From Volume 17, Issue 1, January 2024 | Pages 12-15
The development of malocclusion in adulthood presents diagnostic and management challenges. The aetiology of any changes must be identified because this will influence patient management, particularly if surgical intervention is considered.
CPD/Clinical Relevance: This case demonstrates the importance of both awareness and clinical suspicion of acromegaly and highlights a novel aetiology of the disease.
Acromegaly is an acquired adult endocrine disorder caused by excessive levels of growth hormone and insulin-like growth factor (IGF-1). In adults, excess growth hormone and IGF-1 result in abnormal growth, including characteristic craniofacial and dental changes, often caused by a pituitary adenoma or concomitant endocrinological involvement.1,2 Chronic exposure to excessive levels of growth hormone and IGF-1 is associated with significant morbidity and mortality.1,3
In this report, a review of the literature along with a case of acromegaly is presented, with atypical aetiology where exogenous growth hormone replacement therapy was prescribed as treatment for panhypopituitarism following pituitary tumour removal.
High levels of growth hormone stimulate cell proliferation and differentiation of both hard and soft tissues, causing enlargement of the hands, feet, forehead, jaw and nose. These physical changes result in broad hands and feet, thickened skin, with patients typically complaining of ring or shoe-size changes. Other changes include soft tissue swelling, increased nasal prominence, thick nails, large pores, deepening nasolabial and forehead creases and oedematous eyelids.4
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