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Acromegaly

Overview
Acromegaly is a disorder that arises due to the body's excess growth hormone, resulting in excessive growth in various tissues of the body, muscles and bones, especially in the legs, hands and face. This condition is generally caused by a benign tumor in the pituitary gland (pituitary). 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 includes infrequent occurrence and minimal symptoms. Most cases of sufferers know they have been attacked by acromegaly after years. Acromegaly can result in life-threatening complications if not treated immediately.
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Symptoms
Not all acromegaly conditions show significant symptoms directly. Symptoms that appear will also be different from each sufferer. Some symptoms that can be experienced are:
  • Enlarged hands and feet.
  • 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, to body odor. 
  • Muscles weaken.
  • Joint pain and mobility are limited.
  • Vision function decreases.
  • Hoarseness and depth (widening of the vocal cords and sinuses).
  • Fast snoring during sleep.
  • The barrel enlarges (barrel chest).
  • Impaired menstrual cycle in women.
  • Erectile difficulties in men.
This condition can also cause important organs of the body such as the liver, kidney, heart and spleen to enlarge, and potentially endanger life. See a doctor immediately or visit the nearest hospital if you feel the symptoms above to get early treatment.

Causes
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 the cause of increased GH production. In rare cases, offspring can be a trigger factor.

The pituitary gland is located in the lower part of the brain and functions 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 for the growth of bone and body tissue. Excessive GH levels will affect IGF-I production, triggering abnormal growth in body tissues, muscles, and bones.
For patients with pituitary tumors, acromegaly can be accompanied by other symptoms, namely if the tumor presses the nerves and tissues around the pituitary, or if the tumor also causes excessive production of thyroid hormone.

Diagnosis
In diagnosing acromegaly, the doctor will first collect information related to the patient's symptoms and medical history, including the type of tumor suffered, changes in body structure, and the treatment being undertaken. After that a further examination will be carried out to ensure the diagnosis, such as:
  • Blood test. There are 2 blood tests that can be done, namely a measurement test of GH and IGF-I levels to determine the number of hormones produced, and a test of suppression of growth hormone to see changes and response of GH levels to the administration of glucose.
  • Scanning CT scans and MRI are generally used to check the accuracy of the location of the tumor in the pituitary gland or other body organs. X-rays can also be done to check bone density and size
Treatment
Acromegaly treatment is focused on reducing the severity of symptoms, regulating excessive hormone levels, and restoring the function of the pituitary gland. The following are three treatment methods that are generally recommended in acromegaly cases:

Operation. Transfenoidal surgery is usually recommended to remove tumors from the pituitary that suppress nerves and trigger excessive GH production. This action is carried out through the nose or upper lip, using endoscopy and other operating devices to remove the existing tumor. This action is carried out under local anesthesia. Suggestions for taking drugs and doing therapy might be done before or after surgery.

Drugs. The following drugs can be used for supporting treatment after surgery, or if surgery cannot be performed (for example in the case of large tumors):
  • Dopamine agonist. Drugs such as bromocriptine and cabergoline serve to suppress growth hormone production. Both drugs are taken once or twice a week in pill form.
  • Somatostatin analogue. Drugs such as lanreotide and octreotide are used to control the production and flow of growth hormones, and reduce the size of adenoma tumors. This drug is given in the form of an injection in the hospital, with an initial dose 3 times a day to see its effectiveness, and is continued once a month for a specified period. This injection is generally given under the skin (subcutaneous) and in the buttock muscle (gluteus muscle).
  • Growth hormone antagonists. One example of this drug is pegvisomant. This drug serves to block the effects of growth hormone on body tissues, suppress symptoms, and regulate IGF-I levels in the liver. Growth hormone antagonists are usually given if the patient does not respond to other treatments, through subcutaneous injections once a day at the hospital. This drug cannot reduce 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 cannot be reached before and reduce growth hormone levels slowly. Radiotherapy can be done in the following 3 ways:
  • Conventional radiation therapy. The tumor is targeted to use an external beam (EBT) which is given in small doses with pauses of 4 to 6 weeks. This is done to avoid damage to the pituitary gland and brain tissue, and provide time to heal the tissue affected by radiation. The results of this therapy are generally felt after years.
  • Gamma knife therapy. The tumor is targeted directly using a strong radiation beam, without affecting the surrounding brain tissue. Patients will be asked to use a special head covering 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 risks causing smaller side effects than conventional radiation therapy.
  • Proton radiation therapy. Not much different from gamma knife therapy, proton radiation therapy emits strong radiation to the tumor with minimal effect on brain tissue. This therapy is given regularly, with a shorter intensity than conventional radiation therapy.

Complications
Untreated acromegaly can cause complications that can endanger lives, such as:
  •  
  • Heart disease, especially enlargement of the heart (cardiomyopathy).
  • Diabetes mellitus.
  • Loss of vision function.
  •  
  • Polyp or precancerous growth in the colon line.
  • Benign tumor growth in the uterus.
  • Emphasis on the spinal cord.
  • Ship aisle syndrome (carpal tunnel syndrome).
  • Sleep apnea, which can close the respiratory tract.
  • Osteoarthritis or decreased mobility in the joints.
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