Acromegaly & Gingatism (Hyperpituitarism)

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Acromegaly/Gigantism (Hyperpituitarism)

Acromegaly and Gigantism are conditions that result from hyperpituitarism, which is the excessive secretion of growth hormone (GH) by the pituitary gland.

Acromegaly and gigantism can also be referred to as hyperpituitarism and the most common cause is prolonged hypersecretion of growth hormone (GH), usually by a hormone-secreting pituitary tumour. As the tumour increases in size, compression of nearby structures may lead to: hyposecretion of other pituitary hormones of both the anterior and posterior lobes damage to the optic nerves, causing visual disturbances.

Gigantism occurs when there is an overproduction of GH in children or adolescents before the closure of the growth plates in bones. This leads to excessive growth in height and overall large stature.
Acromegaly occurs when GH overproduction happens in adulthood, after the growth plates have closed. Instead of growing taller, individuals with acromegaly experience abnormal growth of the hands, feet, and facial features, leading to a distinct appearance.

The effects of excess GH include:
> excessive growth of bones
> enlargement of internal organs
> formation of excess connective tissue
> enlargement of the heart and raised blood pressure
> reduced glucose tolerance and a predisposition to diabetes mellitus.

Growth hormone stimulates skeletal and soft tissue growth. Growth hormone (GH) excess therefore produces gigantism in children and acromegaly in adults.

Gigantism occur before fusion of the diaphysis and an individual increases in height
reaching 7-8 feet.
Acromegaly occur after fusion of the diaphysis with the epiphysis and there is enlargement of the acral parts
Both are caused due to a pituitary tumor in almost all cases.

Pathophysiology and clinical manifestations of acromegaly/gigantism:

Pituitary adenomas secrete excessive amounts of GH, which stimulates the production of insulin-like growth factor 1 (IGF-1) in the liver and other tissues. IGF-1 is responsible for the growth-promoting effects of GH. The excessive GH and IGF-1 levels result in tissue overgrowth, primarily affecting bones, cartilage, and soft tissues throughout the body.

Clinical manifestations Acromegaly and Gigantism:

The clinical manifestations of acromegaly and gigantism are similar and include gradual enlargement and thickening of the bones and tissues. This can lead to changes in facial features, such as;

Enlarged hands and feet: The bones and soft tissues in the hands and feet can become enlarged, resulting in larger glove and shoe sizes.
Facial changes: This can include a protruding jaw (prognathism), enlarged nose, thickened lips, and a prominent forehead.
Enlarged tongue: The tongue may become larger, potentially causing difficulties with speech and swallowing.
Increased size of internal organs: The heart, liver, and other organs may enlarge, leading to various complications.

The hands and feet may also increase in size. Other manifestations may include

joint pain
limited joint mobility
increased sweating
oily skin
sleep apnea, and enlarged nerves.

In children with gigantism, excessive growth can lead to abnormally tall stature.

Clinical Feature	Acromegaly	Gigantism
Onset	Adulthood (after growth plates have closed)	Childhood or adolescence (before growth plates have closed)
Height	Normal height (since growth plates are closed)	Abnormally increased height (due to prolonged bone growth)
Facial Features	Enlarged jaw, nose, and brow; coarse facial features	Normal facial proportions, but overall larger facial structure
Hand and Foot Size	Enlarged hands and feet, with thickened skin	Large hands and feet relative to body size
Joint Pain	Common due to joint hypertrophy	May occur but less common
Skin Changes	Thick, oily skin; excessive sweating	May have thickened skin
Organ Enlargement (Visceromegaly)	Enlarged organs (heart, liver, kidneys)	Possible, due to overall body enlargement
Cardiovascular Complications	Hypertension, cardiomyopathy	May develop cardiovascular issues due to increased body size
Bone and Soft Tissue Overgrowth	Bone thickening, particularly in the skull and jaw	Generalized overgrowth of bones and soft tissues
Visual Disturbances	Possible due to optic chiasm compression by a pituitary tumor	Possible if tumor compressing optic chiasm
Other Symptoms	Headaches, fatigue, sleep apnea, carpal tunnel syndrome	Headaches, fatigue, may develop other symptoms as they age

Diagnosis and treatment of acromegaly/gigantism:

Clinical Evaluation:

History: Look for symptoms like:

Enlarged hands, feet, and facial features (jaw, nose, forehead)
Headaches, vision problems
Joint pain and stiffness
Sleep apnea, snoring
Excessive sweating, fatigue
Menstrual irregularities in women
Impotence in men
Increased ring size, shoe size, hat size
Thickened skin, enlarged tongue

Physical Exam: Assess for signs of:

Acral enlargement (hands, feet, jaw)
Enlarged tongue
Hypertrophy of the soft tissues
Carpal tunnel syndrome
Enlarged organs (liver, spleen)

Biochemical Tests:

IGF-1 (Insulin-like Growth Factor-1): The most sensitive and reliable test. Elevated levels are highly suggestive of acromegaly or gigantism.
GH levels: Can be measured, but are less reliable than IGF-1 as GH levels fluctuate throughout the day.

Imaging Studies:

MRI (Magnetic Resonance Imaging): The gold standard for visualizing the pituitary gland and identifying a tumor.
CT (Computed Tomography) scan: Can also be used to assess the pituitary gland, but MRI is preferred.

Investigations:

Pituitary Function Tests:

Hormonal evaluation: To assess the function of other pituitary hormones (TSH, ACTH, FSH, LH, prolactin) as other pituitary hormones may be affected by the tumor.

Cardiovascular Evaluation:

Echocardiogram: To assess heart size and function, as acromegaly can lead to cardiomegaly and heart failure.
Electrocardiogram (ECG): To assess heart rhythm and electrical activity.

Management and Treatment

The primary treatment for acromegaly/gigantism is the surgical removal or reduction of the pituitary adenoma through transsphenoidal surgery.

In cases where surgery is not possible or does not fully resolve the condition, other treatment modalities may include medication (such as somatostatin analogs or GH receptor antagonists) to lower GH levels, radiation therapy to target the tumor, or a combination of these approaches.

1. Medical Management:

Somatostatin Analogues: (e.g., octreotide, lanreotide) are synthetic versions of the naturally occurring hormone somatostatin, which inhibits GH release. They are effective in controlling GH levels and reducing tumor size in some patients.
Dopamine Agonists: (e.g., bromocriptine, cabergoline) can be effective in some patients, especially those with GH-secreting tumors that are sensitive to dopamine.
Pegvisomant: A GH receptor antagonist that blocks the action of GH at its target tissues. It is effective in reducing GH levels and improving symptoms, but can be associated with liver toxicity.

2. Surgical Management:

Transsphenoidal Surgery: This involves removing the pituitary tumor through the nose and sinuses. It can be very effective in treating acromegaly, but it is a major surgery with potential risks.

3. Radiation Therapy:

Stereotactic Radiosurgery: This is a non-invasive treatment that delivers a high dose of radiation to the tumor, destroying it gradually. It can be used as a primary treatment or as an adjunct to surgery.

Nursing Care:

Patient Education: Educate the patient about acromegaly, its causes, treatments, and potential complications.
Symptom Management: Help patients manage symptoms like headaches, joint pain, sleep apnea, and fatigue.
Medication Administration: Administer medications as prescribed and monitor for side effects.
Monitoring for Complications: Observe signs and symptoms of complications like cardiovascular disease, diabetes, and vision problems.
Support and Emotional Care: Provide emotional support and guidance to patients and their families as they adjust to the diagnosis and treatment.
Regular Monitoring: Includes regular IGF-1 and GH level monitoring, as well as monitoring for complications.
Lifestyle Modifications: Weight management, exercise, and a healthy diet are important for improving overall health and managing complications.

Nursing interventions for acromegaly/gigantism:

Monitor and assess the patient’s physical and psychological well-being, including symptoms, vital signs, and emotional state.
Educate the patient about the condition, its management, and the importance of treatment compliance.
Assist in the administration of prescribed medications and monitor for potential side effects.
Monitor and manage pain, including joint pain and headaches, through appropriate pain management strategies.
Support the patient in maintaining a healthy lifestyle, including regular exercise and a balanced diet.
Provide emotional support and counseling to address body image concerns and potential psychosocial challenges.
Assess and monitor the patient’s endocrine function, including hormonal levels, to evaluate treatment effectiveness and detect any complications.
Monitor the patient’s cardiovascular health by assessing blood pressure, heart rate, and signs of heart enlargement or dysfunction.
Assist with the management of comorbidities that may arise, such as diabetes, hypertension, and sleep apnea.
Educate the patient on the importance of regular follow-up appointments, including hormone level monitoring, imaging studies, and other necessary investigations.
Collaborate with the healthcare team to provide coordinated care and ensure continuity of treatment.
Help the patient cope with potential psychological and emotional challenges associated with the condition, such as body image changes, anxiety, and depression.
Promote a safe environment by assisting with mobility, falls prevention, and management of joint pain and limited mobility.
Encourage the patient to engage in activities that promote overall well-being and quality of life.
Provide nutritional counseling to ensure a balanced diet that supports bone health.
Foster open communication and a therapeutic relationship with the patient, addressing any concerns or questions they may have.

Complications

Sterility in females and importance in males
Poor learning ability
Lack of sexual development
Poor concentration
Irritability
Heart disease
Diabetes mellitus
Gallstone
Enlargement of internal organs like heart, liver
Cancer
Polyp formation

Nursing Care Plan for Acromegaly and Gigantism

Assessment	Nursing Diagnosis	Goals/Expected Outcomes	Interventions	Rationale	Evaluation
1. Patient verbalizes anxiety over physical appearance changes (thickened skin, enlarged face, hands, and feet).	Disturbed Body Image related to anxiety over thickened skin and enlargement of face, hands, and feet.	The patient will verbalize acceptance of their appearance and demonstrate behaviors to enhance body image.	– Provide emotional support and counseling to address feelings of self-consciousness. – Encourage patient participation in grooming and self-care activities. – Involve the patient in support groups with others experiencing similar conditions.	To reduce anxiety and promote positive coping mechanisms. Engaging in self-care can enhance self-esteem. Support groups offer emotional support and shared experiences.	The patient reports reduced anxiety and increased acceptance of physical changes.
2. Patient shows signs of emotional distress, and expresses feelings of helplessness due to changes in appearance.	Ineffective Coping related to change in appearance.	The patient will demonstrate effective coping strategies and verbalize reduced distress.	– Assess the patient’s current coping mechanisms and provide education on effective coping strategies. – Refer the patient to a psychologist or counselor for additional support. – Encourage participation in activities that the patient enjoys and finds relaxing.	Understanding current coping methods allows for targeted interventions. Professional counseling can help the patient develop healthy coping strategies. Participation in enjoyable activities can reduce stress and improve mood.	The patient demonstrates effective coping strategies and verbalizes reduced emotional distress.
3. Patient reports tingling sensations in the hands and feet, and reduced sensitivity to touch.	Disturbed Sensory Perception related to nerve compression from tissue overgrowth.	The patient will report a reduction in tingling and an improvement in sensory perception.	– Monitor and document changes in sensory perception regularly. – Educate the patient on the importance of avoiding activities that could lead to injury due to decreased sensation. – Collaborate with physical therapy to enhance sensory perception.	Regular monitoring helps in identifying worsening or improving conditions. Educating the patient reduces the risk of injury. Physical therapy can improve sensory function and prevent complications.	The patient reports reduced tingling and improved sensory perception.
4. Patient reports difficulty sleeping due to soft tissue swelling.	Disturbed Sleeping Pattern related to soft tissue swelling.	The patient will report improved sleep quality and reduced nighttime discomfort.	– Elevate the head of the bed to reduce swelling and improve breathing. – Encourage the patient to maintain a regular sleep schedule. – Administer prescribed medications to reduce swelling as needed.	Elevation can help reduce fluid accumulation in tissues. A regular sleep schedule improves sleep quality. Medications can help manage swelling and discomfort.	The patient reports improved sleep and reduced nighttime discomfort.
5. Patient shows signs of dehydration (dry skin, decreased urine output).	Fluid Volume Deficit related to increased metabolic demands and soft tissue growth.	The patient will maintain adequate hydration, as evidenced by normal skin turgor and urine output.	– Monitor daily fluid intake and output, and encourage adequate fluid consumption. – Administer intravenous fluids as prescribed if oral intake is insufficient. – Educate the patient on the importance of hydration and signs of dehydration to watch for.	Monitoring fluid balance helps prevent complications. IV fluids provide hydration when oral intake is insufficient. Education empowers the patient to manage their condition effectively.	The patient maintains normal hydration levels, with normal skin turgor and urine output.
6. Patient expresses anxiety about changes in appearance and possible social implications.	Anxiety related to change in appearance.	The patient will report reduced anxiety and demonstrate relaxation techniques.	– Assess the patient’s level of anxiety and provide reassurance. – Teach relaxation techniques such as deep breathing and progressive muscle relaxation. – Encourage open communication about concerns and fears.	Assessing anxiety levels allows for appropriate interventions. Relaxation techniques help reduce anxiety. Open communication fosters trust and understanding.	The patient reports reduced anxiety and effectively uses relaxation techniques.
7. Patient shows a lack of understanding about their condition and its management.	Knowledge Deficit related to lack of information about acromegaly/gigantism and its management.	The patient will demonstrate an understanding of their condition and engage in appropriate self-care behaviors.	– Provide comprehensive education about acromegaly/gigantism, including causes, symptoms, and treatment options. – Encourage the patient to ask questions and participate in care decisions. – Offer written materials and resources for further learning.	Education empowers the patient to manage their condition effectively. Involving the patient in care decisions increases adherence to the treatment plan. Written materials provide ongoing reference and support learning.	The patient demonstrates understanding of their condition and actively participates in their care.

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OPIO JEJE

February 25, 2023 at 9:50 am

Thanks for d information

Kule Johnson

August 9, 2024 at 12:18 am

thanks for the information, but I wish you start the idea of managing these conditions using a nursing process, but all fails please always make some nursing diagnoses, thanks so much

Okwera tonny

January 28, 2025 at 7:02 am

Thank for summarising the mgt