Acromegaly is a chronic, slowly developing disease characterized by progressive disfigurement and disability (Melmed 1990). The disfigurement of the face occurs insidiously in most patients and develops only slowly, so that very often the disorder is diagnosed only when a new physician replaces the usual doctor and sees the patient for the first time, and/or when photographs of the patient taken over a number of years are collected together (Molitch 1992).
Apart from the cosmetic changes, a multitude of complaints interfere with normal daily working life in most patients. In addition, complications related to the cardiovascular and respiratory systems, and to tumour formation (Table 1), often cause premature death if not effectively treated (Lamberts 1992, Wass 1994). Mortality risk in acromegalic patients is probably two to three times that of healthy people (Alexander et al. 1980).
Pathogenesis and diagnosis
The clinical syndrome of acromegaly is caused in virtually all patients