A few less commonly discussed points about acromegaly

What is pseudoacromegaly?

Pseudoacromegaly is a medical condition with some clinical features of acromegaly, but without any increase in growth hormone or IGF-1 (intrinsic growth factor). Pseudoacromegaly is commonly associated with insulin resistance and there are reports of Pseudoacromegaly in patients receiving minoxidil (an arterial vasodilator medicine sometimes used in high blood pressure when other antihypertensive drugs fail to act) at high doses.

What are the complications of acromegaly?

Acromegaly may cause complications such as severe headache, high blood pressure, enlargement of heart, heart failure, diabetes mellitus, kidney failure, visual defects (especially loss of vision in the outer visual fields known as bitemporal hemianopia) due to compression of optic nerve. Other less serious complications of acromegaly are excessive sweating and seborrhea (excess production of sebum). Both of these indicate active growth hormone producing pituitary tumor.

How acromegaly is diagnosed?

Initially acromegaly is suspected by appearance of patients. After clinical suspicion of an individual, imaging and laboratory investigations are used for confirming diagnosis.

  • MRI scan of brain using gadolinium contrast is commonly used imaging technique for delineation of the pituitary from other brain tissues.
  • Estimation of IGF-1 in blood is highly sensitive for diagnosis of acromegaly and is commonly used for diagnosis.
  • Growth hormone values (especially single value) may be of little use as blood levels of growth hormone vary greatly even in healthy individuals. If growth hormone level is used for diagnosis of acromegaly, it should be estimated 2 hours after a 75 or 100 gram glucose tolerance test. GH levels are suppressed in normal individuals and normally below 1 ?g/Liter.  Growth hormone levels higher than1 ?g/Liter is confirmatory of acromegaly if taken 2 hours after a 75 or 100 gram glucose tolerance test.
  • Other laboratory tests can support diagnosis of acromegaly, such as thyroid stimulating hormone (TSH), gonadotropic hormones (such as lutinizing hormone or LH and follicle stimulating hormone FSH), prolactin, adrenocorticotropic hormone (ACTH) etc.

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