Acromegaly Nursing Care Plan & Management

 Definition

  • Acromegaly is a rare, chronic, and disabling disorder of body growth and endocrine dysfunction in adults (after closure of the epiphyses) that is caused by excessive levels of growth hormone (GH). It occurs in approximately 40 persons per million. In adults, it is almost always due to a growth hormone–secreting pituitary adenoma. The excess production of GH causes enlargement of tissues and an altered production of glucocorticoids, mineralocorticoids, and gonadotropins. Left untreated, acromegaly causes gross physical deformities, crippling neuromuscular alterations, major organ dysfunctions, and decreased visual acuity. Arthritis or carpal tunnel syndrome may also develop. Acromegaly increases an individual’s risk for heart disease, diabetes mellitus, and gallstones. The resultant cardiac disease reduces life expectancy.
Causes
  • The overproduction of GH is a result of hyperpituitarism. More than 90% of patients have a pituitary adenoma. The etiology of adenomas is unknown. Hyperpituitarism can also occur with lung, gastric, breast, and ovarian cancers and may have a genetic cause.
Genetic Considerations
  • While most cases of acromegaly are not inherited, mutations in the GNAS1 gene can cause GH secreting pituitary adenomas (somatotrophinomas). These can be transmitted in an autosomal dominant pattern. Familial acromegaly may also be a feature of multiple endocrine neoplasia type I (MEN I), an autosomal dominant disorder that includes peptic ulcer disease and pituitary, parathyroid, and pancreas endocrine abnormalities.
Gender, Ethnic/Racial, and Life Span Considerations
  • Diagnosis of acromegaly usually occurs after the age of 40 in men and 45 in women, and occurs more frequently in women than in men. Ethnicity and race have no known effects on the risk for acromegaly.

Risk Factors
  • Some rare cases of acromegaly are hereditary.
  • The average age of diagnosis is 40-45 years old.
Symptoms
  • Symptoms usually develop very slowly over time.
  • Acromegaly can cause serious complications and premature death if not treated.
  • In children, excess GH production causes elongation of the bones and associated soft tissue swelling. If not treated, children with this disorder can grow ta height of 7-8 feet.
  • Symptoms and complications in adults may include the following:
    • Abnormally large growth and deformity of the:
      • Hands (rings no longer fit)
      • Feet (need a bigger size shoe)
      • Face (protrusion of brow and lower jaw)
      • Jaw (teeth do not line up correctly when the mouth is closed)
      • Lips
      • Tongue
    • Carpal tunnel syndrome
    • Skin changes, such as:
      • Thickened, oily, and sometimes darkened skin
      • Severe acne
      • Excessive sweating and offensive body order due to enlargement of the sweat glands
    • Deepening voice due to enlarged sinuses, vocal cords, and soft tissues of the throat
    • Fatigue and weakness in legs and arms
    • Sleep apnea
    • Arthritis and other joint problems especially in the jaw
    • Hypothyroidism
    • Enlargement of the liver, kidneys, spleen, heart, and/or other internal organs, which can lead to:
      • Diabetes
      • High blood pressure
      • Cardiovascular disease
  • In women:
    • Irregular menstrual cycles
    • Galactorrhea (abnormal production of breast milk) in 50% of cases
  • In men:
    • In about 50% of cases, impotence