Endocrinology & Metabolic

Acromegaly

Acromegaly is adult growth-hormone excess, usually from a pituitary somatotroph adenoma, producing progressive acral and facial change and important cardiovascular, metabolic, respiratory and musculoskeletal complications.

Definition

Acromegaly is a chronic multisystem disorder caused by growth-hormone excess after epiphyseal fusion, usually from a pituitary somatotroph adenoma, acting largely through increased IGF-1. Before epiphyseal fusion the comparable disorder is gigantism.

First principles

Growth hormone excess acts mainly through IGF-1

A somatotroph pituitary adenoma secretes growth hormone autonomously. Growth hormone stimulates hepatic and peripheral production of insulin-like growth factor 1, which drives soft-tissue, cartilage, bone and organ enlargement. After epiphyseal fusion this produces acromegaly; before fusion it produces gigantism.

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