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Medical Edge Newspaper Column from Mayo Clinic
PITUITARY MALFUNCTION MAY REQUIRE EXTENSIVE TREATMENT
DEAR MAYO CLINIC: My son, age 52, has had two pituitary tumors removed. He was diagnosed with acromegaly. Please tell me about this condition and what causes these tumors to develop. — Tucson, Ariz.
ANSWER: To understand acromegaly, it’s helpful first to know a bit about the pituitary gland, a small, bean-shaped organ located at the base of the brain. This gland influences almost every part of the body. Its hormones help regulate important functions, such as growth, blood pressure, metabolism and reproduction. When a problem occurs in the pituitary gland, its effects often appear throughout the body.
Acromegaly develops when the pituitary gland produces too much growth hormone in adults, which causes bones and other organs to enlarge. It also causes fluid retention, which makes soft tissue swell. Children who produce too much growth hormone, because they can grow taller, develop a related condition called gigantism. These children have excessively long bone growth and an abnormal increase in height, in addition to the changes seen in acromegaly.
Visible symptoms of acromegaly may include enlarged hands and feet, as well as changes in the shape of the face, such as a protruding lower jaw and brow, an enlarged nose, thickened lips and wider spacing between teeth.
The most common cause of acromegaly is a noncancerous (benign) tumor of the pituitary gland, as in your son’s case. What causes these tumors is not clear. In some rare cases, they form due to an inherited gene mutation. People with that mutation usually have a strong family history of tumors of the pituitary and other glands. But for most people, what causes a pituitary tumor to develop is unknown. Having one pituitary tumor usually doesn’t mean a person will develop more. In fact, once a tumor is removed completely, others rarely follow.
But removing a pituitary tumor can be challenging. Acromegaly progresses very gradually, and it’s easy to miss subtle symptoms. Most individuals diagnosed with the disease have had it for about 10 years before it’s identified. When the disease finally is diagnosed, the pituitary tumor often has spread into areas of the brain where it is difficult to remove completely.
Treatment becomes more complicated because a single surgery can cure acromegaly only if the entire tumor is removed. If that doesn’t happen, additional surgery may be necessary. This could have been the case for your son. If his tumors were detected and removed one after the other, it’s possible the second tumor actually was part of the original tumor that was left behind after the first procedure.
If the entire tumor cannot be removed surgically, radiation therapy may be used to destroy lingering tumor cells and reduce growth hormone levels. Radiation can be given in daily treatments, usually over four to six weeks (conventional fractionated radiation therapy). Or it can be given in a single procedure that delivers a high dose of radiation to the tumor cells while limiting the amount of radiation to the normal surrounding tissues (stereotactic radiosurgery, also called Gamma Knife radiosurgery).
What kind of radiation therapy a person receives depends on the size and location of the remaining tumor cells. At Mayo Clinic, we recommend stereotactic radiosurgery whenever possible because it minimizes the risk of damaging the normal function of the pituitary gland, as well as the surrounding tissue.
If surgery is not an option, or if a patient still experiences symptoms after radiation therapy, medications also are available. These medications can lower the production of growth hormone or block its effects on the body, relieving the symptoms of acromegaly.
With appropriate treatment, acromegaly often can be cured. Although enlarged bones cannot be made smaller again, tissue that has swollen due to fluid retention usually decreases in size after treatment. In addition, comprehensive treatment greatly reduces the risk of developing the serious complications associated with acromegaly, such as high blood pressure, colon polyps, sleep apnea, degenerative arthritis, heart conditions and lung disease. Even after treatment, though, acromegaly usually requires long-term monitoring by a doctor to make sure the pituitary gland continues to function properly.
— Todd Nippoldt, M.D, Endocrinology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Acromegaly
Appointment Information
More Information on Acromegaly
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