Clinical manifestations of acromegaly depend on the level of growth hormone and insulin-like growth hormone produced in acromegalic patients' body. Besides, age, misdiagnosis, late diagnosis, and tumor size also contribute to the clinical presentation. Clinical features vary from person to person and are usually characterized by overgrowth of acral and soft tissues, diabetes, heart and lung failure, hypertension, pain in joints, etc.
The mortality rate is correlated with the extent of overproduction of growth hormones in acromegalic patients' body. Overproduction of growth hormones affects most of the body parts in acromegalic patients. 25% of the patients die from respiratory failure, 15% from neoplasm, and 65% die from cardiovascular collapse.
The prominent features of acromegaly in patients grow gradually and can be seen a little later. Different healthcare professionals diagnose acromegalic patients due to different symptoms. For example, ophthalmologists mostly diagnose such people due to their sight disturbance, gynecologists diagnose them due to irregular menstrual cycles, and infertility; dentists can diagnose acromegalic patients due to the separation of maxillary teeth found in them.
Most of the clinical manifestations of acromegalic patients include:
- Excessive secretion of growth hormone resulting in soft tissue manifestation and volume expansion.
- Pituitary adenomas which lead to neurological symptomatology and disturbance in vision.
- Oily skin, unpleasant odor, and hyperhidrosis due to deposition of glycosaminoglycans deposition.
Some of these clinical manifestations can be reversed by controlling the levels of growth hormone in the body. However, some of them are completely irreversible.
Cardiovascular Clinical Symptoms
Increased growth hormone level contributes to hypertension, heart diseases, and has a negative effect on life expectancy. 65% of the patients suffering from acromegaly also suffer from other conditions related to the cardiovascular system known as acromegalic cardiomyopathy (cardiac involvement is seen without any other contributing factor). Intracranial aneurysm is also seen in some patients, and it is seen as a sign of poor management of the disease. The best way to decrease the mortality rate in such situations is to control the growth hormone level. Diabetes also contributes to lipid metabolism abnormalities. It increases the risk of low cholesterol levels and hypertriglyceridemia. Excess of growth hormone can lead to insulin resistance, i.e., insulin's ability to suppress glucose production and stimulation of its use is altered. The occurrence of diabetes mellitus in the case of acromegaly is around 20 - 50%. When acromegaly is treated, and the growth hormone levels return to normal, insulin resistance and diabetes go away.
The leading respiratory complication associated with acromegaly is sleep-related breathing disorders like sleep apnea. Many anatomical changes also occur that affect the facial bones and soft tissues. This also affects the volume of the lungs and the geometry of the rib cage. The elasticity of the lungs also gets disturbed, and the distance between the lungs gets increased. Sleep apnea affects 20 – 80% of patients with acromegaly, causing snoring and daytime sleepiness. About one–third of the people with acromegaly develop central sleep apnea, which is caused due to the inability to manage the respiratory system and is associated with increased production of GH and IGF – I. The small and upper airways get narrowed, and the lung volume and capacity get increased. Therefore most parts of the lungs remain poorly aerated or unaerated. This leads to a decrease in inspiration capacity and causes hyperventilation. Surgical treatments for acromegaly helps in controlling sleep apnea.
About 70% of acromegalic patients face problems in their joints. Aarticular alterations are the most frequent, which causes severe morbidity and disability in such patients. There are two ways in which arthropathy in acromegaly is seen. Initially increased level of growth hormone and IGF – I cause an increase in articular cartilage and ligaments, causing mechanical discomfort. Cartilage and periarticular fibrous tissue get thick, and the space between the joints narrows, causing joint pain and chronic osteoarthritis. Uncontrolled or chronic access to the GH and IGF – I develop many spine morphology and function alterations. Early diagnosis of acromegaly can reduce severe spine complications, as is seen in people with chronic acromegaly conditions.