Permasalahan Penegakan Diagnosis Seorang Pasien dengan Kecurigaan Akromegali dengan Hipotiroid Sentral

Abstract

Acromegaly is a rare disease caused by excess growth hormone (GH) secretion. Acromegaly is most commonly caused by pituitary adenomas, but can also occur by extra pituitary tumors that secrete large amounts of GH. Hypersecretion of GH will lead to the production of Insulin like Growth Factor-1(IGF-1) which ultimately leads to increased cell proliferation and differentiation, increased linear growth and increased anti-insulin effect mediated by IGF-1. Diagnosis of acromegaly requires a combination of IGF-1 levels examination and also radiological imaging such as Magnetic Resonance Imaging (MRI) of the head or Computerised Tomography (CT) scan of the chest or abdomen. Acromegaly can be treated with surgery and pharmacological therapy to reduce the amount of GH, radiotherapy also can be an option. Both acromegaly that is caused by pituitary adenoma and excessive extra pituitary GH secretion have similar treatment. In this case report, we discuss a woman with clinical and laboratory manifestations suggesting typical acromegaly with a previous history of post-resection pituitary tumor. There were difficulties in establishing the diagnosis in this case due to the limited supporting examinations available.