Federal University of Minas Gerais, Department of Internal Medicine, Rua Alfredo Balena 110, Belo Horizonte, MG 30330-120, Brazil.
Nat Rev Endocrinol. 2012 Oct;8(10):605-11. doi: 10.1038/nrendo.2012.101. Epub 2012 Jun 26.
Acromegaly is a chronic disease characterized by the presence of a pituitary growth hormone (GH)-producing tumour, excessive secretion of growth hormone, raised levels of insulin-like growth factor I (IGF-I) and characteristic clinical presentation of acral enlargement. Over the past two decades, major advances have occurred in the understanding of some aspects of acromegaly--such as the biology of pituitary tumours, the physiology, molecular mechanisms of GH secretion and IGF-I generation, and the pathogenesis of comorbidities. Moreover, new approaches to diagnosis and surveillance (both in terms of screening and follow-up) of acromegaly have led to increases in the number of patients diagnosed with active disease, many of whom would previously have been missed. The development of sensitive assays for detecting plasma GH and IGF-I levels, as well as the widespread use of MRI for visualization of small tumours, have been major contributing factors to these improvements. Treatment advances have resulted in improved cure rates and disease control through novel neurosurgical techniques and pharmacological approaches. This Review summarizes and discusses the changes in our understanding of the epidemiology, diagnosis, treatment, and follow-up of acromegaly and its comorbidities.
肢端肥大症是一种慢性疾病，其特征为存在垂体生长激素（GH）分泌肿瘤、生长激素过度分泌、胰岛素样生长因子 I（IGF-I）水平升高以及肢端肥大的特征性临床表现。在过去的二十年中，人们对肢端肥大症的某些方面的认识取得了重大进展，例如垂体肿瘤的生物学、GH 分泌和 IGF-I 生成的生理学和分子机制，以及合并症的发病机制。此外，肢端肥大症的诊断和监测（包括筛查和随访）的新方法导致了更多的活动性疾病患者被诊断出来，其中许多患者以前可能被漏诊。检测血浆 GH 和 IGF-I 水平的灵敏检测方法的发展以及 MRI 对小肿瘤的广泛应用是这些改进的主要促成因素。治疗方法的进步通过新的神经外科技术和药物治疗方法，提高了治愈率和疾病控制率。本综述总结和讨论了我们对肢端肥大症及其合并症的流行病学、诊断、治疗和随访的认识的变化。
