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# Acromegaly and gigantism

Too much growth hormone, almost always from a benign pituitary tumour. In adults it enlarges the hands, feet and face; in children it causes gigantism.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Pituitary gland](https://durgical.com/en/anatomy/pituitary-gland/)
- [Sella turcica](https://durgical.com/en/anatomy/sella-turcica/)
- [Mandible](https://durgical.com/en/anatomy/mandible/)
- [Optic chiasm](https://durgical.com/en/anatomy/optic-chiasm/)
- [Frontal bone](https://durgical.com/en/anatomy/frontal-bone/)
- [Maxillae](https://durgical.com/en/anatomy/maxilla/)
- [Sphenoid sinus](https://durgical.com/en/anatomy/sinus-of-sphenoid-bone/)
- [Cavernous sinus](https://durgical.com/en/anatomy/cavernous-sinus/)

## In embryology

- [Pituitary gland: Rathke pouch and the neurohypophysis](https://durgical.com/en/embryology/pituitary-gland-rathke-pouch-and-the-neurohypophysis/)

## In the clinical exam

- [Diagnostic facies](https://durgical.com/en/clinical-exam/diagnostic-facies/)

## Why it happens

- [Hypertrophy: physiologic and pathologic](https://durgical.com/en/general-pathology/hypertrophy-physiologic-and-pathologic/)
- [Growth hormone and IGF-1](https://durgical.com/en/physiology/growth-hormone-and-igf-1/)
- [Measuring hormones: stimulation and suppression tests](https://durgical.com/en/physiology/measuring-hormones-stimulation-and-suppression-tests/)
- [Pituitary: adenohypophysis and neurohypophysis](https://durgical.com/en/histology/pituitary-adenohypophysis-and-neurohypophysis/)

## What it is

A chronic disease caused by excess growth hormone (GH) and its mediator IGF-1, nearly always from a GH-secreting pituitary adenoma. Before the growth plates close it causes gigantism (excessive height); after closure it causes acromegaly (enlargement of bones and soft tissues).

## Who gets it

Rare, with an insidious course: diagnosis is often delayed by many years, and in Latin American series most tumours are already macroadenomas when found. Affects men and women similarly, usually diagnosed in middle age.

## Causes

- GH-secreting pituitary adenoma (somatotroph adenoma) in almost all cases
- Rarely ectopic GHRH secretion by a neuroendocrine tumour
- Inherited syndromes: MEN 1, McCune-Albright syndrome, Carney complex, familial isolated pituitary adenoma

## Risk factors

- Family history of pituitary tumours or MEN 1
- Genetic syndromes listed above (rare)

## Pathophysiology

GH acts mainly through IGF-1 made in the [liver](https://durgical.com/en/anatomy/liver/), which drives growth of bone, cartilage and soft tissues. GH also opposes insulin, causing insulin resistance and diabetes, and promotes sodium retention and hypertension. The enlarging adenoma can compress the [optic chiasm](https://durgical.com/en/anatomy/optic-chiasm/) and the normal pituitary.

## Classification

- Gigantism: GH excess before epiphyseal closure
- Acromegaly: GH excess after epiphyseal closure
- By tumour size: microadenoma under 10 mm, macroadenoma 10 mm or more

## Symptoms and signs

- Enlarged hands and feet (larger ring and shoe size)
- Coarse facial features: prominent brow and jaw (prognathism), widened teeth spacing, large nose and [tongue](https://durgical.com/en/anatomy/tongue/)
- Excessive sweating, oily thick [skin](https://durgical.com/en/anatomy/skin/) and skin tags
- Joint pain, [carpal tunnel](https://durgical.com/en/anatomy/carpal-tunnel/) syndrome and snoring with sleep apnoea
- Headache and visual field defects
- In children, accelerated growth and very tall stature

## Red flags

- Sudden severe headache and vision loss (pituitary apoplexy)
- [Chest](https://durgical.com/en/anatomy/region/chest/) pain, breathlessness or oedema suggesting cardiomyopathy or heart failure
- Very high glucose with dehydration
- Rapid visual field loss

## Diagnosis

**Clinical**
Compare old photographs, look for acral and facial changes, measure blood pressure and examine visual fields. In children, plot height on growth charts.

**Tests**
Serum IGF-1 is the screening test; failure of GH to suppress during an oral glucose tolerance test confirms the diagnosis. Other pituitary hormones, prolactin, glucose and HbA1c are checked.

**Imaging**
Pituitary MRI to locate and size the adenoma. Echocardiography, sleep study and colonoscopy are used to look for complications.

## Differential diagnosis

- Constitutional tall stature (in children)
- Familial coarse features or pachydermoperiostosis
- Hypothyroidism (thick skin and coarse features)
- Marfan syndrome and Klinefelter syndrome as causes of tall stature
- Ectopic GHRH secretion

## Goal of treatment

Normalise IGF-1 and GH, remove or control the tumour, protect vision and pituitary function, and treat cardiovascular, metabolic and joint complications.

## Treatment

**Surgical**
Transsphenoidal resection of the adenoma is first-line and can cure many microadenomas.

**Medical**
When surgery fails or is not possible: somatostatin analogues (octreotide, lanreotide), the GH receptor antagonist pegvisomant, and sometimes cabergoline.

**Procedure**
Radiotherapy (conventional or stereotactic) for residual tumour not controlled by medicine.

**Follow-up**
Periodic IGF-1, MRI, visual fields and screening for diabetes, hypertension, heart disease, sleep apnoea and colon polyps.

## Drugs for this condition

- [Bromocriptine](https://durgical.com/en/pharmacology/bromocriptine/)

## Complications

- Hypertension, cardiomyopathy and heart failure
- Type 2 diabetes from insulin resistance
- Obstructive sleep apnoea
- Arthropathy and carpal tunnel syndrome
- Colonic polyps and colorectal cancer
- Hypopituitarism and visual loss

## Prognosis

Untreated, cardiovascular and respiratory disease shorten life expectancy. With biochemical control, mortality approaches that of the general population, although bone and joint changes do not fully reverse.

## Prevention

- No primary prevention; earlier recognition of facial and acral changes shortens diagnostic delay
- Screening of relatives in familial syndromes such as MEN 1

## Test yourself

Think of the answer, then tap the question to see it.

## What is the best screening test for acromegaly?

Serum IGF-1, which reflects integrated GH secretion.

## Which test confirms acromegaly?

Failure of GH to suppress during an oral glucose tolerance test.

## What is the first-line treatment of a GH-secreting adenoma?

Transsphenoidal surgical resection; somatostatin analogues and pegvisomant are used if it is not curative.

## What is the most common cause of death in untreated acromegaly?

Cardiovascular disease (hypertension, cardiomyopathy and heart failure).

## What determines whether GH excess causes gigantism or acromegaly?

Whether the epiphyseal growth plates are still open (gigantism) or already closed (acromegaly).

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/acromegaly-and-gigantism/)

## Related conditions

- [Pituitary adenoma](https://durgical.com/en/conditions/pituitary-adenoma/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/)
- [Carpal tunnel syndrome](https://durgical.com/en/conditions/carpal-tunnel-syndrome/)
- [Colorectal polyps and hereditary polyposis syndromes (FAP, Lynch)](https://durgical.com/en/conditions/colorectal-polyps-and-hereditary-polyposis-syndromes/)
- [Multiple endocrine neoplasia (MEN 1, 2A, 2B)](https://durgical.com/en/conditions/multiple-endocrine-neoplasia/)
- [Hypopituitarism (incl. Sheehan syndrome and pituitary apoplexy)](https://durgical.com/en/conditions/hypopituitarism/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Acromegaly](https://medlineplus.gov/ency/article/000321.htm) (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025); [Gigantism](https://medlineplus.gov/ency/article/001174.htm) (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025).

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Source: https://durgical.com/en/conditions/acromegaly-and-gigantism/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/acromegaly-and-gigantism/