Other symptoms may include joint pain, thicker skin, deepening of the voice, headaches, and problems with vision.

[3] Complications of the disease may include type 2 diabetes, sleep apnea, and high blood pressure.

[17] These tumors produce excessive growth hormone and compress surrounding brain tissues as they grow larger.

Other adenomas grow rapidly and invade surrounding brain areas or the sinuses, which are located near the pituitary.

[19] Pituitary adenomas and diffuse somatomammotroph hyperplasia may result from somatic mutations activating GNAS, which may be acquired or associated with McCune–Albright syndrome.

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.

[citation needed] 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.

[24] 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.

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

[25] 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.

[26] In some cases, octreotide treatment can cause diabetes because somatostatin and its analogues can inhibit the release of insulin.

[citation needed] 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.

Side effects of these dopamine agonists include gastrointestinal upset, nausea, vomiting, light-headedness when standing, and nasal congestion.

Bromocriptine lowers GH and IGF-1 levels and reduces tumor size in fewer than half of people with acromegaly.

[citation needed] The latest development in the medical treatment of acromegaly is the use of growth hormone receptor antagonists.

[citation needed] Surgical removal of the pituitary tumor is usually effective in lowering growth hormone levels.

The first is endonasal transsphenoidal surgery, which involves the surgeon reaching the pituitary through an incision in the nasal cavity wall.

[citation needed] 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.

[citation needed] Even when surgery is successful and hormone levels return to normal, people must be carefully monitored for years for possible recurrence.

[citation needed] 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.

[citation needed] 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.

[12] 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.