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LO.5.

The treatment of acromegaly and gigantism


Untreated acromegaly will show the result of a reduction in survival. Death is more
common in heart failure, coronary artery disease and hypertension-related causes.
The addition of enhancers deaths also applies to neoplasia, especially on the colon
tumor. This treatment berindikasikan to everyone except those who are older or
who have minimal abnormalities. The goal of therapy to achieve the level of growth
hormone under 5mU / L or (2.5 ng / mL). It has been proved that the mortality has
been reduced to a normal level. Normal IGF-1 is also a goal of therapy.
Complete treatment can slow down the achievement. If possible at all. Generally the
pros and cons of surgery, radiotherapy, medical treatment. This process can be
assessed by monitoring the level of growth hormone and IGF-1.
If there is, there should hipopituitari and followed with diabetes and / or
hypertension should be treated conventionally; both are usually increased with the
treatment of acromegaly. Some specialists advocate colocnskopi checks regularly to
detect and remove polyps to reduce the risk of colon cancer.
a. Surgery
Trans sphenoidal Surgery is the main treatment. It will show results in the case of a
major clinical remission (60-90%) with pituitarymikroadenoma, growth hormone
before operative is very high and the level of IGF-1 also indicate poor prognosis for
surgical treatment
b. radiotherapy pituitary
External Radiotherapy is the use of normal after surgery failed to normalize the
levels of pituitary growth hormone as primary therapy. Often combined with
medium-term treatment with the somatostatin analog or dopamine agonists for
biochemical slow response to radiotherapy
c. medical therapy
There are three target receptors for the treatment of acromegaly, viz receptor.
pituitary somatostatin, dopamine receptor (D2) and growth hormone receptors in
peripheral
Somatostatin receptor antagonist
Octreotidedanlanreotideadalah analog sintetikpadasomatostatin that
mempunyaiaksiselektifpadareseptorsubtipesomatostatin (SST2 and SST5), which
mempunyaipenunjukantumorsekresi sangattinggi growth hormone.
Obattersebutmerupakanpengobatanjangkapendekyang
bersifatsementara.Tetapibanyaksekaranghanyamenggunakanterapi
primer.Pengurangantingkat GH and IGF-1
seringkepadapasien.Keduaobattersebutbiasanyadiberikansebagaiinjeksi depot
bulanandanbiasanyatoleransinyabaiktapidikaitkandenganmeningkatnyainsidenpada
batuempedudansangatlahmahal

Dopamine antagonists
Dopaminagonisbertindakatasreseptordandapatdiberikanuntukmengecilkan tumor
sebelumterapi definitive atauuntukmengontrolgejaladansekresi sustained growth
hormone; kemungkinanefektifdalampencampuranproduksi growth hormone
(somatotroph) danproduksiprolaktin (mammotroph) tumors.
Dosisbromocriptine 10-60mg sehariataucabergoline 0.5 mg daily
(lebihtinggiuntukprolaktinomas) dimanaseharusnyadimulaisecaralambat. GH
Keduaobattersebutdiberikansendirianuntukmengurangi
untuktingkatkeamananhanyapadakasus tapimerekabergunauntukpenyakit minor
residual analog ringanataukombinasidengan somatotatindanaktifitasreseptor
dopamine dalampengembangan
Bromocriptine
Suatuantagonisdopamin, dapatefektifmanurunkankadar GH

The growth hormone antagonist

BWF World Rankings - BWF (2/25/2016)


.
[Men's Singles]
1. Chen Long [CHN] 96931
2. Lee Chong Wei [MAS] 77153
3. Kento Momota [JPN][+1] 76601
4. Jan O Jorgensen [DEN][-1] 76422
5. Lin Dan [CHN] 74277
6. Viktor Axelsen [DEN] 72472
7. Chou Tien Chen [TPE] 63285
8. Tian Houwei [CHN] 61502
9. Tommy Sugiarto [INA][+1] 59114
10. K. Srikanth [IND][-1] 58534
24. Dionysius Hayom Rumbaka [-4] 41930
31. Ihsan Maulana Mustofa [+2] 37286
32. Anthony Ginting [+2] 37050
35. Jonatan Christie [+1] 35286
62. Sony Dwi Kuncoro [-2] 25000
73. Firman Abdul Kholik [+1] 22781

85. Simon Santoso [-4] 20850


93. Andre Kurniawan Tedjono [-6] 20320
119. Wisnu Yuli Prasetyo 15840
128. Muhammad Bayu Pangisthu 14900
131. Resky Aureza Megananda 14540
142. Shesar Hiren Rhustavito [+2] 13230
163. Adi Pratama 11770
170. Fikri Ihsandi Hadmadi [+1] 11190
179. Evert Sukamta 10450
193. Thomi Azizan Mahbub [+2] 9250
207. Krishna Adi Nugraha [+3] 8310
208. Nathaniel Ernestan Sulistyo [+3] 8120
212. Wibowo Kho Henrikho [+5] 7860
217. Akbar Panji [+4] 7680
239. Riyanto Subagja [+3] 7060
243. Vega Vio Nirwanda [+3] 6910
249. Ivanudin Rifan Fauzin [+3] 6730
[Women's Singles]
1. Carolina Marin [ESP] 92850
2. Saina Nehwal [IND] 76522
3. Li Xuerui [CHN] 74767
4. Ratchanok Intanon [THA] 74198
5. Sung Ji Hyun [KOR][+1] 72516
6. Wang Shixian [CHN][+1] 72338
7. Wang Yihan [CHN][-2] 72238
8. Nozomi Okuhara [JPN] 69762
9. Tai Tzu Ying [TPE] 65250
10. Sun Yu [CHN][+1] 59772
21. Maria Febe Kusumastuti 42881
24. Lindaweni Fanetri [-1] 40430
48. Hanna Ramadhini [+2] 26431
63. Fitriani [+7] 24122
83. Ruselli Hartawan [+2] 20260
85. Dinar Dyah Agustine [+1] 19920
97. Gregoria Mariska 17890
103. Febby Angguni [-1] 17180
113. Bellaetrix Manuputty 15654
114. Adrianti Firdasari 15600

121. Rusydina Antardayu Riodingin 14690


125. Aprilla Yuswandari 14310
131. Hera Desi [-1] 13300
155. Yulia Yosephin Susanto [-1] 10600
160. Lyanny Alessandra Mainaky 9940
165. Gabriela Meilani Moningka 9470
199. Jauza Fadhila Sugiarto 6800
[Men's Doubles]
1. Lee Yong Dae/Yoo Yeon Seong [KOR] 94130
2. Hendra Setiawan/Mohammad Ahsan [INA] 84470
3. Mathias Boe/Carsten Mogensen [DEN][+1] 74734
4. Fu Haifeng/Zhang Nan [CHN][-1] 74647
5. Chai Biao/Hong Wei [CHN] 71775
6. Kim Gi Jung/Kim Sa Rang [KOR][+1] 66237
7. Hiroyuki Endo/Kenichi Hayakawa [JPN][-1] 66057
8. Mads Conrad-Petersen/Mads Pieler Kolding [DEN] 64193
9. Ko Sung Hyun/Shin Baek Choel [KOR] 60510
10. Liu Xiaolong/Qiu Zihan [CHN][+1] 57235
10. Angga Pratama/Ricky Karanda Suwardi [-1] 56814
14. Gideon Markus Fernaldi/Kevin Sanjaya Sukamuljo 51360
22. Wahyu Nayaka Arya Pankaryanira/Ade Yusuf 42980
26. Berry Angriawan/Ryan Agung Saputra [+1] 37590
48. Fajar Alfian/Muhammad Rian Ardianto [+1] 25940
68. Hardianto Hardianto/Kenas Adi Haryanto [-1] 20100
103. Hendra Aprida Gunawan/Markis Kido [-3] 13140
[Women's Doubles]
1. Luo Ying/Luo Yu [CHN] 76093
2. Nitya Krishinda Maheswari/Greysia Polii [INA] 73849
3. Kamilla Rytter Juhl/Christinna Pedersen [DEN][+1] 72954
4. Misaki Matsutomo/Ayaka Takahashi [JPN][-1] 72579
5. Tian Qing/Zhao Yunlei [CHN][+2] 65648
6. Jung Kyung Eun/Shin Seung Chan [KOR][-1] 64997
7. Chang Ye Na/Lee So Hee [KOR][-1] 60286
8. Eefje Muskens/Selena Piek [NED] 54025
9. Ma Jin/Tang Yuanting [CHN] 54019
10. Naoko Fukuma/Kurumi Yonao [JPN] 52035

32. Anggia Shitta Awanda/Ni Ketut Mahadewi Istirani [+1] 35246


41. Della Destiara Haris/Rosyita Eka Putri Sari [+7] 29824
48. Devi Tika Permatasari/Keshya Nurvita Hanadia [-1] 26780
62. Pia Zebadiah Bernadeth/Variella Aprilsasi Lejarsar Putri [-3] 21100
71. Apriani/Jauza Fadhila Sugiarto [-1] 18360
77. Dian Fitriani/Nadya Melati 16340
98. Nisak Puji Lestari/Merisa Cindy Sahputri [-2] 11930
291. Tiara Rosalia Nuraidah/Rizki Amelia Pradipta 2720
[Mixed Doubles]
1. Zhang Nan/Zhao Yunlei [CHN] 99735
2. Tontowi Ahmad/Liliyana Natsir [INA] 80512
3. Liu Cheng/Bao Yixin [CHN] 77200
4. Ko Sung Hyun/Kim Ha Na [KOR] 75460
5. Xu Chen/Ma Jin [CHN][+1] 73741
6. Joachim Fischer Nielsen/Christinna Pedersen [DEN][-1] 71290
7. Chris Adcock/Gabrielle Adcock [ENG] 67574
8. Praveen Jordan/Debby Susanto [INA] 66382
9. Lee Chun Hei Reginald/Chau Hoi Wah [HKG] 59445
10. Lu Kai/Huang Yaqiong [CHN] 59290
15. Edi Subaktiar/Gloria Emanuelle Widjaja 43580
18. Ronald Alexander/Melati Daeva oktaviani 40170
21. Riky Widianto/Richi Puspita Dili 38010
35. Markis Kido/Pia Zebadiah Bernadeth [+2] 32050
43. Fran Kurniawan/Komala Dewi 28190
48. Irfan Fadhilah/Weni Anggraini 26020
49. Hafiz Faisal/Shella Devi Aulia 25580
66. Alfian Eko Prasetya/Annisa Saufika [+1] 20530