Acromegaly 1

ACROGEMALY - BASIC CONCEPTS

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.