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Acromegaly is a progressive, multi-system disease caused by excessive growth hormone production that, if untreated, may lead to significant morbidity, mortality and impact on a sufferer's quality of life. Changes to the orofacial complex are a prominent feature of the disease, meaning the dental profession is in a unique position to be able to recognize the condition early. This article discusses its presentation, diagnosis and management with a particular focus on the potential effects on the orofacial complex, leading to an exploration of the difficulties that may be encountered when dental rehabilitation is required.
CPD/Clinical Relevance: Dental professionals may be the first to recognize the orofacial changes associated with acromegaly.
Article
Acromegaly is an endocrine disease caused by excessive production of growth hormone (GH) inducing increased production of insulin-like growth factor-I (IGF-1), which, in more than 95% of cases, is due to a benign adenoma of the pituitary gland.1,2 It is differentiated from gigantism by the condition developing in adulthood, defined as subsequent to the closure of the epiphyseal plates which occurs typically between the ages of 12 and 16 years or girls and 14 and 19 years for boys.1
While rare, there is significant population variability of the disease. A review of the epidemiological data demonstrated an incidence of 0.2–1.1 cases per 100,000 of the population and a prevalence of 2.8–13.7 cases per 100,000.3 There appears to be no difference in prevalence between males and females, with the average age at diagnosis between 40 and 50 years old.1 This late apparent onset may be, at least in part, due to the effects typically being insidious, leading to an average delay in diagnosis after condition development of between 4 and 10 years.1,2,4 Despite the chronic nature of the disease, there is significant associated morbidity and mortality, with an estimated reduction in life expectancy of 10 years if left untreated.2,5
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