Acromegaly

What is Acromegaly?

Acromegaly is a rare disorder caused by too much growth hormone, most often from a noncancerous tumor (adenoma) in the pituitary gland. The extra growth hormone raises insulin-like growth factor 1 (IGF-1), which causes tissues to overgrow and affects the heart, lungs, joints, metabolism and other systems.^{[1, 2]}

Common symptoms

Acromegaly develops slowly. The classic signs are coarser facial features and enlarging hands and feet, and it also affects the heart, joints, lungs and metabolism.^[1] Joint involvement is among the most frequent complications and can be one of the earliest symptoms.^[3]

Other common problems include sweating, headache, tiredness, numbness or tingling in the hands, and sleep apnea.^{[4, 5]} Anxiety and depression are also common and can lower quality of life.^[6]

Causes and risk factors

Most growth hormone-secreting adenomas arise on their own, without an inherited cause. They are almost always benign but can grow locally despite treatment.^[2] Rare genetic syndromes and familial forms exist.^[1]

How it is diagnosed and treated conventionally

Diagnosis is made by an endocrinologist with blood tests for IGF-1 and growth hormone, and imaging of the pituitary.^{[2, 7]} The main treatment goals are to normalize IGF-1 and growth hormone, shrink or control the tumor, relieve symptoms, manage complications and improve quality of life.^[2]

This usually takes a combination of pituitary surgery, medical therapy and, less often, radiation.^[2] Symptoms and quality of life improve on treatment, but some complications may not be fully reversible.^{[2, 4]}

Why Acromegaly calls for a whole-person approach

Acromegaly is a hormone disease with effects throughout the body, so care is led by a specialist team. Some complications may not be reversible even with disease control, and anxiety and depression are common.^{[2, 6]}

Supportive care aims at these day-to-day symptoms. It does not treat the tumor or the hormone excess.

Joint and musculoskeletal pain

Acromegalic arthropathy results from overgrowth of cartilage and bone, and it can limit movement and cause lasting pain.^[3] Pain from this joint disease is part of why some people look for additional comfort measures.

Sleep and sleep apnea

Obstructive sleep apnea is common in acromegaly, and a meta-analysis found that the apnea-hypopnea index improved after treatment of the acromegaly.^[5] Sleep apnea needs its own medical evaluation and care.

Mood and quality of life

A systematic review of 55 studies found that anxiety and depression are significantly present in people with acromegaly. They were linked to lower quality of life, joint problems, body image concerns and longer disease duration.^[6]

Fatigue and headache

Fatigue and headache are among the individual symptoms that improved on treatment in a meta-analysis of 46 studies, so persistent symptoms should be reported to your endocrinologist.^[4]

Acupuncture as supportive care in Acromegaly

What the research shows

We found no clinical trials of acupuncture for acromegaly. The evidence below is for symptoms, not for the disease, and it comes from people who do not have acromegaly.

An individual patient data meta-analysis of 39 trials with 20,827 patients found acupuncture was better than sham and no-acupuncture controls for chronic musculoskeletal pain, osteoarthritis pain, chronic headache and shoulder pain. The benefit was small compared with sham, and it declined only slightly over a year.^[8] A review of 80 trials in knee osteoarthritis found acupuncture may reduce pain, but the certainty of the evidence was very low.^[9]

For sleep, a meta-analysis of 24 trials in insomnia found acupuncture improved sleep scores compared with medicines after more than three weeks, with high variability between studies.^[10] None of this shows that acupuncture would help joint disease or sleep apnea caused by acromegaly.

How acupuncture may work

How acupuncture might ease pain or help sleep is not fully known. In the pooled pain trials, differences from sham treatment were small, which suggests that factors beyond needle placement, such as the treatment experience, contribute to the effect.^[8] Acupuncture has no known effect on growth hormone or on a pituitary tumor.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, usually left in place for about 20 to 40 minutes. A course of several visits is followed by a reassessment of whether it is helping with symptoms.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Also tell us about recent pituitary surgery or radiation, and about any joint problems.

Ayurvedic medicine as supportive care in Acromegaly

The Ayurvedic view

Ayurveda has no classical name that matches acromegaly. Practitioners may describe features such as joint pain, heaviness or excess sweating in terms of the doshas, and plan supportive care around the person's symptoms and constitution. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and may include:

• Diet and daily routine aimed at regular sleep, steady meals and stress reduction
• Gentle warm oil massage for stiff joints, where suitable
• Breathing practices and relaxation
• Herbs for stress or sleep, prescribed individually after review of your medicines

Panchakarma is not appropriate during pregnancy, acute illness, frailty or in the weeks around surgery, and it is generally not suited to people with significant heart disease or other complications of acromegaly. The clinic can also discuss a herbal preparation applied to the skin (transdermal therapy), but no research supports it for this condition.

What the research shows

We found no clinical trials of Ayurvedic treatment for acromegaly. Evidence for individual herbs exists only for symptoms in other groups of people. Ashwagandha (Withania somnifera) was studied in a meta-analysis of 9 trials with 558 people and was associated with lower stress and anxiety scores and lower cortisol compared with placebo, and a separate meta-analysis of 5 trials found a small benefit for sleep. The authors said safety data for long-term use were limited.^{[12, 13]}

A review of curcumin and turmeric extracts in arthritis found they may improve pain and inflammation, but the trials were small and of low quality, and they did not include people with acromegaly.^[14]

Herbal medicine as supportive care in Acromegaly

Herbs and formulas that have been studied

No herb or formula has been studied as a treatment for acromegaly. Herbs that are traditionally used for pain, stress or sleep, such as those listed under Ayurveda, are the only ones that have been evaluated for symptoms, and only in other populations.

What the research shows

There is no research on herbal medicine for acromegaly. The symptom-level evidence for ashwagandha and curcumin is described above and is limited by small, short trials in other conditions.^{[12, 14]} Nothing suggests that any herb can lower growth hormone or shrink a pituitary tumor.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reported interactions include bleeding when ginkgo or danshen are combined with warfarin, and altered levels of other prescribed drugs with some herbs.^[15] People with acromegaly often take several medicines and may have diabetes or heart problems, so every herb should be reviewed by your physician first.

Ashwagandha deserves special care here. A review of its endocrine effects found it may change thyroid hormone and cortisol levels, which matters for people with pituitary disease and hormone replacement.^[16] Ashwagandha has also been linked to liver injury, which was severe in people with existing liver disease.^[17] Herbal supplements account for about 20% of drug-induced liver injury in the United States.^[18]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[19] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine may describe the joint pain and heaviness of acromegaly as obstruction by dampness or blood stasis, and Ayurveda uses the doshas to describe constitution and imbalance. Neither framework describes a pituitary tumor or excess growth hormone.

What can be measured are the symptoms: pain, sleep disruption and stress, which acupuncture and some herbs have been studied for in other groups.^{[8, 12]} Supportive care in this context is about comfort, not about changing the hormone disorder.

How this care fits with your medical care

Acromegaly needs treatment directed by an endocrinologist. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. We do not diagnose or manage acromegaly, adjust hormone-lowering medicines, or replace your physicians.

Please bring your diagnosis, recent IGF-1 and imaging results, details of any surgery or radiation, a full list of medicines and supplements, and any sleep apnea treatment you use. Do not stop or change prescribed treatment, including medicines or CPAP, without your prescriber.

When to seek urgent medical care

Acromegaly and its treatment can cause emergencies, so some symptoms need immediate attention.

• Sudden severe headache, especially with vomiting or a change in consciousness
• New loss of vision or changes in your visual field
• Chest pain, shortness of breath or a rapid or irregular heartbeat
• Extreme thirst, frequent urination or confusion, which can signal very high blood sugar
• Weakness, dizziness, vomiting or fainting, which can signal low hormone levels after pituitary treatment
• Pauses in breathing during sleep with severe daytime sleepiness

If any of these occur, call 911 or go to the nearest emergency department.