Acromegaly Health Article

Definition

Acromegaly is a rare condition caused by abnormally high amounts of human growth hormone (HGH). An organ in the brain known as the pituitary gland, normally secretes this growth hormone. Normal amounts of HGH are needed for normal growth and physical maturity in children. However, in acromegaly, there is an increased amount of HGH released, generally by a tumor that forms in the pituitary. Untreated, acromegaly can lead to numerous disabling conditions, as well as a significantly decreased life span.

Description

Acromegaly was first described in scientific detail by the French physician, Pierre Marie. In 1886, Dr. Marie, along with his assistant, Souza-Leite, described in detail 48 patients with acromegaly. These patients all exhibited a rapid growth in their height; significantly enlarged hands and feet; change in appearance of their faces; frequent headaches; and a high incidence of visual problems. Dr. Marie believed all of these problems were due to a defect in the patients' pituitary gland, a small glandular structure located in the middle of the brain.

While Dr. Marie was the first to formally state that a problem in the pituitary gland was responsible for the condition of acromegaly, the link between pituitary defects and acromegaly remained controversial for many years. It was not until 1909, when Dr. Harvey Cushing introduced the concepts of hyperpituitarism in reference to acromegaly, that the association became generally accepted. Dr. Cushing believed acromegaly was due to the pituitary gland, a small structure located deep in the brain and known to be somehow involved in growth, over-secreting some type of substance that caused patients to become "giants." Dr. Cushing also put forth the idea that the over-activity of the pituitary gland was caused by a tumor in the gland, an idea that was proven by autopsies done on patients with acromegaly. At the time, however, it still was not clear how a tumor in the pituitary gland could cause such changes in people afflicted with the tumor.

In the decades after World War II, the structure and function of the pituitary gland was further studied. Dr. Herbert Evans at the University of California at Berkley was the first to isolate many secretions, also known as hormones, which were found to be made in and secreted from the pituitary gland. One of these hormones was found to be human growth hormone, or HGH. It was also discovered that certain tumors can form in the pituitary gland and secrete high levels of HGH, resulting in abnormal growth and, as time progresses, acromegaly.

Acromegaly is a rare condition, with only about 1,000 cases per year in the United States among a total population of 250 million. Its striking consequence of excessive height has caused it to remain a fascinating disease among both scientists, doctors, and the public. Besides causing great height and unusual facial features, it is now known that acromegaly also causes serious conditions that can be life threatening, such as heart disease, respiratory disease, arthritis, neuromuscular problems, and diabetes. With early detection and treatment, the consequences of acromegaly can be minimized and patients afflicted with the condition can lead mainly healthy, productive lives.

Genetic profile

The genetics behind the majority of cases of acromegaly is still poorly understood. The most common cause of acromegaly is a benign (non-cancerous) tumor in the pituitary gland that secretes HGH. It is known that the benign tumor arises from cells in the pituitary gland, possibly due to a defect in the pituitary gland itself. The gene responsible for this tumor formation is unknown.

Even though the genetics of tumor formation in the pituitary gland leading to most cases of acromegaly is not yet known, there are other conditions that lead to acromegaly in which the genetic causes of the conditions are known. In a very rare condition called familial acromegaly, there is a gene on chromosome 11 believed to cause the formation and growth of an HGH-secreting tumor in the pituitary gland. Familial acromegaly is transmitted in an autosomal dominant pattern—which means that it has an equal chance of affecting both boys and girls in a single family. This condition can also cause tumors in other areas of the body besides the pituitary, including the parathyroid gland, which controls the amount of calcium in the bloodstream, and the pancreas, which regulates insulin needed for the body to process sugars.

Another uncommon condition causing HGH-secreting tumors in the pituitary gland is called multiple endocrine neoplasia-1, or MEN-1. This is an autosomal dominant condition characterized by a combination of pituitary, parathyroid, and pancreatic tumors. The gene for this condition has also been found on chromosome 11 and is known as the MEN-1 gene. About half the patients with this abnormal gene will eventually develop acromegaly.

Carney syndrome is a rare autosomal dominant disorder that can cause HGH-secreting pituitary tumors and acromegaly in about 20% of patients who have the syndrome. Carney syndrome is associated with a defective gene on chromosome 2. Besides acromegaly, people with Carney syndrome also frequently have abnormal skin pigmentation, heart tumors, and tumors of the testicles and adrenal glands.

McCune-Albright syndrome is a very rare disorder that can cause acromegaly through HGH-secreting tumors in the pituitary. Other conditions associated with this syndrome are polycystic fibrous dysplasia (affecting bone growth, especially in the pelvis and long bones of the arms and legs), abnormal skin pigmentation, early puberty, and thyroid problems. The gene for the syndrome, named GNAS1, is located on chromosome 20.