Excessive growth hormone secretion from a pituitary adenoma in adulthood causes acromegaly, characterized by abnormal growth of bones and soft tissues, especially in the hands, feet, and face. If excessive growth hormone occurs before long bone growth plate closure, it results in gigantism. Specific changes seen in acromegaly include thickening of the skin, especially on the hands and feet, enlargement of the skull and jaw, bone and joint changes in the hands, and changes to the spine including increased vertebral size and platyspondyly.

1. ACROMEGALY
In adulthood, excessive
growth hormone secretion
from a pituitary eosinophilic
adenoma produces growth of
intramembranous bone tissue
and subcutaneous
hypertrophy. This is especially
prominent in the hands and
feet (acral parts), from which
the term acromegaly is
derived. Excessive production
of growth hormone before the
closure of the long bone
growth centers will manifest
as gigantism.

2. ACROMEGALY
Skin Changes
The usual site for skin changes actually measured
is the heel pad thickness. An increase in skin
thickness may be visible, especially in the hands
and feet, with a heel measurement > 20 mm being
suggestive of acromegaly.

3. ACROMEGALY
Skull.
Many skull changes have been documented; however, the
most recognizable include sella turcica enlargement from
the pituitary neoplasm, sinus overgrowth, occipital
protuberance overgrowth, malocclusion, and widened
mandibular angle (pragnathic jaw).

4. ACROMEGALY
Hand.
Many measurements have been applied to the hand, with
variable reliability in the diagnosis of acromegaly; however,
the most definitive changes will be seen in bone and joint
aberrations. Bone changes include widened shafts of the
phalanges and metacarpals, bony protuberances, and
prominent ungual tufts, which may assume a spade-like
appearance. A reliable indicator is the generalized increase in
joint space width owing to cartilage overgrowt

5. ACROMEGALY
Spine.
Numerous changes occur in
the vertebral column. The
dimensions of the vertebra
increase in both sagittal and
transverse planes, especially
in the lumbar spine. The
vertical height remains
unchanged, resulting in the
vertebral bodies appearing
flattened and increased in
their sagittal dimensions
(platyspondyly).

6. ACROMEGALY
Spine.
Premature degeneration
with exuberant
osteophytes and
widened disc heights
complete the most
typically observed
changes. Occasionally,
posterior body
scalloping may be
observed from dural
ectasia.

7. ACROMEGALY
Similar widening of the facet joints can be
observed. Hyperostosis of the tips of the spinous
processes can be pronounced. Spinal stenosis,
although a rare complication, can occur secondary
to thickened laminae and articular process with the
spinal ligaments thickened and calcified.