Acromegaly


Pathology: Acromegaly (aka: Marie’s disease) is a metabolic condition in which the body tissues gradually enlarge secondary to hypersecretion of growth hormone or an increase in insulin-like growth factor 1 (IGF-1)(Wultz, 2010).  This condition can be caused by a pituitary adenoma of the anterior lobe of the pituitary(Wultz, 2010).  Overproduction of growth hormone in adults is called Acromegaly, where as in children, it is called gigantism. 

Demographics: (Wultz, 2010)
  • Incidence: 3-4 cases/ 1 million people per year.
  • Prevalence: 50-90 cases/1 million people
  • Age for diagnosis: age 40 years old for males and 45 years old for females. 
  • Predominant sex: same for males and females

Clinical Presentation: (Wultz, 2010)
  • Course features resulting from growth of soft tissue
  • Coarse, oily skin
  • Hands and feet that are spadelike, fleshy, and moist
  • Prognathism, which can give an underbite
  • Carpal tunnel syndrome
  • Excessive sweating
  • Arthralgias and severe osteoarthritis
  • History of increased hat, glove, and/or shoe size
  • Hypertension
  • Skin tags
  • Muscle weakness and decreased exercise capacity
  • Headache, often severe
  • Diabetes mellitus
  • Visual field defects

Other complications noted: (Dekkers, 2008)
  • Hypertension
  • Diabetes mellitus
  • Sleep apnea
  • Cardiomyopathy
  • Cardiovascular disease
  • Colon polyps

Acromegaly may be associated with a tumor and precautions should be taken. If the patient is undergoing chemotherapy or radiation for their tumor, the therapist needs to be mindful of the potential side effects of these treatments. 

Differential Diagnosis: (Dekkers, 2008)
Special tests:
  • Growth hormone levels- elevated
  • Insulin-like growth factor 1- elevated
  • X-ray- abnormal growth shown in spine
  • MRI- tumor in the pituitary
  • Echocardiogarm- may show enlarged heart, leaky mitral valve, or leaky aortic valve  

Bottom Line: Treat and Refer
Contact physician immediate if symptoms of Acromegaly occur. 

These patients may have a tumor causing these symptoms and should contact their physician immediately.  Physical therapists cannot treat Acromegaly itself and should refer out to a physician if symptoms are noted.  A physical therapist can however treat a patient with Acromegaly for any musculoskeletal reason.  Close monitoring should be taken regarding symptoms and complications of Acromegaly. 

References:  Please refer to the "other" section in the reference list.