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(Acromegaly) Growing feet could mean tumour


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Growing feet could mean tumour

Carmel Thomason

16/ 4/2007


LOOKING back at photos taken over the last 20 years it's clearly visible that Christine Fletcher and her twin sister, Susan Lamb are not identical as they once were.


However, the changes were so gradual that no-one really noticed. As always, friends and family told them that they could tell who was who when they were together but not when they were apart.


Even the pair themselves didn't really notice the changes. "It's something that creeps up so slowly you tend not to think much about it," explains Christine, a 57-year-old shop assistant from Manchester.


"We were always more or less the same size, but then I started to need bigger shoes than Susan - she is a size 8 and I'll take a 9 or 10. I put having big hands and feet down to being tall because I'm nearly 5ft 10, but I did notice my hands were bigger than they were because my rings were getting tight."


Real change


The growth in Christine's hands and feet as well as slight enlargement of her facial features not seen in her twin, Susan, is due to a rare condition called acromegaly.


In acromegaly the pituitary gland produces too much growth hormone, the most noticeable symptoms being hands and feet become larger, while facial features can become more coarse and prominent.


Other symptoms include sweating, soft-tissue swelling, joint disorders and, in come cases, extreme height.


Actor Richard Kiel, famous for his role as James Bond's steel-toothed nemesis, Jaws, has spoken openly about his own experience with the condition.


Like most suffers it took years before the 7ft 2ins star was diagnosed.


Slow diagnosis


However, acromegaly remains very rare, with approximately 60-70 cases per million people in the UK.


It is not hereditary and can develop at any age, although is predominately found in patients in the middle age group.


In more than 90 per cent of acromegaly cases the over-production of growth hormone is caused by a benign tumour on the pituitary gland.


The pituitary gland is located in the base of the skull, immediately under the brain and behind the eyes.


It is the controlling gland through which the brain instructs all the other major endocrine glands, producing hormones which are distributed in the body via the blood stream to control the stress response; metabolic rate; growth; milk production; sexual function and fertility.


Not ill


In Christine's case it was the production of growth hormone in her body which was disturbed. ?I never felt ill with it at all,? Christine explains.


?That's why it's hard to diagnose. You can see the symptoms but they develop over such a long time I can't say how long I've had it until I look at old photographs.


Looking at 20 years ago I was the just same as my sister, but exactly when the tumour began to affect me, I don't know.?


Christine's acromegaly was picked up after the thickening of tissues in her wrist caused her to develop carpal tunnel syndrome, a common condition that occurs when there is too much pressure on a nerve in the wrist.


?I had an operation for carpal tunnel one wrist and came away not thinking any more of it,? Christine remembers.


?Then the other hand started so I had to have that one done as well. It's day surgery under local anaesthetic so when I saw the surgeon I asked if he could have a look at my hands because they seemed to have got bigger.?


Being a twin it was easy for Christine to see her probable growth by comparing the size of her hands and feet with Susan.




However, a blood test followed by an MRI scan confirmed she had a tumour on her pituitary and she was diagnosed with acromegaly.


?At first I was treated with injections to brings my growth hormone level down,? she says. ?It did make my growth hormone level more normal, but it doesn't get rid of the tumour.


?I tried the injections for over a year and I knew at the end of the day the only alternative was surgery.?


Under the care of Mr Kanna Gnanalingham, a consultant Neurosurgeon at Hope Hospital, Christine underwent endoscopic pituitary surgery, a keyhole surgical technique which removes the tumour through the nose.


?I was nervous, but Mr Gnanalingham and the staff at Hope Hospital were fantastic. They were very positive and explained everything that was going to happen.


Stay over


?Afterwards I had to stay in hospital for six days while they monitored my hormone levels had gone back to normal but I didn't need any painkillers. All I had was a runny nose and I couldn't blow it for a couple of weeks so I felt a bit bunged up.


?The tumour has gone and I've got to have an MRI scan every 12 months and have check up blood tests to make sure it doesn't come back.?




After removal of the tumor hormone levels usually return to normal straight away.


Patients often find that enlarged features improve, however, where acromegaly has affected height, as in the case of actor, Richard Kiel, bone, once grown, will not reduce in size.


?I've been told that sometimes hands and feet can go back to normal but it can take as long for this to happen as it took the change to happen in the first place,? Christine adds.


?Since the operation I haven't really seen any change, but I'm keeping an open mind about it, as long as the tumour's gone that's all I'm bothered about.?

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