A personal series of 256 cases of
acromegaly/
gigantism seen over a 20-year period from 1963 is described. The insidious nature of the condition resulted in delay in diagnosis which was often made by a doctor when seeing the patient for an unrelated problem. Other features which commonly led to the diagnosis being made were
headache, change in appearance,
carpal tunnel syndrome, amenorrhoea and diabetes. The Hardy system for grading the radiological appearance of the pituitary tumour was used. Widely invasive tumours were not common but tended to occur in patients with younger age of onset and high GH levels. The occurrence of various symptoms and clinical features was noted and the changes resulting from reducing the GH level to normal. The incidence of
hypertension, but not of
coronary artery disease, is increased and the blood pressure may be reduced following successful treatment. The effects on the upper and lower respiratory tract are reported as well as sleep apnoea and problems associated with anaesthesia.
Skin manifestations included sweating, pigmented skin tags,
acanthosis nigricans and cutis verticis gyrata. In the skeletal system the incidence of kyphoscoliosis and
osteoarthritis especially of the hip is reported: the question of hip replacement is discussed.
Diabetes mellitus disappeared in most cases if the
acromegaly was cured. In men but not in women the incidence of
colloid nodular goitre was increased as was
hyperthyroidism in middle-aged women. In two patients a
parathyroid adenoma was present: hypercalcaemia was present in five additional patients, but the cause was not determined. The common occurrence of amenorrhoea in the younger women was noted, it was not always associated with
hyperprolactinaemia, and often responded to successful treatment of the
acromegaly. The association of
acromegaly with
hirsutism and galactorrhoea is confirmed. The incidence of
impotence and loss of
libid in the men is discussed: in a proportion of those in whom the
acromegaly was cured, potency returned, but in a number depression occurred and what was believed to be psychogenic
impotence persisted.
Hyperprolactinaemia was found in 49 out of 151 patients with active
acromegaly in whom the
prolactin level was measured. Previous reports have indicated a doubling of death rates in acromegalics. In this series there were 47 deaths observed compared to 37.2 expected. The increased death rate was in women of all ages and in men under the age of 55, The increased deaths in the women were from cardiovascular and cerebrovascular causes and from
breast cancer.(ABSTRACT TRUNCATED AT 400 WORDS)