Acromegaly disease
Acromegaly is a condition that arises due to excess growth hormone in the body. Growth hormone, or growth hormones, is a hormone produced by the pituitary gland in the human brain.
In children, growth hormone affects growth and development. As with adults, growth hormone affects energy levels, muscle strength, and bone health.
Excess growth hormone in children is called gigantism and this condition is relatively rare. In adults, Acromegaly is often found in middle age. Acromegaly is also a very rare condition found. It is thought to have only three new cases of Acromegaly on every one million people annually.
Causes of Acromegaly
Acromegaly is associated with growth hormone. Hormonal regulation systems in the human body are generally arranged in cascade form. For the growth hormone, for example, Cascade begins with the production of growth hormone-releasing hormone (GHRH) by the hypothalamus of the brain.
GHRH will stimulate the pituitary gland to produce growth hormone. The discharge of this hormone in the bloodstream will stimulate the liver to produce insulin-like growth factor I (IGF-I). Higher IGF-I levels will further tell the pituitary gland to reduce the production of growth hormone.
If the production of the growth hormone is excessive, it will result in excess production of IGF-I. It can lead to enlarged organs and excess bone growth. It can also result in changes in the metabolism of sugar and fat, so it can cause diabetes, high blood pressure, and heart problems.
In most cases acromegaly, about 95% of cases, excess production of growth hormone due to the presence of benign tumors on the pituitary gland called adenoma. By its size, these adenomas can be distinguished into macro (when measuring more than 1cm) and micro. Adenomas in the brain that are enlarged can also suppress certain tissues in the brain (depending on the location of the adenoma) to give certain symptoms.
Although it is rare to find acromegaly can also cause tumors in other parts of the body such as the lungs, pancreas, and other parts of the brain. Often, these tumors produce GNRH which causes the production of growth hormone by the pituitary gland. The tumor can also produce a direct growth hormone.
Acromegaly Diagnosis
To determine the diagnosis of Acromegaly, the doctor will conduct a thorough evaluation by doing an anamnesis around the signs and symptoms, as well as a physical examination. The supporting examination that may be needed to support the diagnosis is:
- Growth hormone levels: elevated levels of this hormone (> 10 ng/ml) after consuming sugar, coupled with clinical symptoms of Acromegaly, can confirm the diagnosis.
- Test consumption of glucose (sugar) Oral: Assess the level of growth hormone after consumption of sugar. In normal circumstances, sugar consumption will stimulate the pituitary to reduce the production of growth hormone.
- IGF-I levels.
- Imaging: MRI or CT-scan to assess the presence of pituitary adenomas or tumors in other parts of the body. X-ray inspection to assess the manifestations of excess growth hormone and IGF-I in Bones.
Acromegaly Symptoms
Some of the symptoms or signs of acromegaly can be recognized, among others:
- Swelling of the hands and feet (note the size of the ring or changed shoes)
- Facial changes: Prominent eyebrows and jaws, there is an enlarged space between the teeth, lower lip, and nose
- Joint pain
- The skin on the facial and extremity area feels rough and oily
- Thick and hard nails
- Wrinkles on the forehead and the surrounding areas of the nose-mouth become deeper
- Skin pores that appear enlarged and hyperpigmentation occurs
- Thick and swollen eyelids
- Excessive sweating
- High blood pressure
- Headaches
- Visual impairment
- Abnormalities in menstrual cycles, sometimes accompanied by a breast discharge
- Erectile dysfunction
- Decreased libido
Acromegaly Treatment
In the case of the pituitary adenoma, a suggested Acromegaly treatment may be surgically removed. Surgery is generally successful in cases of tumor diameters below 10mm.
Medications can be administered if surgery does not lower the growth hormone level or can be administered in large cases of tumors to shrink their size before surgery. The medications that may be administered are the analog somatostatin, the GH receptor antagonist (GHRA), and the dopamine agonist.
If after surgery there is still a tumor, and drugs can not help reduce the symptoms can be considered radiation therapy.