Racine Michael S, Barkan Ariel L
Division of Endocrinology and Metabolism, University of Michigan Medical Center, 3920 Taubman Center, Box 0354, Ann Arbor, Michigan 48109-0354, USA.
Pituitary. 2002;5(2):67-76. doi: 10.1023/a:1022356313153.
The primary treatment of acromegaly remains transsphenoidal adenomectomy, yet the tissue overgrowth of acromegaly often progresses following surgery, and responds to radiotherapy only after significant delay. Persistently elevated serum growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations can be normalized in about half of post-surgery acromegalics using the pharmacologic alternatives presently available, the dopamine agonists (DA) and somatostatin (SST) analogs. Cabergoline, the most efficacious DA, normalizes IGF-I in approximately 37% of patients, whereas the long-acting SST analogs, Octreotide LAR and Lanreotide SR, do so in 66%. Significant tumor shrinkage may be attained with SST analogs in particular, and when necessary, the primary medical treatment of acromegaly may be successfully addressed with this class of drugs. Greatly enhanced efficacy is expected from the GH receptor antagonist pegvisomant, which is nearing market availability and will enable the normalization of serum IGF-I in virtually all patients treated. We review here the pharmacologic treatments of excessive GH secretion.
肢端肥大症的主要治疗方法仍是经蝶窦腺瘤切除术，然而肢端肥大症的组织过度生长在手术后常继续进展，且在放疗后有显著延迟才会有反应。使用目前可用的药物替代疗法，即多巴胺激动剂（DA）和生长抑素（SST）类似物，约一半的手术后肢端肥大症患者持续升高的血清生长激素（GH）和胰岛素样生长因子-I（IGF-I）浓度可恢复正常。最有效的DA卡麦角林可使约37%的患者IGF-I恢复正常，而长效SST类似物奥曲肽长效释放制剂和兰瑞肽缓释剂则为66%。特别是SST类似物可使肿瘤显著缩小，必要时，肢端肥大症的主要药物治疗可用这类药物成功解决。生长激素受体拮抗剂培维索孟的疗效有望大幅提高，该药即将上市，几乎可使所有接受治疗的患者血清IGF-I恢复正常。我们在此综述GH分泌过多的药物治疗。
