Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Int J Gen Med. 2013;6:31-8. doi: 10.2147/IJGM.S38594. Epub 2013 Jan 18.
Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure. If biochemical control is not achieved following surgery, other treatment options include medical therapy and radiation therapy. Improved biochemical control may only alleviate rather than reverse the associated comorbidities. Thus, lifelong monitoring of patient health is needed, with particular attention to the management of cardiovascular risk factors. It is additionally important to consider the impact of both disease and treatment on patients' quality of life and minimize that impact where possible, but particularly for chronic therapies. For the majority of patients, chronic therapy is likely to include somatostatin analog injections. In some circumstances, it may be possible to extend the dosing interval of the analog once good biochemical control is achieved. Additional convenience may be gained from the possibility of self-/partner administration of treatment or administration of treatment by a health care professional at home. Overall, it is clear that the care of patients with acromegaly requires a highly coordinated approach involving numerous specialties (eg, endocrinology, surgery, cardiology). Further, patients' needs must be at the core of management and every effort must be made to improve health care experiences and minimize treatment burdens.
肢端肥大症是一种罕见疾病，通常由垂体腺瘤过度分泌生长激素引起。该疾病与多种严重合并症和死亡率增加有关。诊断的延迟往往很长。这可能是由于医疗保健专业人员对疾病的认识不足、起病隐匿且分化特征、以及患者更可能出现其他在初级保健中更常见的症状的原因。早期识别肢端肥大症可促进及时开始治疗，并可能最大限度地减少生长激素过多的永久性影响。许多患者的主要治疗方法是垂体手术，但并非所有患者都有资格接受手术或实现手术治愈。如果手术后未达到生化控制，其他治疗选择包括药物治疗和放射治疗。生化控制的改善可能只能缓解而不能逆转相关合并症。因此，需要对患者的健康进行终身监测，特别注意心血管危险因素的管理。此外，还需要考虑疾病和治疗对患者生活质量的影响，并尽可能减轻这种影响，但对于慢性治疗尤其如此。对于大多数患者，慢性治疗可能包括生长抑素类似物注射。在某些情况下，一旦达到良好的生化控制，就有可能延长类似物的给药间隔。如果能够自行/由伴侣给药或由医疗保健专业人员在家中给药，可能会增加额外的便利性。总的来说，很明显，肢端肥大症患者的护理需要涉及多个专业的高度协调方法（例如，内分泌学、外科、心脏病学）。此外，患者的需求必须是管理的核心，必须尽一切努力改善医疗保健体验并减轻治疗负担。
