What Are The Complications Of Acromegaly?

Acromegaly is a disorder of the hormones where too much growth hormone is produced by the pituitary gland during adulthood. An excess amount of growth hormone in the body will cause the bones in the feet, hands, and face to increase in size. Acromegaly can form at any age, but it usually affects middle-aged individuals. This condition typically takes a long time to recognize because it is rare, and physical alterations happen gradually over time. Common symptoms of acromegaly include increased shoe size, increased ring size, protruding brow and jaw, enlarged nose, wider spacing between teeth, thickened lips, and deepening of the voice. Acromegaly is usually caused by a hormone-secreting tumor in the pituitary gland, lungs, or pancreas. There are numerous complications that occur as acromegaly progresses, and a lack of treatment often results in premature death.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition where a nerve in the carpal tunnel or narrow channel on the underside of the wrist becomes compressed. Carpal tunnel syndrome is a complication commonly seen in acromegaly patients. This condition often affects the median nerve, which provides the palm side sensation to the fingers and thumb excluding the little finger. It is also responsible for the motor function of the muscles around the base of the thumb. The median nerve runs to the hand from the forearm through the carpal tunnel space in the wrist. The squeezed nerve can cause tingling, numbness, pain, and other symptoms in the arm and hand. Acromegaly can cause the bones to grow excessively or grow larger than they are supposed to. It can also cause the bones to develop into an abnormal shape. The bones of the hand, wrist, or arm can affect the nerves in the area adversely if they are distorted or larger than normal. Any shape abnormality or excessive growth in the bones that causes irritation or compression of the median nerve within the carpal tunnel space can cause carpal tunnel syndrome to develop.

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Hypertension

Hypertension or high blood pressure is a condition where long term force of the blood on the walls of the arteries is high enough to cause serious health issues such as heart disease. The resistance to arterial blood flow and the amount of blood the heart pumps are both factors that determine blood pressure levels. There are numerous ways the excess hormones in patients with acromegaly can produce the complication of hypertension. Excess growth hormone produces an anti-natriuretic action or intercepts the healthy process of urinary sodium excretion the kidneys are responsible for carrying out. Too much sodium in the blood causes the blood pressure to increase. The prevalence of insulin resistance in acromegaly patients can produce hypertension from increasing the amount of sodium that is being reabsorbed into the blood. In addition, excess growth hormones can stimulate sympathetic nervous activity which may influence blood pressure levels. The increased amount of growth hormones can cause new growth of abnormal blood vessels that contribute to the prevalence of hypertension in acromegaly patients.

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Diabetes Mellitus

Diabetes mellitus is a disease where the pancreas makes less insulin than it should, or no insulin at all. Diabetes can also happen when the pancreas does produce insulin, but the insulin does not function as it should. Without properly functioning insulin, the glucose in the blood that comes from the consumed food cannot enter the cells to synthesize into cellular energy. This impairment results in rising levels of glucose and less cellular energy around the body. The excess growth hormone produced in individuals affected by acromegaly causes them to become less sensitive to the insulin their pancreas produces. The abnormal amount of growth hormones also decrease the amount of glucose uptake from adipose or fatty tissues and muscles. The high growth hormone levels also change the functioning of beta cells in the pancreas that produce insulin. These metabolic abnormalities stop the body from being able to maintain glucose homeostasis the way it should. When an individual is unable to maintain blood sugar homeostasis, diabetes mellitus can develop.

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Cardiomyopathy

Cardiomyopathy is a disease that affects the heart muscle where it has a difficult time pumping blood to the rest of the body. There are three main types of cardiomyopathy: dilated, restrictive, and hypertrophic cardiomyopathy. Individuals with acromegaly often develop cardiomyopathy as a complication of their disorder. This association occurs because of the effect that excess hormones have on the cardiomyocytes or muscle cells of the heart. The cells can be displaced and develop functional and structural irregularities of the heart muscle. Hypertrophic cardiomyopathy is the variation seen the most in individuals with acromegaly. This form of cardiomyopathy is when the heart muscle thickens on inside but does not cause an overall enlargement of the hollow muscle. This interior thickening diminishes the heart's total blood capacity. The result of this decreased capacity is an increase in heart rate and an increase in the output of blood upon contraction of the heart. When acromegaly precipitated cardiomyopathy is left untreated, it usually results in heart failure.

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Sleep Apnea

Sleep apnea is a sleep disorder where a patient's breathing repeatedly starts and stops throughout the night when they are asleep. Three main types of sleep apnea are called obstructive, central, and complex sleep apnea. The most common manifestation of this disorder in individuals affected by acromegaly is obstructive sleep apnea. This type of sleep apnea happens when the muscles in the throat relax, and the airway closes or narrows as the patient inhales. The result of this is the individual cannot get enough air, which effectively lowers blood oxygen levels. The patient's brain is able to sense they are not breathing normally, and it signals them to wake up to reopen the airway. Changes in the structure of the bones that surround the upper airway can occur as a result of too much growth hormones in the body. Soft-tissue changes may also occur in the region of the upper airway as a result of excess growth hormones. These changes are what causes the blockage in the patient's airway when they inhale, and the throat relaxes. This mechanism results in obstructive sleep apnea.