Šiprová Helena, Souček Miroslav
Vnitr Lek. 2015 Feb;61(2):157-60.
Acromegaly is a rare and serious disease. A successful and rational therapy of acromegaly ought to combine surgery, radiotherapy and pharmacotherapy. The submitted article presents a case of acromegaly that was only diagnosed at the stage when total pituitary adenoma removal was impossible. Even so, the long-term stabilisation of the disease was reached by way of repeated surgery through transfenoidal and transcranial approach, by linear accelerator radiation therapy and Leksell Gamma Knife radiotherapy and by pharmacotherapy with somatostatin analogon octreotide and growth hormone receptor antagonist pegvisomant. The octreotide and pegvisomant dosage has been repeatedly changed according to IGF1 levels. The contemporary somatostatin analogon Sandostatin LAR 30 mg is given once every 3 weeks and the growth hormone receptor antagonist Somavert 20 mg is applied daily. Despite this serious disease, the patient has already been living contentedly for 10 years. From the ethical point of view, the financials costingness of the therapy should be considered as reasonable.
肢端肥大症是一种罕见且严重的疾病。成功且合理的肢端肥大症治疗应结合手术、放疗和药物治疗。提交的文章介绍了一例肢端肥大症病例，该病例直到无法进行垂体腺瘤全切时才被诊断出来。即便如此，通过经蝶窦和经颅入路的重复手术、直线加速器放射治疗和Leksell伽玛刀放射治疗以及使用生长抑素类似物奥曲肽和生长激素受体拮抗剂培维索孟进行药物治疗，实现了疾病的长期稳定。奥曲肽和培维索孟的剂量根据胰岛素样生长因子1（IGF1）水平多次调整。当代生长抑素类似物善龙30毫克每3周给药一次，生长激素受体拮抗剂思增20毫克每日应用。尽管患有这种严重疾病，该患者已经幸福地生活了10年。从伦理角度来看，该治疗的费用应被视为合理。
