Acromegaly Nursing Management and Interventions

Too much growth hormone in an adult means bone and soft tissue keep enlarging after the growth plates have closed. The changes creep in slowly, so the patient often notices rings and shoes no longer fit before anyone names the disorder. Catch it early, because some of the damage is irreversible.

Definition

Acromegaly is a rare disorder of excessive bone and soft tissue growth driven by elevated growth hormone. In young children, before the growth plates fuse, excess growth hormone causes a similar condition called gigantism.

Causes

In most cases, acromegaly comes from over-secretion of growth hormone (GH) by a benign tumor of the pituitary gland, the small gland at the base of the brain that produces many hormones. In a small number of cases, malignant tumors of other organs (pancreas, adrenal, lung) are the source of excess GH.

Risk Factors

Some rare cases are hereditary. The average age of diagnosis is 40 to 45 years.

Symptoms

Symptoms develop very slowly, and untreated acromegaly can cause serious complications and premature death. In children, excess GH elongates the bones with associated soft tissue swelling; untreated, these children can grow to a height of 7 to 8 feet.

In adults, look for abnormal growth and deformity of the hands (rings no longer fit), feet (need a bigger shoe), face (protrusion of brow and lower jaw), jaw (teeth do not line up when the mouth is closed), lips, and tongue. Also carpal tunnel syndrome; skin changes (thickened, oily, sometimes darkened skin; severe acne; excessive sweating and body odor from enlarged sweat glands); a deepening voice from enlarged sinuses, vocal cords, and soft tissues of the throat; fatigue and weakness in the legs and arms; sleep apnea; arthritis and joint problems, especially in the jaw; hypothyroidism; and enlargement of the liver, kidneys, spleen, heart, and other internal organs, which can lead to diabetes, high blood pressure, and cardiovascular disease.

In women: irregular menstrual cycles and galactorrhea (abnormal breast milk production) in 50% of cases. In men: impotence in about 50% of cases.

Diagnosis

Blood tests measure insulin-like growth factor (IGF-I), growth hormone releasing hormone (GHRH), and other pituitary hormones. A glucose tolerance test checks whether the GH level drops, which it will not in acromegaly. If these confirm acromegaly, imaging locates the tumor: head CT scan (an x-ray that uses a computer to image the brain and surrounding structures) and MRI scan.

Nursing Diagnosis

Disturbed body image related to anxiety over thickened skin and enlargement of the face, hands, and feet. Ineffective coping.

Treatment

Goals: reduce GH production to normal levels, stop and reverse the symptoms of over-secretion, correct other endocrine abnormalities (thyroid, adrenal, sex organs), and reduce tumor size.

Surgery. Surgical removal of the pituitary tumor, or other causative tumor, is the preferred treatment in most cases.

Radiosurgery. Highly focused external radiation beams shrink the tumor. Used most often when patients do not respond to conventional surgery or medications.

Radiation therapy. Used in combination with medical or surgical treatment.

Medication. Drugs reduce GH secretion from the pituitary: Cabergoline (Dostinex), oral; Pergolide (Permax), oral; Bromocriptine (Parlodel), may be given before surgery to shrink the tumor; Octreotide (Sandostatin), by injection; Pegvisomant, by injection for patients not responding to other treatment. Medications are often combined with other therapies to treat larger tumors affecting surrounding structures.

Prevention

There is no way to prevent acromegaly, but early diagnosis and treatment help prevent serious complications, some of which are irreversible.