Acromegaly is a disorder that results from excess

growth hormone Growth hormone (GH) or somatotropin, also known as human growth hormone (hGH or HGH) in its human form, is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in ...

(GH) after the growth plates have closed. The initial symptom is typically enlargement of the hands and feet. There may also be an enlargement of the forehead, jaw, and nose. Other symptoms may include joint pain, thicker skin, deepening of the voice, headaches, and problems with vision. Complications of the disease may include type 2 diabetes, sleep apnea, and high blood pressure. Acromegaly is usually caused by the

pituitary gland In vertebrate anatomy, the pituitary gland, or hypophysis, is an endocrine gland, about the size of a chickpea and weighing, on average, in humans. It is a protrusion off the bottom of the hypothalamus at the base of the brain. The h ...

producing excess growth hormone. In more than 95% of cases the excess production is due to a

benign tumor A benign tumor is a mass of cells ( tumor) that does not invade neighboring tissue or metastasize (spread throughout the body). Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have r ...

, known as a

pituitary adenoma Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas.inherited from a person's parents. Acromegaly is rarely due to a tumor in another part of the body. Diagnosis is by measuring growth hormone after a person has consumed a

glucose Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, u ...

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. Treatment options include

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...

to remove the tumor, medications, and

radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Rad ...

. 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. Without treatment, life expectancy is reduced by 10 years; with treatment, life expectancy is not reduced. Acromegaly affects about 3 per 50,000 people. It is most commonly diagnosed in middle age. Males and females are affected with equal frequency. It was first described in the medical literature by Nicolas Saucerotte in 1772. The term is from the Greek () meaning "extremity", and () meaning "large".

Signs and symptoms

Features that may result from a high level of GH or expanding tumor include: * 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 Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin. Causes Hyperpigmentation can be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris.James, William; Be ...

and

hyperhidrosis Hyperhidrosis is a condition characterized by abnormally increased sweating, in excess of that required for regulation of body temperature. Although primarily a benign physical burden, hyperhidrosis can deteriorate quality of life from a psychologi ...

may occur in these people. * Skin tags *

Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunn ...

Complications

* Problems with bones and joints, including

osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the ...

, nerve compression syndrome due to bony overgrowth, and

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunn ...

* Hypertension *

Diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

Cardiomyopathy Cardiomyopathy is a group of diseases that affect the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. ...

, potentially leading to

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...

* Colorectal cancer * Sleep Apnea *

Thyroid nodule Thyroid nodules are nodules (raised areas of tissue or fluid) which commonly arise within an otherwise normal thyroid gland. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant. Small, asymptomatic ...

s and thyroid cancer * Hypogonadism * Compression of the optic chiasm by the growth of pituitary adenoma leading to visual problems

Causes

Pituitary adenoma

About 98% of cases of acromegaly are due to the overproduction of growth hormone by a

of the pituitary gland called an adenoma. These tumors produce excessive growth hormone and compress surrounding brain tissues as they grow larger. In some cases, they may compress the

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived fro ...

s. Expansion of the tumor may cause headaches and visual disturbances. In addition, compression of the surrounding normal pituitary tissue can alter production of other hormones, leading to changes in menstruation and breast discharge in women and impotence in men because of reduced testosterone production. 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 Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the spheno ...

, which are located near the pituitary. In general, younger people tend to have more aggressive tumors. 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 In biology, a mutation is an alteration in the nucleic acid sequence of the genome of an organism, virus, or extrachromosomal DNA. Viral genomes contain either DNA or RNA. Mutations result from errors during DNA or viral replication, m ...

, 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.

Other tumors

In a few people, acromegaly is caused not by pituitary tumors, but by

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s of the

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an ...

, lungs, and

adrenal gland The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are found above the kidneys. Each gland has an outer cortex ...

s. 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. In people with GHRH-producing, non-pituitary tumors, the pituitary still may be enlarged and may be mistaken for a tumor. Therefore, it is important that physicians carefully analyze all "pituitary tumors" removed from people with acromegaly so as to not overlook the possibility that a tumor elsewhere in the body is causing the disorder.

Diagnosis

If acromegaly is suspected, medical laboratory investigations followed by medical imaging if the lab tests are positive confirms or rules out the presence of this condition.

IGF1 Insulin-like growth factor 1 (IGF-1), also called somatomedin C, is a hormone similar in molecular structure to insulin which plays an important role in childhood growth, and has anabolic effects in adults. IGF-1 is a protein that in humans is ...

provides the most sensitive lab test for the diagnosis of acromegaly, and a GH suppression test following an oral

load, which is a very specific lab test, will confirm the diagnosis following a positive screening test for IGF1. A single value of the GH is not useful in view of its pulsatility (levels in the blood vary greatly even in healthy individuals). GH levels taken 2 hours after a 75- or 100-gram glucose tolerance test are helpful in the diagnosis: GH levels are suppressed below 1 μg/L in normal people, and levels higher than this cutoff are confirmatory of acromegaly. 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 Prolactin (PRL), also known as lactotropin, is a protein best known for its role in enabling mammals to produce milk. It is influential in over 300 separate processes in various vertebrates, including humans. Prolactin is secreted from the pi ...

. An MRI of the brain focusing on the

sella turcica The sella turcica ( Latin for 'Turkish saddle') is a saddle-shaped depression in the body of the sphenoid bone of the human skull and of the skulls of other hominids including chimpanzees, gorillas and orangutans. It serves as a cephalometr ...

after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumor. A number of other

overgrowth syndrome Overgrowth syndromes in children constitute a group of rare disorders that are characterised by tissue hypertrophy. Individual overgrowth syndromes have been shown to overlap with regard to clinical and radiologic features. The details of the gene ...

s can result in similar problems.

Differential diagnosis

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. Cases have been reported due to minoxidil at an unusually high dose. It can also be caused by a selective post receptor defect of insulin signalling, leading to the impairment of metabolic, but preservation of mitogenic, signalling.

Treatment

The goals of treatment are to reduce GH production to normal levels thereby reversing or ameliorating the signs and symptoms of acromegaly, to relieve the pressure that the growing pituitary tumor exerts on the surrounding brain areas, and to preserve normal pituitary function. Currently, treatment options include surgical removal of the tumor, drug therapy, and

of the pituitary.

Medications

Somatostatin analogues

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. Somatostatin analogues are also sometimes used to shrink large tumors before surgery. 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. In some cases, octreotide treatment can cause

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

due to the fact that somatostatin and its analogues can inhibit the release of

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism ...

. With an aggressive adenoma that is not able to be operated on, there may be a resistance to octreotide and 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.

Dopamine agonists

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 A dopamine agonist (DA) is a compound that activates dopamine receptors. There are two families of dopamine receptors, D2-like and D1-like, and they are all G protein-coupled receptors. D1- and D5-receptors belong to the D1-like family and the ...

, 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 cosecrete

. 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.

Growth hormone receptor antagonists

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 Pegvisomant, sold under the brand name Somavert, is a growth hormone receptor antagonist used in the treatment of acromegaly. It is primarily used if the pituitary gland tumor causing the acromegaly cannot be controlled with surgery or radiation ...

(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.

Surgery

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 The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal ...

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. 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. A review of GH levels in 1,360 people worldwide immediately after surgery revealed that 60% had random GH levels below 5 ng/ml. Complications of surgery may include

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the ...

leaks, meningitis, or damage to the surrounding normal pituitary tissue, requiring lifelong pituitary

hormone replacement Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal ...

. 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.

Radiation therapy

Radiation therapy has been used both as a primary treatment and combined with surgery or drugs. It is usually reserved for people who have tumor 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.

Selection of treatment

The initial treatment chosen should be individualized depending on the person's characteristics, such as age and tumor size. If the tumor has not yet invaded surrounding brain tissues, removal of the pituitary adenoma by an experienced neurosurgeon is usually the first choice. After surgery, a person must be monitored long-term for increasing GH levels. If surgery does not normalize hormone levels or a relapse occurs, a doctor will usually begin additional drug therapy. The current first choice is generally octreotide or lanreotide; however, bromocriptine and cabergoline are both cheaper and easier to administer. With all of these medications, long-term therapy is necessary, because their withdrawal can lead to rising GH levels and tumor re-expansion. Radiation therapy is generally used for people whose tumors are not completely removed by surgery, for people who are not good candidates for surgery because of other health problems, and for people who do not respond adequately to surgery and medication.

Prognosis

Life expectancy of people with acromegaly is dependent on how early the disease is detected. Life expectancy after the successful treatment of early disease is equal to that of the general population. 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.

Notable people

A number of famous people have or have had acromegaly. For several people in this list, stark physical features associated with excess growth hormone have greatly contributed to their fame. Thus one should keep in mind that this list is tilted towards showing rather pronounced cases of acromegaly: * Daniel Cajanus (1704–1749), "The Finnish Goliath". His natural size portrait and femur are still extant. His height was estimated to have been 247 cm (8' 1"). * Mary Ann Bevan (1874–1933), an English woman, who after developing acromegaly, toured the

sideshow In North America, a sideshow is an extra, secondary production associated with a circus, carnival, fair, or other such attraction. Types There are four main types of classic sideshow attractions: *The Ten-in-One offers a program of ten ...

circuit as "the ugliest woman in the world". * André the Giant (born André Roussimoff, 1946–1993), French professional wrestler and actor *

Salvatore Baccaro Salvatore Baccaro (6 May 1932 – 13 March 1984) was an Italian character actor. He was recognizable for his known acromegaly Acromegaly is a disorder that results from excess growth hormone (GH) after the growth plates have closed. The initi ...

(1932–1984), Italian character actor. Active in B-movies,

comedies Comedy is a genre of fiction that consists of discourses or works intended to be humorous or amusing by inducing laughter, especially in theatre, film, stand-up comedy, television, radio, books, or any other entertainment medium. The term origin ...

, and horrors because of his peculiar features and spontaneous sympathy * Paul Benedict (1938–2008), American actor. Best known for portraying Harry Bentley, '' The Jeffersons'' English next door neighbour *

Big Show Paul Donald Wight II (born February 8, 1972) is an American professional wrestler and actor. He is signed to All Elite Wrestling (AEW) as an in-ring performer, and as a commentator for its web television show, '' AEW Dark: Elevation,'' under ...

(born Paul Wight; 1972), American professional wrestler and actor, had his pituitary tumor removed in 1991. *

Eddie Carmel Eddie Carmel (born Oded Ha-Carmeili ; March 16, 1936 – August 14, 1972) was an Israeli-born American entertainer with gigantism and subsequent acromegaly resulting from a pituitary adenoma. He was popularly known as "The Jewish Giant", "The H ...

, born Oded Ha-Carmeili (1936–1972), Israeli-born entertainer with gigantism and acromegaly, popularly known as "The Jewish Giant" * Ted Cassidy (1932–1979), American actor. Best known for portraying Lurch in the TV sitcom '' The Addams Family'' *

Rondo Hatton Rondo Hatton (April 22, 1894 – February 2, 1946) was an American journalist and actor. After writing for ''The Tampa Tribune'', Hatton found a career in film due to his unique facial features, which were the result of acromegaly. He headlin ...

(1894–1946), American journalist and actor. A Hollywood favorite in B-movie horror films of the 1930s and 1940s. Hatton's disfigurement, due to acromegaly, developed over time, beginning during his service in World War I. *

Sultan Kösen Sultan Kösen (born 10 December 1982) is a Turkish farmer who holds the Guinness World Record for tallest living male at . Of Kurdish ethnicity, he is the seventh-tallest man in history. Kösen's growth resulted from the conditions gigantis ...

, the world's tallest man *

Maximinus Thrax Gaius Julius Verus Maximinus "Thrax" ("the Thracian"; – 238) was Roman emperor from 235 to 238. His father was an accountant in the governor's office and sprang from ancestors who were Carpi (a Dacian tribe), a people whom Diocleti ...

, Roman emperor (, reigned 235–238). Descriptions, as well as depictions, indicate acromegaly, though remains of his body are yet to be found. *

The Great Khali Dalip Singh Rana (born 27 August 1972) is an Indian professional wrestler and wrestling promoter better known by his ring name The Great Khali. He is best known for his tenure in WWE where he became the first Indian-born WWE World Heavy ...

(born Dalip Singh Rana), Indian professional wrestler, is best known for his tenure with WWE. He had his pituitary tumor removed in 2012 at age 39. *

Primo Carnera Primo may refer to: People *DJ Premier (born 1966), hip-hop producer, sometimes goes by nickname Primo *Primo Carnera (1906–1967), Italian boxer, World Heavyweight champion 1933–1934 * Primo Cassarino (born 1956), enforcer for the Gambino cr ...

(1906–1967), nicknamed the Ambling Alp, was an Italian professional boxer and wrestler who reigned as the boxing World Heavyweight Champion from 29 June 1933 to 14 June 1934. * Maurice Tillet (1903–1954), Russian-born French professional wrestler, is better known by his ring name, the French Angel. * Richard Kiel (1939–2014), actor, "Jaws" from two James Bond movies and Mr. Larson in ''

Happy Gilmore ''Happy Gilmore'' is a 1996 American sports comedy film directed by Dennis Dugan and produced by Robert Simonds. It stars Adam Sandler as the title character, an unsuccessful ice hockey player who discovers a newfound talent for golf. The scr ...

'' * 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. His remarkable recovery is likely an example of spontaneous selective pituitary tumor apoplexy. *

Earl Nightingale Earl Nightingale V (March 12, 1921 – March 25, 1989) was an American radio speaker and author, dealing mostly with the subjects of human character development, motivation, and meaningful existence. He was the voice during the early 1950s of ...

(March 12, 1921 – March 25, 1989) was an American radio speaker and author, dealing mostly with the subjects of human character development, motivation, and meaningful existence. He was the voice during the early 1950s of Sky King, the hero of a radio adventure series, and was a WGN radio program host from 1950 to 1956. Nightingale was the author of The Strangest Secret, which economist Terry Savage has termed "…one of the great motivational books of all time." Nightingale’s daughter, Pamela, mentioned her father had acromegaly during a podcast about her father that aired in June 2022. * Tony Robbins, motivational speaker *

Carel Struycken Carel Struycken (; born 30 July 1948) is a Dutch actor. He is known for playing the Giant/Fireman in the television series ''Twin Peaks'' (1990–1991, 2017), the occasional guest role of Mr. Homn in '' Star Trek: The Next Generation'' (1987–1 ...

, Dutch actor, , is best known for playing Lurch in '' The Addams Family'' film trilogy, The Giant in ''

Twin Peaks ''Twin Peaks'' is an American mystery serial drama television series created by Mark Frost and David Lynch. It premiered on ABC on April 8, 1990, and originally ran for two seasons until its cancellation in 1991. The show returned in 2017 ...

'', 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. * Peter Mayhew (1944–2019), British-American actor, was diagnosed with gigantism at age eight. Best known for portraying Chewbacca in the '' Star Wars'' film series. * Irwin Keyes, American actor. Best known for portraying Hugo Mojoloweski, George's occasional bodyguard on '' The Jeffersons'' * Morteza Mehrzad,

Iranian Iranian may refer to: * Iran, a sovereign state * Iranian peoples, the speakers of the Iranian languages. The term Iranic peoples is also used for this term to distinguish the pan ethnic term from Iranian, used for the people of Iran * Iranian lan ...

Paralympian The Paralympic Games or Paralympics, also known as the ''Games of the Paralympiad'', is a periodic series of international multisport events involving athletes with a range of physical disabilities, including impaired muscle power and impaired ...

and medalist. Member of the Iranian sitting volleyball team. Top scorer in the 2016 gold medal match * Neil McCarthy, British actor. Known for roles in '' Zulu'', '' Time Bandits'', and many British television series * Nikolai Valuev, Russian politician and former professional boxer * Antônio "Bigfoot" Silva, Brazilian kickboxer and

mixed martial arts Mixed martial arts (MMA), sometimes referred to as cage fighting, no holds barred (NHB), and ultimate fighting, and originally referred to as Vale Tudo is a full-contact combat sport based on striking, grappling and ground fighting, incor ...

fighter. * (Leonel) Edmundo Rivero, Argentine tango singer, composer and impresario It has been argued that

Lorenzo de' Medici Lorenzo di Piero de' Medici (; 1 January 1449 – 8 April 1492) was an Italian statesman, banker, ''de facto'' ruler of the Florentine Republic and the most powerful and enthusiastic patron of Renaissance culture in Italy. Also known as Lorenzo ...

(1449–92) may have had acromegaly. Historical documents and portraits, as well as a later analysis of his skeleton, support the speculation. Pianist and composer Sergei Rachmaninoff, 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. The Bogdanoff twins had shown some signs of acromegaly and their continued denials that they had plastic surgery that greatly altered their facial appearance made some consider the disease. However, acromegaly was not proven before they died.

References

External links

*
2011 American Association of Clinical Endocrinologists Guideline

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