Katznelson Laurence
Stanford University School of Medicine, Stanford, CA 94305-5826, USA.
Nat Clin Pract Endocrinol Metab. 2006 Feb;2(2):109-17; quiz following 117. doi: 10.1038/ncpendmet0096.
Acromegaly is an insidious disease that, in most cases, is a result of a pituitary adenoma that hypersecretes growth hormone (GH). The goals of therapy are to control excess GH secretion and limit, if not reverse, the long-term medical consequences and risk of premature mortality associated with acromegaly. Surgery is currently the preferred primary therapeutic option because it can lead to rapid reductions in GH levels and prevent mass effects from local tumor growth. Medical therapy is used most often in an adjuvant, secondary role for patients in whom surgery has been unsuccessful. Radiation therapy is most commonly recommended in the setting of failed surgery and lack of adequate control with medical therapy. A role of primary medical therapy for patients de novo has been proposed, particularly with regard to somatostatin analogues. These analogues may control GH levels and reduce tumor volume in up to 50% of subjects, suggesting that they may be efficacious in this context. The use of somatostatin analogues to improve surgical outcome has also been proposed, but there is a lack of randomized trials available to address this issue. Primary medical therapy is well tolerated and further studies are necessary to identify patients who should be targeted for such therapy.
肢端肥大症是一种隐匿性疾病，在大多数情况下，是由垂体腺瘤分泌过多生长激素（GH）所致。治疗的目标是控制GH分泌过多，并限制（若不能逆转）与肢端肥大症相关的长期医学后果和过早死亡风险。手术目前是首选的主要治疗选择，因为它可使GH水平迅速降低，并防止局部肿瘤生长产生的占位效应。药物治疗最常用于手术失败患者的辅助、次要治疗。放射治疗最常用于手术失败且药物治疗控制不佳的情况。有人提出了原发性药物治疗对初诊患者的作用，特别是关于生长抑素类似物。这些类似物可控制高达50%的受试者的GH水平并缩小肿瘤体积，表明它们在此情况下可能有效。也有人提出使用生长抑素类似物改善手术结果，但缺乏解决此问题的随机试验。原发性药物治疗耐受性良好，有必要进一步研究以确定适合此类治疗的患者。
