Acromegaly

Acromegaly is a rare, chronic, debilitating condition which, if untreated, not only causes significant morbidity but reduces life expectancy by about 10 years. Because the disease process is insidious and early presenting features can be atypical, physicians, dentists and surgeons should consider this diagnosis if any of the typical features of acromegaly are present. This is important because surgery remains the only hope of cure and surgical outcome varies widely with the size of the adenoma, which is related to the duration of the disease (90% versus 40–45% in microadenoma versus macroadenoma). The diagnosis of acromegaly is based on three key findings: clinical features, elevated insulin-like growth factor I and inability to suppress serum growth hormone to less than 1 mU/litre following a 75 g oral glucose challenge. Following biochemical confirmation of the disorder, magnetic resonance imaging of the pituitary is performed to assess the size and regional anatomy in anticipation of future surgery. Medical control of acromegaly has improved significantly during the last few years with the introduction of long-acting somatostatin analogues and the relatively newer agent, pegvisomant. Radiation therapy is a potential adjuvant therapy for patients with residual disease, but can take 5–10 years to have its full effect.