Acromegaly is a disorder that arises from the body's excess growth hormone, resulting in excessive growth in various body tissues, muscles and bones, especially on the feet, hands and face. This condition is generally caused by benign tumors in the pituitary gland. Increased production of growth hormone can also be caused by tumors in other organs such as the lungs or pancreas, but very rarely. Acromegaly is generally diagnosed in adult patients aged 40 to 45 years. This condition is rare and shows minimal symptoms. Most cases of patients know themselves as acromegaly after years. Acromegaly can lead to life-threatening complications if not treated promptly.
Causes of Acromegaly
The cause of acromegaly is the high production of growth hormone (GH) produced by the pituitary gland. Ninety-five percent of acromegaly cases show a tumor in the pituitary gland, which is a cause of increased GH production. In rare cases, heredity can be a triggering factor.
The pituitary gland is located at the bottom of the brain and serves to produce various important hormones for the body, one of which is growth hormone (GH). GH triggers the liver to produce insulin-like growth factor I ( IGF-I) as a stimulant of bone growth and tissue. Excess GH levels will affect the production of IGF-I, triggering abnormal growth in body tissues, muscles, and bones.
For patients with pituitary tumors, acromegaly may be accompanied by other symptoms, ie when the tumor compresses the nerves and tissues around the pituitary, or if the tumor also causes excessive production of thyroid hormones.
Symptoms of Acromegaly
Not all acromegaly conditions exhibit significant symptoms directly. The visible symptoms will be different from each patient. Some of the symptoms that can be experienced are:
- Legs and hands grow.
- The face structure is changing.
- The size of the tongue, nose, and lips enlarged.
- Dental structure widened.
- Oily skin and rough.
- Abnormal skin growth.
- Excessive sweating, to body odor.
- Muscles weaken.
- Joint pain and movement ability become limited.
- The function of vision decreases.
- Hoarse and deep voice (widening of vocal cords and sinuses).
- Snoring fast during sleep.
- Cavity enlarged (barrel chest).
- Menstrual cycle disorders in women.
- Erectile difficulties in men.
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Diagnosis of Acromegaly
In diagnosing acromegaly, the physician will first collect information regarding symptoms and medical history of the patient, including the type of tumor suffered, changes in body structure, and medication that is being undertaken. After that, follow-up examination will be done to confirm the diagnosis, such as:
- Blood test. There are two blood tests that can be performed, namely the measurement of GH and IGF-I levels to determine the amount of hormone produced, and the growth hormone suppression test to see the changes and responses of GH levels to glucose.
- Scanning. CT and MRI scans are generally used to check the accuracy of tumor sites in the pituitary gland or other organs. X-rays can also be performed to check bone density and size.
Treatment of Acromegaly
Acromegaly treatment is focused on reducing the severity of symptoms, regulating excess hormone levels, and restoring the function of the pituitary gland. The following are three treatment methods that are generally recommended in cases of acromegaly:
- Surgery. The usual transfenoidal surgery is recommended to remove the tumor from the pituitary that suppresses the nerves and triggers excess GH production. This action is done through the nose or upper lip, using endoscopy and other surgical tools to remove the existing tumor. This action is performed under conditions of local anesthesia. Suggestions for taking medication and doing therapy may be done before or after surgery.
- Medications The following medications may be used for the treatment of support after surgery, or if surgery can not be performed (eg in the case of large tumors):
- Dopamine agonist. Drugs such as bromocriptine and cabergoline serve to suppress the production of growth hormone. Both drugs are taken once or twice a week in pill form.
- Analog somatostatin. Drugs such as lanreotide and octreotide are used to control the production and flow of growth hormones, as well as shrink the size of adenoma tumors. These drugs are given in the form of injection in the hospital, with initial dose 3 times a day to see the effectiveness, and continued once a month for a specified period. These injections are generally given under the skin (subcutaneously) and in the butt muscles (gluteus muscle).
- The antagonist of growth hormone. One example of this drug is pegvisomant . This drug serves to block the effects of growth hormone on body tissues, suppress symptoms, and regulate levels of IGF-I in the liver. Growth hormone antagonist drugs are usually given if the patient does not respond to other treatments, through daily subcutaneous injections at the hospital. These drugs can not shrink tumor size or reduce hormone levels in the body.
- Radiotherapy Radiotherapy is generally recommended if the patient does not respond well to surgery or medication. This therapy serves to destroy tumor cells that can not be reached before and slowly slow down the growth hormone levels. Radiotherapy can be done in three ways:
- Conventional radiation therapy. The tumor is targeted using an external beam (EBT) given in small doses with a gap of 4 to 6 weeks. This is done to avoid damage to the pituitary gland and brain tissue, as well as to give time for healing radiated tissue. The results of this therapy are generally felt after many years.
- Gamma knife therapy (gamma knife). The tumor is targeted directly using a strong radiation beam, regardless of surrounding brain tissue. Patients will be asked to use a special head cover to minimize head movement. This therapy is only done once, with results that can be felt after 3 to 5 years. Gamma knife therapy also poses a risk of smaller side effects than conventional radiation therapy.
- Proton radiation therapy. Not much different from gamma blade therapy, proton radiation therapy emits strong radiation on tumors with minimal effects on brain tissue. This therapy is given regularly, with a shorter intensity than conventional radiation therapy.
Complications of Acromegaly
Untreated acromegaly can lead to life-threatening complications, such as:
- Heart disease, especially heart enlargement (cardiomyopathy).
- Diabetes mellitus.
- Loss of vision function.
- Growth of polyps or precancer in the colon.
- Growth of benign tumors in the womb.
- Emphasis on the spinal cord.
- Carpal tunnel syndrome syndrome.
- Sleep apnea , which can close the respiratory tract.
- Osteoarthritis or decreased ability of movement in joints.