Acromegaly

Acromegaly is a disorder of the body due to excess growth hormone (growth hormone), resulting in excessive growth in body tissues, muscles and bones, especially in the legs, hands and face.

Acromegaly is generally caused by benign tumors in the pituitary gland (pituitary). Increased growth hormone production can also be caused by tumors in other body organs, such as the lungs or pancreas.

Acromegaly is diagnosed in adult patients aged 40-45 years. This condition is rare and rarely symptomatic. Sufferers find themselves stricken with acromegaly after years.

Acromegaly can lead to life-threatening complications if not treated immediately.

Cause.

• High production of growth hormone produced by the pituitary gland.
• Tumors of the pituitary gland. The pituitary gland is located in the lower part of the brain and functions to produce hormones essential for the body.
• Check growth hormone will affect IGF-I production, triggering abnormal growth in body tissues, muscles and bones.

The symptoms.

Not all acromegaly conditions show significant symptoms directly. Some symptoms that can be felt :

• Enlarged legs and arms.
• The structure of the face changes.
• The size of the tongue, nose and lips enlarges.
• Widened tooth structure.
• Oily and rough skin.
• Abnormal skin growth.
• Excessive sweating and body odor.
• Dizzy.
• Limp.
• Weakened muscles.
• Joint pain and mobility are limited.
• Decreased visual function.
• Hoarseness (widening of the vocal cords and sinuses).
• Snore loudly during sleep.
• Enlarged cavity (barrel chest).
• Menstrual cycle disorders in women.
• Erectile difficulties in men.
• The liver, kidneys, heart and lymph are enlarged.

Diagnosis.

• Symptoms and medical history of the patient.
• Types of tumors suffered.
• Changes in body structure.
• Treatment being undertaken.
• Blood tests : measure GH and IGF-I levels to find out how much hormone is produced.
• Growth hormone suppression test to see changes and responses of GH levels to glucose administration.
• CT scan.
• MRI to determine the location of tumors in the pituitary gland or other body organs.
• X-ray to determine bone density and size.

Treatment.

• Acromegaly treatment is focused on reducing the severity of symptoms.
• Regulate excessive hormone levels.
• Restore the function of the pituitary gland.

Three treatment methods :

Transfenoidal surgery ➡ to remove tumors from the pituitary that compresses nerves and triggers excessive GH production. Surgery is done through the nose or upper lip using endoscopy and surgery. Performed under conditions of local anesthesia.

Medication supportive ➡ treatment after surgery or if surgery cannot be performed (in the case of large tumors) :

• Dopamine agonists (bromocriptine and cabergoline) function to suppress the growth hormone production. Taken once or twice a week in pill form.
• Somatostatin analogues (lanreotide and octreotide) are used to control the production and flow of growth hormones, as well as reduce the size of tumor adenomas. This drug is given by injection, the initial dose 3 × a day is continued once a month for a specified period of time. Injections under the skin (subcutaneous) and in the buttocks muscle (gluteus muscle).
• Growth hormone antagonist (pegvisomant). This drug works to block the effects of growth hormone on body tissues, suppress symptoms and regulate IGF-I levels in the liver. Growth hormone antagonists are given if the patient does not respond to other treatments, by injection subcutaneously once a day. This drug cannot reduce tumor size or reduce hormone levels in the body.

Radiotherapy ➡ if the patient does not respond to surgery or medication. This therapy is to destroy tumor cells that cannot be reached and suppress the growth hormone levels slowly.

• Conventional radiation therapy : using an external beam (EBT) given in small doses for a distance of 4-6 weeks. This is done to avoid damage to the pituitary gland and brain tissue. The results of therapy are felt after many years.
• Gamma knife : uses a strong radiation beam, without being exposed to the surrounding brain tissue. The patient uses a special head covering to minimize head movement. This therapy is only done once, with results that can be felt after 3-5 years. Gamma knife therapy is associated with less side effects than conventional radiation therapy.
• Proton radiation therapy : emits strong radiation to tumors with little effect on brain tissue. This therapy is given periodically in a shorter intensity than conventional radiation therapy.

Complications.

Untreated acromegaly can cause complications, such as :

• Hypertension.
• Heart disease.
• Cardiac enlargement (cardiomyopathy).
• Diabetes mellitus.
• Loss of vision function.
• Goiter.
• Polyp growth in the colonic line.
• Benign tumor growth in the uterus.
• Emphasis on spinal cord.
• Carpal Tunnel Syndrome.
• Sleep apnea.
• Osteoarthritis.
• Decreased joint movement ability.