Acromegaly

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|image1=Acromegaly hands.JPEG

|caption1=Compared with the hand of an unaffected person (left), the hand of a person with acromegaly (right) is enlarged, with fingers that are widened, thickened and stubby, and with thicker soft tissue

|image2=Acromegaly prognathism.JPEG

|caption2=Mandibular overgrowth leads to prognathism, maxillary widening, teeth spacing and malocclusion

|image3=Browprotrusion.jpg

|caption3=Brow ridge and forehead protrusion remaining after tumor removal and tissue swelling eliminated

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Features that may result from a high level of GH or expanding tumor include:{{citation needed|date=May 2022}}

• Headaches – often severe and prolonged
• Soft tissue swelling visibly resulting in enlargement of the hands, feet, nose, lips, and ears, and a general thickening of the skin
• Soft tissue swelling of internal organs, notably the heart with the attendant weakening of its muscularity, and the kidneys, also the vocal cords resulting in a characteristic thick, deep voice and slowing of speech
• Generalized expansion of the skull at the fontanelle
• Pronounced brow protrusion, often with ocular distension (frontal bossing)
• Pronounced lower jaw protrusion (prognathism) with attendant macroglossia (enlargement of the tongue) and teeth spacing
• Hypertrichosis, hyperpigmentation and hyperhidrosis may occur in these people.{{cite book | last1 = James | first1 = William | last2 = Berger | first2 = Timothy | last3 = Elston | first3 = Dirk | name-list-style = vanc | date = 2005 | title = Andrews' Diseases of the Skin: Clinical Dermatology | edition = 10th | publisher = Saunders | isbn = 0-7216-2921-0 }}{{Rp|499|date=May 2009}}
• Skin tags
• Carpal tunnel syndrome

• Problems with bones and joints, including osteoarthritis, nerve compression syndrome due to bony overgrowth, and carpal tunnel syndrome{{cite journal | vauthors = Melmed S, Casanueva FF, Klibanski A, Bronstein MD, Chanson P, Lamberts SW, Strasburger CJ, Wass JA, Giustina A | display-authors = 6 | title = A consensus on the diagnosis and treatment of acromegaly complications | journal = Pituitary | volume = 16 | issue = 3 | pages = 294–302 | date = September 2013 | pmid = 22903574 | pmc = 3730092 | doi = 10.1007/s11102-012-0420-x }}
• Hypertension{{cite journal | vauthors = Laws ER | title = Surgery for acromegaly: evolution of the techniques and outcomes | journal = Reviews in Endocrine & Metabolic Disorders | volume = 9 | issue = 1 | pages = 67–70 | date = March 2008 | pmid = 18228147 | doi = 10.1007/s11154-007-9064-y | s2cid = 1365262 }}
• Diabetes mellitus{{cite journal | vauthors = Fieffe S, Morange I, Petrossians P, Chanson P, Rohmer V, Cortet C, Borson-Chazot F, Brue T, Delemer B | display-authors = 6 | title = Diabetes in acromegaly, prevalence, risk factors, and evolution: data from the French Acromegaly Registry | language = en-US | journal = European Journal of Endocrinology | volume = 164 | issue = 6 | pages = 877–84 | date = June 2011 | pmid = 21464140 | doi = 10.1530/EJE-10-1050 | doi-access = free }}
• Cardiomyopathy, potentially leading to heart failure
• Colorectal cancer{{cite journal | vauthors = Renehan AG, O'Connell J, O'Halloran D, Shanahan F, Potten CS, O'Dwyer ST, Shalet SM | title = Acromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications | journal = Hormone and Metabolic Research | volume = 35 | issue = 11–12 | pages = 712–25 | year = 2003 | pmid = 14710350 | doi = 10.1055/s-2004-814150 | s2cid = 260166366 }}
• Sleep apnea
• Thyroid nodules and thyroid cancer{{cite journal | vauthors = Wolinski K, Czarnywojtek A, Ruchala M | title = Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly—meta-analysis and systematic review | journal = PLOS ONE| volume = 9 | issue = 2 | pages = e88787 | date = 2014-02-14 | pmid = 24551163 | pmc = 3925168 | doi = 10.1371/journal.pone.0088787 | bibcode = 2014PLoSO...988787W | doi-access = free }}
• Hypogonadism
• Compression of the optic chiasm by the growth of pituitary adenoma leading to visual problems{{cite journal | vauthors = Melmed S, Jackson I, Kleinberg D, Klibanski A | title = Current treatment guidelines for acromegaly | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 83 | issue = 8 | pages = 2646–52 | date = August 1998 | pmid = 9709926 | doi = 10.1210/jcem.83.8.4995 | doi-access = free }}

About 98% of cases of acromegaly are due to the overproduction of growth hormone by a benign tumor of the pituitary gland called an adenoma.{{cite book | vauthors = Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J |title=Harrison's Principles of Internal Medicine|date=8 April 2015|publisher=McGraw Hill|isbn=978-0071802154|pages=2269–2271|edition=19th}} These tumors produce excessive growth hormone and compress surrounding brain tissues as they grow larger. In some cases, they may compress the optic nerves. Expansion of the tumor may cause headaches and visual disturbances. In addition, compression of the surrounding normal pituitary tissue can alter the production of other hormones, leading to changes in menstruation and breast discharge in women and impotence in men because of reduced testosterone production.{{cite journal |url= https://www.ncbi.nlm.nih.gov/books/NBK551529/ | title= Anatomy, Head and Neck, Pituitary Gland

|website= National Center for Biotechnology Information, U.S. National Library of Medicine | year= 2022

| pmid= 31855373

|access-date= 27 June 2021| last1= Ganapathy

| first1= M. K.

| last2= Tadi

| first2= P.

}}

A marked variation in rates of GH production and the aggressiveness of the tumor occurs. Some adenomas grow slowly and symptoms of GH excess are often not noticed for many years. Other adenomas grow rapidly and invade surrounding brain areas or the sinuses, which are located near the pituitary. In general, younger people tend to have more aggressive tumors.{{cite journal |url= https://www.ncbi.nlm.nih.gov/books/NBK551529/ | title= Anatomy, Head and Neck, Pituitary Gland |website= National Center for Biotechnology Information, U.S. National Library of Medicine | year= 2022 | pmid= 31855373 |access-date= 27 June 2021| last1= Ganapathy | first1= M. K. | last2= Tadi | first2= P. }}

Most pituitary tumors arise spontaneously and are not genetically inherited. Many pituitary tumors arise from a genetic alteration in a single pituitary cell that leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth but is acquired during life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells; it permanently switches on the signal that tells the cell to divide and secrete growth hormones. The events within the cell that cause disordered pituitary cell growth and GH oversecretion currently are the subject of intensive research.

Pituitary adenomas and diffuse somatomammotroph hyperplasia may result from somatic mutations activating GNAS, which may be acquired or associated with McCune–Albright syndrome.{{cite journal | vauthors = Vortmeyer AO, Gläsker S, Mehta GU, Abu-Asab MS, Smith JH, Zhuang Z, Collins MT, Oldfield EH | display-authors = 6 | title = Somatic GNAS mutation causes widespread and diffuse pituitary disease in acromegalic patients with McCune–Albright syndrome | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 97 | issue = 7 | pages = 2404–13 | date = July 2012 | pmid = 22564667 | pmc = 3791436 | doi = 10.1210/jc.2012-1274 }}{{cite journal | vauthors = Salenave S, Boyce AM, Collins MT, Chanson P | title = Acromegaly and McCune–Albright syndrome | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 99 | issue = 6 | pages = 1955–69 | date = June 2014 | pmid = 24517150 | pmc = 4037730 | doi = 10.1210/jc.2013-3826 }}

In a few people, acromegaly is caused not by pituitary tumors, but by tumors of the pancreas, lungs, and adrenal glands. These tumors also lead to an excess of GH, either because they produce GH themselves or, more frequently, because they produce GHRH (growth hormone-releasing hormone), the hormone that stimulates the pituitary to make GH. In these people, the excess GHRH can be measured in the blood and establishes that the cause of the acromegaly is not due to a pituitary defect. When these nonpituitary tumors are surgically removed, GH levels fall and the symptoms of acromegaly improve.{{citation needed|date=August 2020}}

Image:Acromegaly growth hormone levels.JPEG

Diagnosis is by measuring growth hormone after a person has consumed a glucose solution, or by measuring insulin-like growth factor I in the blood. After diagnosis, medical imaging of the pituitary is carried out to determine if an adenoma is present. If excess growth hormone is produced during childhood, the result is the condition gigantism rather than acromegaly, and it is characterized by excessive height.

Image:Acromegaly pituitary macroadenoma.JPEG of a pituitary macroadenoma that caused acromegaly with compression of the optic chiasm]]

Other pituitary hormones must be assessed to address the secretory effects of the tumor, as well as the mass effect of the tumor on the normal pituitary gland. They include thyroid stimulating hormone (TSH), gonadotropic hormones (FSH, LH), adrenocorticotropic hormone, and prolactin.{{citation needed|date=October 2021}}

An MRI of the brain focusing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumor. A number of other overgrowth syndromes can result in similar problems.{{citation needed|date=May 2022}}

Pseudoacromegaly is a condition with the usual acromegaloid features but without an increase in growth hormone and IGF-1. It is frequently associated with insulin resistance.{{cite journal |last1=Yaqub |first1=Abid |last2=Yaqub |first2=Nadia |title=Insulin-mediated pseudoacromegaly: a case report and review of the literature |journal=West Virginia Medical Journal |date=1 September 2008 |volume=104 |issue=5 |pages=12–16 |id={{Gale|A201087184}} |pmid=18846753 }} Cases have been reported due to minoxidil at an unusually high dose.{{cite journal | vauthors = Nguyen KH, Marks JG | title = Pseudoacromegaly induced by the long-term use of minoxidil | journal = Journal of the American Academy of Dermatology | volume = 48 | issue = 6 | pages = 962–5 | date = June 2003 | pmid = 12789195 | doi = 10.1067/mjd.2003.325 }} It can also be caused by a selective post-receptor defect of insulin signalling, leading to the impairment of metabolic, but preservation of mitogenic, signaling.{{cite journal | vauthors = Sam AH, Tan T, Meeran K | title = Insulin-mediated 'pseudoacromegaly' | journal = Hormones | volume = 10 | issue = 2 | pages = 156–61 | year = 2011 | pmid = 21724541 | doi = 10.14310/horm.2002.1306 | doi-access = free }}

Image:Acromegaly treatment diagram.JPEG, radiotherapy, somatostatin analogues and dopamine agonists act at the level of the pituitary adenoma, while GH receptor antagonists act in the periphery by blocking the growth hormone receptor and thus impairing the effects of GH on the different tissues.]]

Treatment options include surgery to remove the tumor, medications, and radiation therapy. Surgery is usually the preferred treatment; the smaller the tumor, the more likely surgery will be curative. If surgery is contraindicated or not curative, somatostatin analogues or GH receptor antagonists may be used. Radiation therapy may be used if neither surgery nor medications are completely effective.{{cite web |title=Acromegaly |url=https://www.niddk.nih.gov/health-information/health-topics/endocrine/acromegaly/Pages/fact-sheet.aspx |website=NIDDK |access-date=20 August 2016 |date=April 2012 |url-status=live |archive-url=https://web.archive.org/web/20160827213949/https://www.niddk.nih.gov/health-information/health-topics/endocrine/acromegaly/Pages/fact-sheet.aspx |archive-date=27 August 2016}} Without treatment, life expectancy is reduced by 10 years; with treatment, life expectancy is not reduced.{{cite book |last1=Ho |first1=Ken |name-list-style = vanc |title=Growth Hormone Related Diseases and Therapy: A Molecular and Physiological Perspective for the Clinician |date=2011 |publisher=Springer Science & Business Media |isbn=9781607613176 |page=400|url=https://books.google.com/books?id=FWmbHHL4BwsC&pg=PA400 |language=en |url-status=live |archive-url=https://web.archive.org/web/20160825193205/https://books.google.ca/books?id=FWmbHHL4BwsC&pg=PA400 |archive-date=2016-08-25}}

The primary current medical treatment of acromegaly is to use somatostatin analogues – octreotide (Sandostatin) or lanreotide (Somatuline).

These somatostatin analogues are synthetic forms of a brain hormone, somatostatin, which stops GH production. The long-acting forms of these drugs must be injected every 2 to 4 weeks for effective treatment. Most people with acromegaly respond to this medication. In many people with acromegaly, GH levels fall within one hour and headaches improve within minutes after the injection. Octreotide and lanreotide are effective for long-term treatment. Octreotide and lanreotide have also been used successfully to treat people with acromegaly caused by non-pituitary tumors.{{citation needed|date=August 2020}}

Somatostatin analogues are also sometimes used to shrink large tumors before surgery.{{cite web |url= https://www.lecturio.com/concepts/acromegaly-and-gigantism/ | title= Acromegaly and Gigantism

|website= The Lecturio Medical Concept Library |access-date= 27 June 2021}}

Because octreotide inhibits gastrointestinal and pancreatic function, long-term use causes digestive problems such as loose stools, nausea, and gas in one-third of people. In addition, approximately 25 percent of people with acromegaly develop gallstones, which are usually asymptomatic.{{cite web |url=https://www.drugs.com/sfx/octreotide-side-effects.html |title=Octreotide Side Effects |access-date=2019-07-24 |url-status=live |archive-url=https://web.archive.org/web/20160422135323/http://www.drugs.com/sfx/octreotide-side-effects.html |archive-date=2016-04-22}} In some cases, octreotide treatment can cause diabetes because somatostatin and its analogues can inhibit the release of insulin.{{citation needed|date=August 2020}} With an aggressive adenoma that is not able to be operated on, there may be a resistance to octreotide in which case a second-generation SSA, pasireotide, may be used for tumor control. However, insulin and glucose levels should be carefully monitored as pasireotide has been associated with hyperglycemia by reducing insulin secretion.{{Cite journal|last1=Yamamoto|first1=Reina|last2=Robert Shima|first2=Kosuke|last3=Igawa|first3=Hirobumi|last4=Kaikoi|first4=Yuka|last5=Sasagawa|first5=Yasuo|last6=Hayashi|first6=Yasuhiko|last7=Inoshita|first7=Naoko|last8=Fukuoka|first8=Hidenori|last9=Takahashi|first9=Yutaka|last10=Takamura|first10=Toshinari|date=2018|title=Impact of preoperative pasireotide therapy on invasive octreotide-resistant acromegaly|journal=Endocrine Journal|volume=65|issue=10|pages=1061–1067|doi=10.1507/endocrj.ej17-0487|pmid=30078825 |issn=0918-8959|doi-access=free}}

For those who are unresponsive to somatostatin analogues, or for whom they are otherwise contraindicated, it is possible to treat using one of the dopamine agonists, bromocriptine, or cabergoline. As tablets rather than injections, they cost considerably less. These drugs can also be used as an adjunct to somatostatin analogue therapy. They are most effective in those whose pituitary tumours also secrete prolactin. Side effects of these dopamine agonists include gastrointestinal upset, nausea, vomiting, light-headedness when standing, and nasal congestion. These side effects can be reduced or eliminated if medication is started at a very low dose at bedtime, taken with food, and gradually increased to the full therapeutic dose. Bromocriptine lowers GH and IGF-1 levels and reduces tumor size in fewer than half of people with acromegaly. Some people report improvement in their symptoms although their GH and IGF-1 levels still are elevated.{{citation needed|date=August 2020}}

The latest development in the medical treatment of acromegaly is the use of growth hormone receptor antagonists. The only available member of this family is pegvisomant (Somavert). By blocking the action of the endogenous growth hormone molecules, this compound is able to control the disease activity of acromegaly in virtually everyone with acromegaly. Pegvisomant has to be administered subcutaneously by daily injections. Combinations of long-acting somatostatin analogues and weekly injections of pegvisomant seem to be equally effective as daily injections of pegvisomant.{{citation needed|date=August 2020}}

Surgical removal of the pituitary tumor is usually effective in lowering growth hormone levels. Two surgical procedures are available for use. The first is endonasal transsphenoidal surgery, which involves the surgeon reaching the pituitary through an incision in the nasal cavity wall. The wall is reached by passing through the nostrils with microsurgical instruments. The second method is transsphenoidal surgery during which an incision is made into the gum beneath the upper lip. Further incisions are made to cut through the septum to reach the nasal cavity, where the pituitary is located. Endonasal transsphenoidal surgery is a less invasive procedure with a shorter recovery time than the older method of transsphenoidal surgery, and the likelihood of removing the entire tumor is greater with reduced side effects. Consequently, endonasal transsphenoidal surgery is the more common surgical choice.{{citation needed|date=August 2020}}

These procedures normally relieve the pressure on the surrounding brain regions and lead to a lowering of GH levels. Surgery is most successful in people with blood GH levels below 40 ng/ml before the operation and with pituitary tumors no larger than 10 mm in diameter. Success depends on the skill and experience of the surgeon. The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is the normalization of GH and IGF-1 levels. Ideally, GH should be less than 2 ng/ml after an oral glucose load. Complications of surgery may include cerebrospinal fluid leaks, meningitis, or damage to the surrounding normal pituitary tissue, requiring lifelong pituitary hormone replacement.{{citation needed|date=August 2020}}

Even when surgery is successful and hormone levels return to normal, people must be carefully monitored for years for possible recurrence. More commonly, hormone levels may improve, but not return completely to normal. These people may then require additional treatment, usually with medications.{{citation needed|date=October 2021}}

Radiation therapy has been used both as a primary treatment and combined with surgery or drugs. It is usually reserved for people who have tumours remaining after surgery. These people often also receive medication to lower GH levels. Radiation therapy is given in divided doses over four to six weeks. This treatment lowers GH levels by about 50 percent over 2 to 5 years. People monitored for more than 5 years show significant further improvement. Radiation therapy causes a gradual loss of production of other pituitary hormones with time. Loss of vision and brain injury, which have been reported, are very rare complications of radiation treatments.{{citation needed|date=August 2020}}

Life expectancy of people with acromegaly is dependent on how early the disease is detected.{{cite journal | vauthors = Lugo G, Pena L, Cordido F | title = Clinical manifestations and diagnosis of acromegaly | journal = International Journal of Endocrinology | volume = 2012 | pages = 540398 | date = 2012 | pmid = 22518126 | pmc = 3296170 | doi = 10.1155/2012/540398 | doi-access = free }} Life expectancy after the successful treatment of early disease is equal to that of the general population.{{cite journal | vauthors = Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JA, Strasburger CJ, Luger A, Clemmons DR, Giustina A | display-authors = 6 | title = A Consensus Statement on acromegaly therapeutic outcomes | journal = Nature Reviews. Endocrinology | volume = 14 | issue = 9 | pages = 552–561 | date = September 2018 | pmid = 30050156 | doi = 10.1038/s41574-018-0058-5 | pmc = 7136157 | doi-access = free }} Acromegaly can often go on for years before diagnosis, resulting in poorer outcome, and it is suggested that the better the growth hormone is controlled, the better the outcome. Upon successful surgical treatment, headaches and visual symptoms tend to resolve. One exception is sleep apnea, which is present in around 70% of cases but does not tend to resolve with successful treatment of growth hormone level. While hypertension is a complication of 40% of cases, it typically responds well to regular regimens of blood pressure medication. Diabetes that occurs with acromegaly is treated with the typical medications, but successful lowering of growth hormone levels often alleviates symptoms of diabetes. Hypogonadism without gonad destruction is reversible with treatment. Acromegaly is associated with a slightly elevated risk of cancer.{{cite journal |last1=Dal |first1=Jakob |last2=Leisner |first2=Michelle Z |last3=Hermansen |first3=Kasper |last4=Farkas |first4=Dóra Körmendiné |last5=Bengtsen |first5=Mads |last6=Kistorp |first6=Caroline |last7=Nielsen |first7=Eigil H |last8=Andersen |first8=Marianne |last9=Feldt-Rasmussen |first9=Ulla |last10=Dekkers |first10=Olaf M |last11=Sørensen |first11=Henrik Toft |last12=Jørgensen |first12=Jens Otto Lunde |title=Cancer Incidence in Patients With Acromegaly: A Cohort Study and Meta-Analysis of the Literature |journal=The Journal of Clinical Endocrinology & Metabolism |date=1 June 2018 |volume=103 |issue=6 |pages=2182–2188 |doi=10.1210/jc.2017-02457 |pmid=29590449 |doi-access=free }}

Acromegaly affects about 3 per 50,000 people. It is most commonly diagnosed in middle age. Males and females are affected with equal frequency.{{cite book |last1=Pack |first1=Allan I. |name-list-style = vanc |title=Sleep Apnea: Pathogenesis, Diagnosis and Treatment |date=2016|publisher=CRC Press|isbn=9781420020885|page=291|edition=2|url=https://books.google.com/books?id=yN_LBQAAQBAJ&pg=PA291 |language=en |url-status=live |archive-url=https://web.archive.org/web/20160825192414/https://books.google.ca/books?id=yN_LBQAAQBAJ&pg=PA291 |archive-date=2016-08-25}} It was first described in the medical literature by Nicolas Saucerotte in 1772.{{cite book |last1=Pearce |first1=John M. S. |name-list-style = vanc |title=Fragments of Neurological History |date=2003 |publisher=World Scientific |isbn=9781783261109 |page=501 |url=https://books.google.com/books?id=2eu3CgAAQBAJ&pg=PA501 |language=en|url-status=live |archive-url=https://web.archive.org/web/20160825200427/https://books.google.ca/books?id=2eu3CgAAQBAJ&pg=PA501 |archive-date=2016-08-25}}{{cite journal |vauthors = Pearce JM |title = Nicolas Saucerotte: Acromegaly before Pierre Marie |journal = Journal of the History of the Neurosciences |volume = 15 |issue = 3 |pages = 269–75 | date = September 2006 |pmid = 16887764 |doi = 10.1080/09647040500471764 |s2cid = 22801883 }} The term is from the Greek {{lang|grc|ἄκρον}} ({{transliteration|grc|akron}}) meaning "extremity", and {{lang|grc|μέγα}} ({{transliteration|grc|mega}}) meaning "large".

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• Pío Pico, the last Mexican Governor of California (1801–1894), manifested acromegaly without gigantism between at least 1847 and 1858. Some time after 1858, signs of the growth hormone-producing tumor disappeared along with all the secondary effects the tumor had caused in him. He looked normal in his 90s.{{cite journal | vauthors = Login IS, Login J | title = Governor Pio Pico, the monster of California...no more: lessons in neuroendocrinology | journal = Pituitary | volume = 13 | issue = 1 | pages = 80–6 | date = July 2008 | pmid = 18597174 | pmc = 2807602 | doi = 10.1007/s11102-008-0127-1 }} His remarkable recovery is likely an example of spontaneous selective pituitary tumor apoplexy.{{cite journal | vauthors = Nawar RN, AbdelMannan D, Selman WR, Arafah BM | title = Pituitary tumor apoplexy: a review | journal = Journal of Intensive Care Medicine | volume = 23 | issue = 2 | pages = 75–90 | year = 2008 | pmid = 18372348 | doi = 10.1177/0885066607312992 | s2cid = 34782106 }}
• (Leonel) Edmundo Rivero, Argentine tango singer, composer and impresario.{{Citation needed|date=January 2023}}
• Tony Robbins, motivational speaker{{cite news |last1=Plaskin |first1=Glenn | name-list-style = vanc |title=Playboy Interview: Tony Robbins |url=http://www.playboy.com/articles/tony-robbins-playboy-interview|access-date=5 March 2015|work=Playboy|date=2013-08-13|url-status=dead|archive-url=https://web.archive.org/web/20150402093816/http://www.playboy.com/articles/tony-robbins-playboy-interview|archive-date=2 April 2015}}
• Antônio "Bigfoot" Silva, Brazilian kickboxer and mixed martial artist.{{Cite web|url=https://extra.globo.com/esporte/mma/ex-treinador-de-pezao-andre-benkei-explica-doenca-do-lutador-afirma-ele-jamais-colocaria-saude-em-risco-11143681.html|title=Ex-treinador de Pezão, André Benkei explica doença do lutador e afirma: 'Ele jamais colocaria a saúde em risco'|date=23 December 2013 }}{{Cite web|url=https://mmajunkie.usatoday.com/2014/09/trt-ban-forces-ufc-headliner-bigfoot-silva-into-surgery|title = TRT ban forces UFC headliner 'Bigfoot' Silva into surgery|date = 12 September 2014}}{{Cite web|url=https://www.usatoday.com/story/sports/ufc/2013/05/23/ufc-title-hopeful-bigfoot-silva-gigantism-ufc-160/2356405/|title=UFC title hopeful 'Bigfoot' Silva a real-life giant|website=USA Today}}
• Carel Struycken, Dutch actor, {{cvt|2.13|m|ft}}, is best known for playing Lurch in The Addams Family film trilogy, The Giant in Twin Peaks, Lwaxana Troi's silent Servant Mr. Homn in Star Trek: The Next Generation, and The Moonlight Man in Gerald's Game, based on the Stephen King book.{{cite news |last1=McLellan |first1=Dennis |title=Shedding Light on a Rare Disease: Woman Hopes O.C. Group Will Increase Awareness of Life-Threatening Effects of Excessive-Growth Illness |url=https://www.latimes.com/archives/la-xpm-1992-12-27-vw-5207-story.html |work=Los Angeles Times |date=27 December 1992 }}
• Nikolai Valuev, Russian politician and former professional boxer{{Citation needed|date=January 2023}}
• Big Show (Paul Wight), American professional wrestler and actor, known for his tenures in WCW, ECW, WWE, and currently, AEW.{{Citation needed|date=September 2023}}
• It has been argued that Lorenzo de' Medici (1449–92) may have had acromegaly. Historical documents and portraits, as well as a later analysis of his skeleton, support the speculation.{{cite journal|title=Acromegaly in Lorenzo the Magnificent, father of the Renaissance|first=Donatella|last=Lippi|author2=Phillipe Charlier|author3=Paola Romagnani

|journal=The Lancet|volume=389|issue=10084|pages = 2104|date=May 2017|doi=10.1016/S0140-6736(17)31339-9|pmid=28561004|s2cid=38097951|doi-access=free}}

• Pianist and composer Sergei Rachmaninoff (1873–1943), noted for his hands that could comfortably stretch a 13th on the piano, was never diagnosed with acromegaly in his lifetime, but a medical article from 2006 suggests that he might have had it.{{cite journal|pmid=17066567|title=The diagnosis of art: Rachmaninov's hand span|first=Manoj|last=Ramachandran|author2=Jeffrey K Aronson|journal=Journal of the Royal Society of Medicine|volume=99|issue=10|pages = 529–30|date=Oct 2006|doi=10.1177/014107680609901015|pmc = 1592053}}
• Matthew McGrory, (1973–2005) American actor known best for his role as Karl the Giant in the 2003 Tim Burton film Big Fish, as well as for his appearances as a member of the Wack Pack on The Howard Stern Show, where he was known as the Original Bigfoot.{{Cite web |title=Misbehaving Pituitaries |url=https://www.damninteresting.com/misbehaving-pituitaries/ |access-date=2024-08-16 |website=Damn Interesting |language=en-US}}
• Marjon van Iwaarden, Dutch singer.{{Cite web |date=2020-05-27 |title=Dutch Acromegaly Patient Marjon van Iwaarden Shares Her Story |url=https://acromegalysupport.com/marjon-van-iwaarden-shares-her-story/ |access-date=2024-08-16 |website=Acromegaly Support - Rare Disease Awareness, Education, and Support |language=en-US}}{{better source needed|date=June 2024}}
• Gheorghe Mureșan, Romanian former basketball player nicknamed The Giant

• Hypothalamic–pituitary–somatic axis
• Macrognathism

{{Reflist}}

• [https://www.aace.com/files/acromegaly-guidelines.pdf 2011 American Association of Clinical Endocrinologists Guideline] {{Webarchive|url=https://web.archive.org/web/20170829231006/https://www.aace.com/files/acromegaly-guidelines.pdf |date=29 August 2017 }}
• [https://web.archive.org/web/20110623033606/http://www.endocrine.niddk.nih.gov/pubs/acro/acro.htm Endocrine and Metabolic Diseases Information Service]

{{Medical resources

| eMedicine_mult = {{eMedicine2|derm|593}}

| DiseasesDB = 114

| ICD10 = {{ICD10|E|22|0||e|20}}inusl

| ICD9 = {{ICD9|253.0}}

| ICDO =

| OMIM = 102200

| MedlinePlus = 000321

| eMedicineSubj = med

| eMedicineTopic = 27

| MeshID = D000172

| Orphanet=963

}}

{{Pituitary disease}}

{{Authority control}}

Category:Endocrine-related cutaneous conditions

Category:Growth disorders

Category:Growth hormones

Category:Neuroendocrinology

Category:Pituitary disorders

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia neurology articles ready to translate