A tumor that produces too much prolactin can cause menstrual problems (in women) and decreased sex drive, problems with fertility and low bone mineral density with increased risk for fractures in both men and women.

Diagnosis and Risk Factors

For nonfunctional tumors, you may only find out that you have this kind of tumor when it shows up on an unrelated MRI or when the tumor has grown large enough to compress the surrounding structures causing headaches, visions problems and symptoms of hormonal deficiency (due to compression of the normal pituitary cells). Functional tumors can present with symptoms of hormonal excess, as described above, but they can still be difficult to diagnose, as many of these symptoms can have other possible causes with overlap between various disorders and the diagnosis is often best made at a tertiary referral center.

Unfortunately, experts don’t know exactly what causes pituitary tumors. Some very rare genetic disorders can make them more likely, but these are associated with symptoms of other components of the syndrome as well. Most tumors have no apparent cause and therefore at present there is no known way to prevent them.

How Pituitary Tumors Are Treated

Some pituitary tumors require surgical resection. If this is needed, the doctors treating you will first need to correct your hormone levels to ensure you are safe during the operation. Following the procedure, you may need to have radiation therapy or take medication to treat any residual tumor and regulate your hormone levels.

That said, not all pituitary tumors need surgery. Asymptomatic small tumors can simply be observed. Also, there are medical treatments available for some tumors, such as those that produce prolactin.

Final Thought

If you have symptoms such as headaches, vision problems, sudden weight gain or menstrual problems, you need to reach out to a center that has experience with handling pituitary tumors. Experienced teams can formulate a treatment plan using different approaches that is optimal for you.

Finally, if your pituitary tumor requires surgical intervention, it is imperative to engage a surgeon who has experience with pituitary tumors. When in doubt, talk to your physician. They can help you with answers to your questions, guidance or a referral.

Have any questions?

We are here to help! If you have any questions, or would like to schedule an appointment with one of our specialists, call us at 855-546-1974.

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Celebrated Physician: Susmeeta Sharma, MD

Growing up in a family of medical doctors, Susmeeta Sharma, MD, knew from an early age that she would one day become a physician too. Her dad was an anesthesiologist and her mother, an OB/GYN.

“I’m not sure I’d be good at anything else,” she says with a laugh.

As director of pituitary endocrinology at MedStar Pituitary Center at MedStar Washington Hospital Center, Dr. Sharma oversees the evaluation and treatment of pituitary and adrenal tumors, as well as other conditions such as prolactinoma, Cushing’s disease, acromegaly, and hormone deficiencies.

“There’s a complexity and logic to evaluating pituitary disorders that I find appealing,” she says. “And the impact you can make on a patient’s well-being through diagnosis and treatment is rewarding.

Before joining the MedStar Pituitary Center, Dr. Sharma completed a fellowship in reproductive and adult endocrinology focusing on pituitary and adrenal disorders at the National Institutes of Health (NIH). She then stayed on as a junior faculty member and the Chief of Outpatient Endocrinology at NIH.

Dr. Sharma credits Lynnette Nieman, MD, a Senior Investigator and Chief of the Endocrinology Consultation Service at the NIH Clinical Center, for helping hone her research skills, which focus on pathogenesis and diagnosis of hormonally active pituitary tumors as well as development of non-surgical treatment modalities for management of pituitary tumors.

Another key mentor was John E. Nestler, MD, now Chair of the Department of Internal Medicine at the VCU School of Medicine, where Dr. Sharma served her internship. Both physicians helped instill a love of mentoring young physicians along their path to clinical endocrinology and patient care—a commitment for which Dr. Sharma was recognized with the NIH Endocrinology fellowship program’s Dr. Phillip Gorden Distinguished Clinical Teacher Award, named for former director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Dr. Sharma hopes to develop research programs to complement those already underway at MedStar Georgetown University Hospital.

“There are many avenues to explore, such as different types of tumors, and why various patient populations develop certain kinds and not others,” adds Dr. Sharma.

Married to a cardiologist, Dr. Sharma practices her problem-solving skills at home by reading mysteries. She also enjoys gardening and cooking Indian food.

Have any questions?

Contact us for more information about the MedStar Pituitary Center or to schedule an appointment. Call us at 855-546-1974.

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Treatments

neurosurgery

Once we have confirmed a diagnosis, including the size and location of the tumor, your team will create a personalized treatment plan. Our neurosurgeons, endocrinologists and neuro- ophthalmologists, collaborate to ensure you receive the most effective care. The high volume of pituitary surgeries we perform has led to excellent outcomes for our patients. 

Pituitary Tumors: Our Approach to Treatment

Your treatment plan will depend on your specific condition, the location of the tumor, the types of symptoms you have and your overall health. We tailor your treatment plan to offer you the best outcome. 

At our center, you will find:

  • High level of expertise: Our team has performed more than 1,000 pituitary tumor surgeries, a higher volume than any other facility in the region. We focus exclusively on pituitary tumors and disorders, giving us the type of intensive expertise that leads to better results for you. Our patients are able to life healthy lives post-treatment, without sign of pituitary disease.
  • Centralized care: From your diagnosis to treatment to follow-up, we provide every aspect of your care right here at our center. Meet our team.
  • Authentic collaboration: Together, our experts manage your care, ensuring an accurate diagnosis and creating an individualized treatment plan. We meet weekly to collaborate on complex cases.
  • Advanced treatment: Our team conducts much of the latest pituitary tumor research right here at our center. This means you have access to the latest medications, techniques and clinical trials available.

Lifelong care: After your surgery, our team, including your endocrinologist, neurologist and neuro-ophthalmologist, provides careful follow-up care. We are often with you for life, performing regular monitoring and scans to manage and prevent any complications

Pituitary Tumor Treatments

We provide the full spectrum of services for pituitary tumors. Treatments we provide include:

  • Watchful waiting: If the tumor is not causing any problems, we may choose not to treat it. You will return for regular monitoring, including imaging scans, to track the tumor’s progress. Regular, careful monitoring allows us to detect if there is any change in the tumor that may require more active treatment. Our clinic coordinator will assist you in scheduling your follow-up appointments.
  • Medical management: We are able to treat many tumors with medication, which can help stop the excess hormone production. Some medications can even shrink the tumors. In addition, after surgery, you may need medication to manage certain endocrine conditions. We work with your local endocrinologist and referring physician to manage your ongoing care.
  • Surgery: Our neurosurgeons perform more pituitary tumor surgeries than any other surgeons in the region. We have extensive experience with this surgery, leaving no visible scar after the surgery. Learn more about pituitary surgery at MedStar Pituitary Center.

Contact Us Today

To make an appointment, or for more information, contact us at 844-PITUITARY (748-8482).

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