Acromegaly

Acromegaly is a rare hormone disorder caused by the body producing too much growth hormone (GH), which leads to increased levels of IGF-1 (insulin-like growth factor-1). In adults, this causes gradual enlargement of bones and soft tissues and can affect multiple body systems. The most common cause is a benign pituitary tumour (pituitary adenoma).

Symptoms often develop slowly over several years, which can delay diagnosis. Early assessment and treatment are important to reduce long-term complications and improve quality of life.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and can coordinate investigations and onward specialist pathways for endocrine and pituitary management where appropriate.

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What causes acromegaly?

In most cases, acromegaly is caused by a growth hormone–secreting pituitary adenoma. Less commonly, excess GH (or GHRH, a hormone that stimulates GH release) can come from tumours elsewhere in the body.

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Symptoms of acromegaly

Symptoms can be physical, hormonal, and metabolic. Common symptoms include: (nhs.uk)

Changes in appearance (often gradual)

• Enlarged hands and feet (rings feel tighter, shoe size increases)
• Coarser facial features (broader nose, more prominent jaw/forehead)
• Enlarged tongue and soft tissues (may affect speech or breathing)
• Thicker, oilier skin and increased sweating
• Deepening of the voice (nhs.uk)

Pain and musculoskeletal symptoms

• Joint pain and stiffness
• Back pain and reduced mobility
• Carpal tunnel-type symptoms (numbness/tingling/weakness in hands) (nhs.uk)

Head and neurological symptoms (pituitary tumour-related)

• Headaches
• Visual disturbance, particularly loss of peripheral vision (from pressure on the optic nerves) (OUP Academic)

Hormonal and general symptoms

• Tiredness and sleep problems
• Sleep apnoea
• Menstrual irregularity or reduced fertility
• Erectile dysfunction / reduced libido (nhs.uk)

Because symptoms can overlap with other conditions, formal testing is needed to confirm the diagnosis.

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Possible complications (if untreated)

Long-standing acromegaly can increase the risk of:

• High blood pressure and heart disease
• Type 2 diabetes and metabolic complications
• Sleep apnoea
• Joint and spine problems (ScienceDirect)

Your consultant will assess these risks and may recommend screening as part of your care pathway.

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis typically involves confirming hormone excess and identifying the source. Investigations may include:

• Blood tests to measure IGF-1 (key screening/diagnostic test) (Springer)
• Oral glucose tolerance test (OGTT) with GH measurements, where needed, to confirm or clarify results (OUP Academic)
• Pituitary MRI to assess for a pituitary tumour and its size/position (OUP Academic)
• Additional assessment for pituitary function (other pituitary hormones), visual field testing, and screening for related complications depending on symptoms and findings (bestpractice.bmj.com)

You will receive a clear explanation of results and what they mean for treatment options.

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Treatment & management

Treatment aims to normalise GH/IGF-1, control tumour growth (if present), relieve symptoms, and reduce long-term complications. Management is usually tailored and may involve one or more of the following:

Surgery

For many patients with a pituitary adenoma, first-line treatment is pituitary surgery (often via a transsphenoidal approach through the nose) to remove or reduce the tumour.

Medicines

Medication may be used:

• if surgery is not suitable,
• if hormone levels remain high after surgery,
• or before surgery in selected cases.

Common medication classes include:

• Somatostatin analogues (reduce GH secretion)
• GH receptor antagonists (block GH effects and lower IGF-1)
• Dopamine agonists (helpful in selected patients) (OUP Academic)

Radiotherapy

Radiotherapy may be considered if surgery and medication do not adequately control the condition, or if the tumour is not fully removable.

Ongoing monitoring

Because acromegaly is a long-term condition, follow-up typically includes repeat IGF-1/GH testing, imaging where appropriate, and monitoring/management of associated conditions (blood pressure, glucose, sleep apnoea, joint problems).

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When to seek urgent help

Seek urgent medical advice if you develop:

• Sudden or severe headache with new visual changes
• Rapid worsening vision (especially peripheral vision)
• Collapse, confusion, or severe drowsiness
• Severe headache with vomiting or fainting

These symptoms can indicate urgent pituitary-related complications and need same-day assessment.

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If you have symptoms suggestive of acromegaly (such as gradual enlargement of hands/feet, headaches, or changes in facial features), contact the Royal Buckinghamshire Hospital for assessment and advice. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.