An Integrative Medicine Approach to Acromegaly

People with acromegaly experience irregular growth of bones and organs along with elevated blood sugar levels and other symptoms due to high levels of growth hormone in their bodies. Because the growth hormone particularly impacts the bones of the hands, feet, and face, acromegaly causes a characteristic appearance with enlarged hands, feet, and facial features. This most commonly occurs due to a tumor in the pituitary gland that produces growth hormones and triggers the liver to produce insulin-like growth factor type 1.

This condition impacts adults, most commonly during the fourth and fifth decades of life. Acromegaly is a rare hormonal disorder, impacting around 3 to 14 of every 100,000 people.  

Integrative medicine offers strategies that can be personalized to each individual, allowing for comprehensive management of this potentially life-threatening condition. Reducing growth hormone and insulin-like growth factor type 1 helps to prevent complications from developing and restores quality of life. 

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What is Acromegaly?

Acromegaly is a rare medical condition that occurs when tumor(s) in the pituitary gland or other tissues produce too much growth hormone in adults who have ceased growth in height. The most common cause of acromegaly is a pituitary adenoma or tumor in the pituitary gland that releases excess growth hormone. These tumors are usually benign (non-cancerous) and slow-growing. Less commonly, acromegaly occurs due to tumors in other parts of the body, such as the lung or pancreas, that produce growth hormone or growth hormone-releasing hormone (GH-RH), which signals the pituitary gland to make more GH.

Your pituitary gland is a tiny endocrine gland located at the base of your brain under the hypothalamus that releases several hormones. One of these is growth hormone, which promotes growth during childhood. Once your growth plates have fused, growth hormone continues to be released to help maintain normal bone, cartilage, and organ structure. 

Growth hormone is also essential for regulating metabolism such as blood glucose/sugar levels. It is also known as human growth hormone (hGH) or somatotropin. The impacts of growth hormone are mediated by triggering your liver to produce insulin-like growth factor 1 (IGF-1). IGF-1 causes growth in bones, cartilage, and organs and also impacts how your body processes fats and carbohydrates.

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In acromegaly, too many growth hormones are released into the body, which causes abnormal growth in bones, cartilage, body organs, and other tissues. This results in a characteristic appearance of larger hands, feet, ears, lips, and nose and a more prominent jaw and forehead. Acromegaly also causes elevated blood sugar levels (hyperglycemia) and can lead to type 2 diabetes, high blood pressure, and heart disease due to elevated growth hormone-triggered levels of IGF-1. 

Additional potential symptoms of acromegaly include excessive sweating or oily skin, voice deepening, joint pain, increasing numbers of skin tags, severe snoring and sleep apnea, irregular menstrual cycles, erectile dysfunction, low libido, spinal cord issues, and carpal tunnel syndrome. When acromegaly is caused by a large pituitary adenoma, it can also result in headaches and visual changes if the tumor presses against nearby parts of the brain. These symptoms can often be subtle and develop slowly over time. 

Conventional Treatments for Acromegaly

Treatment of acromegaly is individualized based on the underlying cause and symptoms. Traditional acromegaly treatments include surgery, medication, and radiation therapy.

Transsphenoidal surgery through the nose and sphenoid sinus in the skull behind the nasal passages is frequently used to access and remove a pituitary tumor that is causing excess growth hormone. Surgery is a curative treatment for acromegaly in around 85% of small tumors and 40% to 50% percent of more extensive tumors.

If surgery is not possible or only part of the tumor can be removed, medication or radiation therapy may be added to manage symptoms and reduce growth hormone production. 

Radiation therapy may be used when the entire tumor cannot be removed to help shrink the remaining tumor cells over time. Radiation can also damage surrounding issues and impact other pituitary hormones, so monitoring is required. 

Medications like octreotide (Sandostatin) and lanreotide (Somatuline Depot) are synthetic versions of the hormone somatostatin that help to reduce growth hormone levels. Somatostatin is a hormone produced by the nervous system and gastrointestinal tract that inhibits the action of growth hormone. These medications act like the natural hormone to signal the pituitary gland to produce less GH and can sometimes help to reduce the size of a pituitary tumor.

Other medications work by blocking the action of growth hormone. These growth hormone antagonists, like pegvisomant (Somavert), block the effect of GH on the body's tissues to help lower IGF-1 levels and relieve symptoms of acromegaly, although they do not lower growth hormone levels or reduce tumor size. 

Another group of medications that are used to treat acromegaly are dopamine agonists, including cabergoline and bromocriptine (Parlodel). These medications help lower levels of growth hormone and IGF-1 and may also help decrease the size of a tumor. They usually need to be taken at high doses, which comes with an increased risk of side effects like nausea, vomiting, stuffy nose, tiredness, dizziness, sleep problems, and mood changes.

Integrative Medicine in Acromegaly Management

Effectively treating acromegaly requires a multidisciplinary and cooperative approach. Integrative medicine for acromegaly offers additional treatment options and modalities that can complement traditional treatments. This holistic acromegaly approach helps to minimize and mitigate side effects, address the whole individual and her needs, and improve quality of life.

While traditional methods of treatment can often result in regulating hormone levels and test results, patients may continue to struggle with ongoing symptoms that impact their quality of life. Integrative medicine offers additional management options for this chronic condition that can help patients live more comfortable and whole lives. This patient-centered approach to care recognizes the importance of symptom control and optimization of quality of life in addition to biochemical control (normalization of serum IGF-1 levels).

An integrative medicine approach to acromegaly recognizes the complete picture of the patient and her day-to-day experience with the condition. This type of management plan incorporates strategies to address symptoms and complications, psychological struggles, and individual needs while optimizing hormone levels. 

Dietary and Nutritional Interventions For Acromegaly

Dietary interventions are one component of an integrative medicine approach to acromegaly. Overall, an anti-inflammatory diet that focuses on whole foods like vegetables, fruits, legumes, and sustainably raised fish and meats in those who consume them helps to reduce inflammation in the body and improve accompanying symptoms like fatigue, swelling, joint pain, and headaches. 

Nutrition status and nutrient levels have a significant impact on the regulation of growth hormone secretion. In the other direction, growth hormone also has an effect on metabolism and how various nutrients are utilized.

Studies have also investigated more targeted acromegaly diets. Research suggests that a caloric, very low-carbohydrate ketogenic diet containing less than 50 grams of carbohydrates per day can help to treat acromegaly and result in a reduction in medication need. This type of diet induces ketosis, which reduces insulin levels. Subsequently, hepatic growth hormone receptors and IGF-1 synthesis are reduced, resulting in the improvement of biochemical markers of disease. A proof-of-concept study investigating this approach showed that two weeks of consuming a diet composed of 35 grams of carbohydrate, approximately 155 grams of fat, and around 115 grams of protein per day was well tolerated and reduced IGF-1 in patients with uncontrolled acromegaly when used as adjuvant treatment to first-generation somatostatin receptor ligands.

Other studies show that periodic or prolonged caloric restriction, an Okinawa diet that is low in protein and rich in carbohydrates, and a diet modified to have low levels of the amino acids leucine, valine, and isoleucine also help control acromegaly and regulate hormone levels.

Lifestyle Changes and Stress Management For Acromegaly

Acromegaly can be a challenging chronic condition to live with. Lifestyle approaches and stress management practices offer potent strategies to help patients cope with the psychological symptoms that accompany this disease.

For example, people with acromegaly commonly experience psychological and somatic symptoms that contribute to depression, stress, and difficulties maintaining relationships due to symptoms and self-consciousness resulting from visible body changes. In addition, the chronic nature of the condition and the need for regular monitoring of complications and blood levels can result in an additional burden, stress, and anxiety. 

Regularly practicing mind-body techniques and stress management practices like meditation and deep breathing help to promote the body's natural relaxation response and build resilience to cope with chronic stress. Studies show that mindfulness-based practices help improve mood, quality of life, and pain levels. A randomized multicentre, international clinical trial found that an eight-week face-to-face group mindfulness program improved sleep, self-compassion, and pain levels in people with acromegaly.

Complementary Therapies FOr Acromegaly

Complementary therapies are also valuable for bringing the body back into balance and reducing symptoms and complications in people with acromegaly. 

The Traditional Chinese Medicine practice of acupuncture utilizes fine needles placed in specific points in the body to stimulate the nervous system and energy flow in the body. This technique offers a holistic approach to pain relief that helps to treat physical pain as well as emotional and psychological factors that go along with and contribute to chronic pain. 

In Traditional Chinese Medicine, acromegaly is thought to involve imbalances in systems looked at as kidney jing deficiency, kidney yang deficiency, and others. Stimulating acupuncture or acupressure points, especially along the spine and scalp, are thought to bring the body towards better balance. 

Other complementary therapies that could benefit acromegaly are under study. For example, curcumin (Curcuma longa), which is found in turmeric, has been shown to have anti-tumor activities that may help treat pituitary tumors. In addition, curcumin has been shown to improve joint pain and inflammation that may accompany acromegaly. 

To help cope with the immense psychological burdens that can result from acromegaly and the physical changes that accompany it, a whole-person approach is needed. Addressing both the mind and body with complementary therapies recognizes the patient as a complete being. One mind-body approach that has shown success in acromegaly is cognitive behavioral therapy. This technique helps to identify and replace unhealthy behaviors, thoughts, and emotions with more constructive behaviors, ideas, and positive reflections on their associated emotions. A study showed that nine weekly group sessions of this type of cognitive behavioral therapy approach improved acromegaly patients’ quality of life and helped them cope with the stress and emotional impacts of changes in their physical appearance.

Functional Medicine Lab Testing For Acromegaly

Since acromegaly often progresses slowly, functional medicine laboratory testing can help to detect the condition in the early stages so that treatment can be implemented to prevent complications from developing. It is also valuable for monitoring potential complications like blood sugar issues and evaluating liver and kidney function. Assessing functional medicine testing for acromegaly allows for the development of personalized treatment plans to improve quality of life.

IGF-1 Levels

IGF-1 level is a marker of growth hormone secretion and is therefore recommended as the initial screen for acromegaly. IGF-1 can be measured in the blood with a test from Access Medical Laboratories. Levels are tested after an overnight fast. An elevated IGF-1 level is indicative of acromegaly. If IGF-1 is normal, this excludes the diagnosis of acromegaly. 

IGF-1 testing may be inaccurate in some cases. This marker can also be elevated during pregnancy and late-stage adolescence and may be falsely elevated, normal, or low with liver and kidney failure, hypothyroidism, malnutrition, severe infection, and poorly controlled diabetes mellitus.

To monitor disease control over time, IGF-1 levels can be longitudinally monitored with management of acromegaly reflected by the target goal of an age-normalized serum IGF-1 value.

Growth Hormone Suppression Test 

Growth hormone levels can also be measured in the blood with testing from Access Medical Laboratories. To confirm the diagnosis of acromegaly a growth hormone suppression test can be used. Blood levels of growth hormone are measured before and after you drink a preparation of sugar (glucose). With acromegaly, growth hormone levels stay elevated after consuming the sugar, whereas they will typically fall in people who do not have acromegaly. Guidelines suggest a diagnosis of acromegaly can be confirmed if suppression of growth hormone to <1 μg/L occurs following documented hyperglycemia during an oral glucose load.

Growth hormone levels can also be used to monitor how well the disease is controlled. A random growth hormone level of <1.0 μg/L is considered the therapeutic goal, reflecting control of acromegaly.

Imaging

If these biochemical laboratory tests are suggestive of acromegaly, imaging to evaluate for the presence of a pituitary tumor should be performed with a magnetic resonance imaging (MRI) or computed tomography (CT) scan.

Liver Function Testing 

A Hepatic Function Panel from‍ BostonHeart Diagnostics assesses overall liver health and function. This test measures liver enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), proteins, and bilirubin (a substance in bile) in the blood.

Patients who are treated with the human growth hormone receptor antagonist pegvisomant should have regular monitoring of liver function with monitoring of liver function tests monthly for the first six months and then every six months after that. 

Kidney Function Testing

‍Acromegaly can impact kidney function and the structure of the kidneys. It is suspected that increased growth hormone in people with acromegaly may lead to hyperfiltration in the kidneys that contributes to the deterioration of renal function over time.

Kidney function can be evaluated with blood testing to measure markers such as blood urea nitrogen (BUN) from BostonHeart Diagnostics, which reflects the amount of urea nitrogen in the blood to determine how well the kidneys are functioning to remove wastes. Creatinine from Access Medical Laboratories and glomerular filtration rate can also be measured in the blood to assess kidney function.

Monitoring and Managing Complications

Often, acromegaly presents slowly over time with non-specific symptoms like joint pain and headaches that may be mistaken for stress, aging, or other diseases. This commonly results in delays in diagnosis, allowing long-term changes and complications to develop.  

If levels of growth hormone remain elevated over long periods of time, complications can develop. If acromegaly goes untreated and these types of complications persist, life expectancy may be reduced by approximately ten years. Long-term exposure to excess growth hormone can contribute to the development of type 2 diabetes, high blood pressure, heart disease like cardiomyopathy (a disease of your heart muscle), arthritis, colon polyps, which can potentially turn into colon cancer if left untreated, and organ failure.

Since acromegaly can impact many parts of the body and organs, resulting in these types of complications, regular monitoring for complications is crucial. For example, imaging of the heart function with an echocardiogram can monitor potential heart issues, while a colonoscopy can help to monitor for colon polyps or signs of colon cancer. In addition, a sleep study can help to evaluate the presence of sleep apnea. X-rays or a DEXA (DXA) scan are used to measure any impacts on bone strength and health. When these comorbidities are identified, they should be managed and monitored over time using laboratory testing and clinical evaluation. 

Patient Education and Empowerment

Involving patients as partners in their own care is critical for empowering them to play an active role in their health and well-being. Educating acromegaly patients about their condition and ways that they can cope with its impacts gives them more tools to cope with their disease and prevent further complications. 

People with chronic diseases like acromegaly must cope with long-term monitoring and ongoing management of their condition in addition to living with the physical and emotional impacts of their disease. Patient empowerment in acromegaly helps people take responsibility for their self-care behaviors that can reduce and/or prevent potential complications. 

Empowerment provides a patient-centered, collaborative approach that helps to improve well-being, decision-making, and self-management. Interventions that help to empower patients with chronic diseases like acromegaly have been shown to improve health status, psychological state, and quality of life. Studies show that group and individual programs increase patient knowledge. These programs help teach people with chronic diseases more effective ways to care for their condition and result in improvements in bio-markers such as blood sugar control, blood pressure regulation, and cholesterol levels. Empowering patients with tools and education helps to improve their confidence in caring for their condition as well as their adherence to self-management.

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An Integrative Approach to Acromegaly: Key Takeaways

Acromegaly is a rare but serious chronic condition that is usually due to a pituitary tumor that produces too much growth hormone. Elevated growth hormone and IGF-1 can lead to chronic and life-threatening complications if not recognized and treated early, so a holistic approach to acromegaly is critical. 

An integrative approach to acromegaly incorporates multidisciplinary management that regulates biochemical levels and addresses patient symptoms and quality of life. Looking at the whole person and recognizing the impact on her physically and psychologically helps to treat the individual and all of her needs. This involves education, functional medicine laboratory monitoring, and patient empowerment so that evidence-based decisions and actions can be carried out as a doctor-patient team.