Acromegaly and heart failure: diagnosis, treatment and outlook

Acromegaly is a rare medical condition that causes bones, organs, and other tissues in the body to become larger than usual. It happens when your pituitary gland produces too much growth hormone (GH). The National Institute of Diabetes and Digestive and Kidney Diseases estimates that 3 to 14 in 100,000 people have acromegaly.

Complications of acromegaly include type 2 diabetes, arthritis, and conditions that affect muscle, cartilage, and bone. Acromegaly can also be a factor in the development of heart disease and heart failure.

Acromegaly is associated with a shorter life expectancy and a higher mortality rate. But your outlook may be brighter if doctors diagnose and treat it early. Since acromegaly can lead to heart failure, it is important to see a doctor or healthcare professional as soon as symptoms appear.

In acromegaly, the excess GH you produce leads to left ventricular hypertrophy (LVH). With LVH, your heart muscle gets bigger and thicker. It can also cause your blood pressure to rise.

Acromegaly also appears to contribute to heart valve disorders. You may develop aortic or mitral valve regurgitation.

Regurgitation means that the valves do not close properly between heartbeats, allowing blood to flow back. Complications include high blood pressure and abnormal heart rhythms, such as atrial fibrillation.

Of all the serious health complications associated with acromegaly, cardiovascular disease is the most serious. According to a study 2018, cardiovascular disease is responsible for more than half of acromegaly-related deaths. This research also suggests that end-stage congestive heart failure resulting from an enlarged heart usually occurs in older people who have not been able to manage the disease or those who have other cardiovascular problems.

LVH affects your heart left ventricle, the chamber that pumps blood to most of the body. When this happens, your heart isn’t as efficient at pumping blood to meet your body’s needs. This causes your blood pressure to rise.

High blood pressure from acromegaly causes systolic dysfunction, which means your heart pumps less blood with each contraction. It forces your heart to work harder. This burden can lead to heart failure.

Acromegaly can also lead to other complications that contribute to heart failure, such as obstructive sleep apnea (OSA). Acromegaly can cause the bones in the jaw and the front of the skull to widen and the tongue and other soft tissues of the larynx to thicken. These changes can block your airways.

OSA can cause repeated pauses in breathing during the night. These breaks also force your heart to work harder, which further contributes to weakening the heart muscle and causing heart failure.

Acromegaly can also contribute to Type 2 diabetes by triggering insulin resistance. This is when your organs fail to respond to insulin and cannot effectively use glucose for energy. Too much glucose in your blood can damage your blood vessels, clogging them and making them less efficient. This forces your heart to pump harder to pump blood throughout the body.

Screening for acromegaly usually follows noticeable changes in the body, such as:

  • forehead and jawline change shape, becoming more pronounced
  • hands and feet swell
  • skin becoming thicker, sometimes oilier

If a doctor suspects acromegaly, they may order two different blood tests to determine if your body is producing too much GH. The two projections are:

  • Insulin-like growth factor (IGF) test: IGF-1 is a hormone involved in the regulation of GH in your body. Unlike GH levels, which can change throughout the day, IGF-1 levels tend to remain stable. Higher than normal IGF-1 levels suggest that you may have acromegaly.
  • Oral Glucose Tolerance Test (OGTT): In an OGTT, you swallow a sugary liquid before a healthcare professional draws blood from you. They will test your blood every 30 minutes for up to 2 hours to check your GH levels. The sugary liquid normally lowers GH levels, but if they remain high, you likely have acromegaly.

Diagnosing heart disease that may be related to acromegaly also involves blood tests to check:

Other screenings to look for changes in heart anatomy or problems with heart function include:

A doctor should also listen to your heart with a stethoscope and check your blood pressure. If any of these specific screenings or symptoms warrant further evaluation, more invasive tests, such as cardiac catheterization, may be appropriate.

The best treatment depends on several factors, including the type and severity of the disease. In some cases, treating the underlying acromegaly can help relieve symptoms of heart disease.

A study 2017 cardiovascular disease in people with acromegaly suggests that use of somatostatin analogues for 6-24 months may decrease LVH and improve heart function.

Since acromegaly is often due to a tumor in the pituitary gland, surgery to remove the tumor or radiation therapy to shrink the tumor can also stop the progression of symptoms and complications. A study 2016 surgical results for acromegaly reported overall remission rate greater than 75%.

Medications and lifestyle changes are usually needed to treat heart problems associated with acromegaly. You may also need devices or procedures to restore optimal heart function. If you have heart valve disease, repair or replacement of the affected valve is often a safe and effective solution.

Doctors can treat arrhythmias with antiarrhythmic drugs or procedures, such as cardioversion or ablation. A doctor may also prescribe blood thinners if they determine the arrhythmia is a risk for stroke.

And if you develop heart failure, a doctor may prescribe the following types of medications:

Doctors also treat heart failure with certain devices. An implantable cardioverter defibrillator can help maintain a healthy heart rhythm. A left ventricular assist device can act as an artificial pump to increase blood flow out of the heart.

People with acromegaly usually only develop heart failure if their condition is left untreated or poorly treated for a long time. In such cases, the 5-year mortality rate is approximately 37.5%.

But if doctors diagnose and treat heart failure in its early stages, as well as acromegaly, your outlook is much better.

It is not always possible to prevent acromegaly from leading to heart failure or other cardiovascular complications. But the best way to reduce the risk of complications is to react early to the symptoms of acromegaly, work closely with your doctors to treat the condition, and monitor your heart health for any signs of trouble.

Does acromegaly always lead to heart failure?

Acromegaly often leads to multiple medical complications, but heart failure and other heart problems are not always among them. However, when doctors make an initial diagnosis, it is not possible to predict all of the health problems that may result.

Is acromegaly fatal?

Acromegaly can be a life-threatening condition. But people who receive an early diagnosis can often start a treatment regimen that reduces symptoms and serious complications.

Does curing acromegaly reverse damage to the heart?

Successful treatment of acromegaly can stop damage to the heart. But usually, you can’t reverse the damage to your heart muscle and valves without surgery or other procedures. Healing acromegaly reduces the risk that further damage is likely to occur.

Acromegaly is a rare condition in which your body produces too much growth hormone. Because it causes excessive tissue growth, most organs, including the heart, are at risk for complications.

Cardiovascular complications tend to be the most common. They understand:

  • high blood pressure
  • cardiomyopathy
  • valve disease
  • arrhythmias

All of the above can contribute to the development of heart failure.

But prompt diagnosis and adherence to medications and other treatments can reduce your risk of acromegaly leading to long-term heart problems.