Acromegaly is characterized by excessive growth hormone secretion after skeletal maturity, which is usually caused by a benign pituitary tumor. This excess growth hormone causes increased insulin-like growth factor 1 production by the liver. Symptoms include enlarged extremities, thickening of soft tissues and bones, joint problems, and enlarged organs. Radiographic features include skull and bone thickening, enlarged sinuses and sella turcica, and joint space widening. Complications can include arthritis, cardiovascular and respiratory issues, and nerve entrapment like carpal tunnel syndrome. Differential diagnoses include pseudoacromegaly and other causes of excessive growth.

1. ACROMEGALY
By
Dr Himani Sharma
PG I

2. PATHOPHYSIOLOGY
 Acromegaly is characterized by hypersecretion of growth hormone
(GH), after skeletal maturity is attained ; which is caused by the
existence of a functional pituitary tumor in more than 95% of
acromegaly cases.
 Common in middle aged adults, predominantly in males
 Pituitary tumors are benign adenomas and can be classified
according to size (microadenomas being less than 10 mm in
diameter and macroadenomas being greater than 10 mm in
diameter)

3.  In rare instances, elevated GH levels are caused by
extra pituitary disorders. In either situation,
hypersecretion of GH in turn causes subsequent
hepatic stimulation of insulin-like growth factor-1
(IGF-1)

7. SYMPTOMS & SIGNS

8. RADIOGRAPHIC FEATURES
a) Skull :
- Calvarial thickening
- Enlarged sinuses
- Enlarged sella turcica
- Prognathic jaw
- Dilatated sinuses
- Dilated mastoid air cells
- Calcification of pinna

9. Thickened calvarium with pituitary enlargement

10. • Enlarged sella with
double flooring
• thickened skull vault
• prognathism

11. b) Hands :
- Terminal phalangeal tufts become hypertrophied
and have a spade appearance which is
called spade phalanx sign
- Joint spaces may be minimally enlarged
- Premature osteoarthritis can set in the advanced
stages of acromegaly

13. • Widening of the
terminal tufts
(between long
arrows)
• bases of the distal
phalanges,
thickening of the
digit soft tissues
(between
arrowheads) and
• widening of the
metacarpophalange

14. c) Feet :
- Heel pad thickness
may be increased
(more than 25 mm)
-

15. Prominence of tendon & ligament
attachment (enthesopathy)

16. d) Spine :
• Enlargement of
posterior bodies
• Posterior scalloping
• Intervertebral disc
widenening

18. Additional findings :
• Enlargement of costochondral junctions
• Periarticular calcification
• Tinel’s sign – distal paraesthesia which is induced by
percussion over entrapped nerve (carpal tunnel
syndrome)

19. COMPLICATIONS
• Premature osteorthritis
• Cardiovascular disease- arrhythmia, cardiomyopathy
• Degenerative disc disease
• Vision abnormalities – papilloedema , optic nerve atrophy,
bitemporal hemianopia
• Carpal tunnel syndrome
• Colonic polyps
• Glucose intolerance or diabetes
• High blood pressure
• Sleep apnea
• Spinal cord compression

20. DIFFERENTIAL DIAGNOSIS
• Pseudoacromegaly
– Presence of similar acromegaly like features in the
absence of elevated GH or IGF-I levels
• Physiologic growth spurt during puberty
• Familial tall stature or large hands and feet
• Myxoedema

21. THANK YOU