Acromegaly & Pituitary Tumors

The patient's rings no longer fit and their shoes are a size larger than last year — these aren't aging changes. They're clues to a growth hormone-secreting pituitary tumor that alters every body system.

Acromegaly results from excess growth hormone (GH) secreted by a pituitary adenoma after epiphyseal plate closure in adults. Because bones can no longer lengthen, GH stimulates periosteal growth — hands, feet, jaw, and brow ridge enlarge gradually. Soft tissue thickens, causing coarse facial features, macroglossia, and deepened voice. Organs enlarge too: cardiovascular disease (cardiomyopathy, heart failure, arrhythmias) is the leading cause of death. Insulin-like growth factor-1 (IGF-1) is the primary screening lab because GH is pulsatile and unreliable as a single draw. Diagnosis is confirmed when GH fails to suppress below 1 ng/mL during an oral glucose tolerance test. Transsphenoidal hypophysectomy (surgical removal through the upper lip/nasal approach) is the first-line treatment. Post-op nursing priorities center on protecting the surgical site: avoid coughing, sneezing, bending, straining, and nose blowing. Monitor for CSF leak by testing nasal drainage for glucose (positive = CSF). A persistent postnasal drip or the patient swallowing frequently suggests a posterior leak. Hormone replacement may be lifelong if remaining pituitary tissue is damaged.

Key Distinctions

Don't confuse acromegaly (adults, bones widen) with gigantism (children, bones lengthen) — same hormone, different skeletal result based on open vs. closed growth plates. Students mix up post-op CSF leak signs with a simple runny nose — nasal drainage that tests positive for glucose or forms a halo sign on linen is CSF until proven otherwise. IGF-1 is the screening test; GH suppression test is confirmatory — they aren't interchangeable.

Clinical Pearl

Post-transsphenoidal surgery: if the pillow is wet and the drainage tastes salty to the patient, think CSF leak — test for glucose immediately and elevate the head of bed.