Castinetti F, Morange I, Dubois N, Albarel F, Conte-Devolx B, Dufour H, Brue T
Service d'endocrinologie, diabète et maladies métaboliques, centre de référence des maladies rares d'origine hypophysaire, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, université de la méditerranée, Marseille, France.
Ann Endocrinol (Paris). 2009 Apr;70(2):107-12. doi: 10.1016/j.ando.2009.03.002. Epub 2009 Apr 3.
Transsphenoidal surgery is currently the first-line treatment of acromegaly. Remission is observed in 80 to 90% microadenomas, 50 to 60% non-invasive macroadenomas, and less than 20% invasive macroadenomas. Predictive factors include age, maximal size of the adenoma, cavernous sinus invasion, initial hormone levels and neurosurgeon's experience. Complications are rare, with about 5% definitive diabetes insipidus and 10% of new anterior pituitary hormone deficits. Somatostatin agonist pretreatment can be proposed as it decreases tumor volume in about 25% cases and might reduce the rate of immediate postsurgical complications; however, there is no obvious difference in surgical remission rate whether patients are pretreated or not. Debulking surgery can also be proposed in very large macroadenomas incompletely controlled by somatostatin agonists or resistant to medical treatment, as it was shown to facilitate somatostatin agonist efficacy in more than 50% cases.
经蝶窦手术是目前肢端肥大症的一线治疗方法。80%至90%的微腺瘤、50%至60%的非侵袭性大腺瘤以及不到20%的侵袭性大腺瘤可实现缓解。预测因素包括年龄、腺瘤最大尺寸、海绵窦侵袭、初始激素水平和神经外科医生的经验。并发症很少见，约5%会出现永久性尿崩症，10%会出现新的垂体前叶激素缺乏。可建议使用生长抑素激动剂进行预处理，因为它可使约25%的病例肿瘤体积缩小，并可能降低术后即刻并发症的发生率；然而，无论患者是否接受预处理，手术缓解率并无明显差异。对于生长抑素激动剂控制不完全或对药物治疗耐药的非常大的大腺瘤，也可建议进行肿瘤减容手术，因为已证明在超过50%的病例中它可提高生长抑素激动剂的疗效。
