Understanding Comorbidities

By Acromegaly Answers Blog Staff

Recently, the writers at Acromegaly Answers (a Web log owned and operated by Ipsen) spoke with Daphne Adelman, a nurse at Northwestern University in Chicago, about comorbidities of acromegaly, what they are, why they occur, and what parts of the body they can affect.

About comorbidities and acromegaly
People with acromegaly wait approximately 4 to 10 years before getting an accurate diagnosis. During those years, their acromegaly is usually untreated. Long-term, untreated acromegaly comes with a higher risk of certain comorbid conditions and serious complications. These conditions can even lead to premature death; people with acromegaly have a 2- to 3-fold higher risk of premature death, generally resulting from cardiovascular, respiratory, and diabetic complications. This is why it is important to diagnose and treat acromegaly as early as possible.

Before diving into the comorbidities of acromegaly, let’s take another look at what causes it: too much growth hormone (GH) and too much insulin-like growth factor-1 (IGF-1). Too much GH is generally the result of a tumor on your pituitary gland. The surplus GH stimulates your liver and other tissues to produce more IGF-1 than your body needs. Together, too much GH and too much IGF-1 cause your organs and bones to grow, even after they should have stopped growing. And when that happens, the diagnosis is acromegaly.

There’s another thing that happens when your body produces too much IGF-1: it causes “comorbidities.” Comorbidity is a medical term that means a condition that happens at the same time as another condition. Comorbidities are not symptoms, which are caused by the disease itself, but conditions that commonly occur alongside the disease, in this case, acromegaly. The comorbidities related to acromegaly can occur throughout your body, affect different systems, and have a serious impact on your organs.

Examples of comorbidities of acromegaly
According to Daphne, too much GH and IGF-1 can affect you in different ways, changing your bones as well as the soft tissues of your body, and resulting in comorbidities, such as:

• Gigantism. If you’re young and your bones are still growing, too much GH and IGF-1 can make your bones continue to grow, causing what is called “gigantism.”
• Arthritis and other joint problems. If your bones have already stopped growing and you have too much GH, it can make the areas around your bones grow, like your cartilage and your joints. Because this growth is uneven and irregular, it can damage your joints, resulting in arthritis and other problems.
• Sleep apnea. As Daphne pointed out earlier, too much GH and IGF-1 can make soft tissue grow, which can create different health problems. If the tissues in your throat enlarge you might have difficulty breathing during sleep. This is a common comorbidity for people with acromegaly, called sleep apnea.
• Misalignment of your jaw and bite problems, widely spaced teeth, swelling of the tongue, or headaches.
• Menstrual problems or infertility.
• Exaggerated growth of your hands and feet.
• Thickened skin or skin tags at various places on your body.
• Excessive sweating, pins-and-needles in your hands and feet, carpal tunnel syndrome in your wrists, or overall joint pain.

Because there are so many comorbidities connected to acromegaly, many different doctors might be the first to notice your symptoms. One clinical study found that almost 40% of acromegaly patients were initially diagnosed by a family doctor, 25% by endocrinologists, 6% by ophthalmologists or optometrists, 5% by dentists, and 5% by neurologists who were looking into headaches.

Acromegaly can affect specific organs

• Cardiovascular problems. Too much GH and IGF-1 can make your heart grow too large and too rigid. Your heart is a powerful muscle that never stops pumping and if the muscle gets too stiff, it can’t pump your blood as well as it should.
• Type 2 diabetes. Your pancreas produces insulin, to help you turn sugar into energy, but too much GH increases your body’s need for insulin. If your pancreas cannot produce more insulin to meet the increased need, you could develop Type 2 diabetes.
• Colon polyps, problems in the gonads, headaches, and strokes.

If you think you have any of these conditions, tell your doctor right away.

Now it’s your turn, Acromegaly Answers blog readers
If you have acromegaly, think you have acromegaly, or care for someone with acromegaly, consider these questions:

• Have you become aware of any comorbidities since you were diagnosed?
• Have you noticed any changes in your sleep patterns?
• Do your shoes and gloves still fit comfortably?
• When you have your teeth cleaned, does the hygienist notice any changes from visit to visit?

Note that articles on this blog are written by a contracted writer/editor. Daphne Adelman received compensation from Ipsen for her time helping to develop this blog post.