Professor Pat Kendall-Taylor
University of Newcastle

Profesor Kendall-Taylor set the scene by telling delegates the incidence of Acromegaly (number of new cases each year) is estimated at 4-6 per million of the population. The prevalence (the total number of people suffering the disorder) is 40 per million people.

Many symptoms felt by the sufferer are due to the excess of Growth hormone. The hands and feet can enlarge so that rings can become too tight and shoe sizes may have to be larger; there may be changes to the facial features making the eyes and the jaw more prominent. The skin may thicken and become greasy and sweaty, the lips may become thicker and the nose may broaden. There can be a change in bite, because the teeth no longer meet.

Some sufferers complain of a tingling feeling or pains in their hands (Carpal Tunnel Syndrome). The fact that the Pituitary gland has become enlarged may cause headaches and if the gland then presses on the nerve of the eye, there may be vision problems. About a third of all patients develop mild sugar diabetes (diabetes mellitus) because growth hormone has an effect on insulin production. There may also be an increase in blood pressure and the tumour may cause headaches, tiredness and loss of peripheral vision.

The disorder is diagnosed by clinical examination, confirmed by measurement of growth hormone levels during an oral glucose tolerance test and a growth hormone profile. The tissue effects of raised growth hormone result in high circulating insulin-like growth factor (IGF-1). If the diagnosis is confirmed, other tests will be needed, to see if other hormones are missing. If so, these will be replaced. In addition, a MRI scan is required in order that the exact size of the pituitary is known.

Treatment is necessary to lessen the likelihood of other illnesses like high blood pressure, bowel polyps, coronary artery disease, visual problems, lung disease, stroke and malignant disease.

Transsphenoidal surgery may enable selective removal of the tumour with cure. However, in some instances consideration of further treatment with Radiotherapy and/or drug therapy may be needed. It may take months or years for the effects of radiotherapy to be complete. Meanwhile, drug therapy will commence. The drug treatment may be with Octreotide, Bromocriptine or Lanreotide. Two new, longer-acting drugs have now been launched.

Patients are followed up after surgery and after radiotherapy for assessment of growth hormone secretion and pituitary function.

Questions were answered relating to radiotherapy, research, Osteoporosis, long term prognosis, prescription of drugs by GPs and the lack of concentration and the tiredness that is experienced by so many people after diagnosis and treatment.