Acromegaly and clinical manifestations.

Acromegaly is a chronic multisystem disorder driven by persistent hypersecretion of growth hormone (GH) and consequent elevation of insulin-like growth factor 1 (IGF-1). Beyond its hallmark acral and craniofacial alterations, it manifests with a broad spectrum of systemic complications that substantially contribute to morbidity and mortality. Skeletal and soft tissue overgrowth cause characteristic disfigurement, while musculoskeletal involvement-including degenerative arthropathy, vertebral fractures, myopathy, and neuropathies-remains a major determinant of long-term disability despite biochemical remission. Cutaneous changes such as skin thickening, hyperhidrosis, seborrhea, and acanthosis nigricans are common and may partially regress after treatment. Cardiovascular sequelae, particularly hypertension, cardiomyopathy, valvular disease, and arrhythmias, represent leading causes of morbidity and mortality. Respiratory involvement, especially obstructive sleep apnea, is frequent and often persists after disease control. Metabolic disturbances, including impaired glucose tolerance, diabetes, and dyslipidemia, are highly prevalent and significantly raise cardiovascular risk. Gastrointestinal manifestations include motility disorders, hepatobiliary involvement, and increased incidence of colonic polyps and colorectal cancer, with emerging evidence of elevated risk for other malignancies. Additional endocrine and neuropsychiatric complications, such as hypopituitarism, thyroid abnormalities, cognitive dysfunction, and depression, further aggravate disease burden and impair quality of life. Despite advances in surgery, medical therapy, and radiotherapy, residual morbidity and irreversible sequelae frequently persist. Early diagnosis and multidisciplinary care are crucial not only for achieving biochemical remission but also for mitigating comorbidities, improving quality of life, and enhancing survival outcomes in acromegaly.

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