Department of Endocrinology, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
Int J Clin Pract. 2011 Aug;65(8):896-902. doi: 10.1111/j.1742-1241.2011.02682.x. Epub 2011 Jun 16.
Analysis of patients with acromegaly followed-up at a single centre, focusing on baseline characteristics, morbidity and efficacy of treatment.
Retrospective review of electronic medical records of acromegalics from 1987 to 2009.
One hundred and fifteen patients (45 men), aged 47 ± 14 years, with a mean follow-up of 8.8 ± 0.8 years were studied. Twenty-five per cent had micro- and 75% macroadenomas. Forty-three per cent presented with visual field defects, 49% had hypertension, 25% diabetes mellitus and 35% dyslipidaemia. At follow-up, 50% had myocardial hypertrophy, 55% colon polypodiasis, 74% nodular thyroid disease and 18% adrenal masses. Surgery was performed in 79% (8% twice), followed by conventional radiotherapy in 27%. Fifty-two per cent of the patients achieved remission. Disease control was reported in 65% of microadenomas and 41% of macroadenomas. Remission rates with surgery alone were 41%. Improvement of remission rates was achieved with subsequent treatment with somatostatin analogues (SSA) (53%), or conventional radiotherapy (63%). Nevertheless, pituitary reserve was compromised with the latter. SSA significantly improved outcomes in microadenomas, even as a monotherapy (remission in 89%), in contrast to macroadenomas (0%), although these agents were associated with impaired glucose metabolism and cholelithiasis in half of the patients.
Acromegaly is associated with an increased morbidity. About half of the treated patients achieved remission (2/3 of microadenomas). The best outcomes were reported for the combination of surgery with radiotherapy, in spite of a higher risk of hypopituitarism. SSA led to remission in a significant percentage of microadenomas, but was associated with increased rates of cholelithiasis and impaired glucose homeostasis.
分析在单一中心随访的肢端肥大症患者，重点关注基线特征、发病率和治疗效果。
回顾性分析 1987 年至 2009 年电子病历中肢端肥大症患者的资料。
研究了 115 例患者（45 例男性），年龄 47 ± 14 岁，平均随访 8.8 ± 0.8 年。25%为微腺瘤，75%为大腺瘤。43%存在视野缺损，49%有高血压，25%有糖尿病，35%有血脂异常。随访时，50%有心肌肥厚，55%有结肠息肉，74%有甲状腺结节性疾病，18%有肾上腺肿块。79%的患者接受了手术（8%的患者接受了两次手术），随后 27%的患者接受了常规放疗。52%的患者达到缓解。微腺瘤的疾病控制率为 65%，大腺瘤为 41%。单独手术的缓解率为 41%。随后用生长抑素类似物（SSA）（53%）或常规放疗（63%）治疗可提高缓解率。然而，后者会损害垂体储备功能。SSA 可显著改善微腺瘤的预后，即使是作为单一治疗（缓解率为 89%），与大腺瘤（0%）形成对比，尽管这些药物会使一半的患者发生葡萄糖代谢紊乱和胆石症。
肢端肥大症与发病率增加有关。大约一半的治疗患者达到缓解（2/3 的微腺瘤）。手术联合放疗的效果最好，尽管垂体功能减退的风险更高。SSA 可使很大一部分微腺瘤患者达到缓解，但会增加胆石症和葡萄糖稳态受损的发生率。
