Duarte Felipe H, Jallad Raquel S, Bronstein Marcello D
Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
Endocrinology Service, AC Camargo Cancer Center, São Paulo, Brazil.
Endocrine. 2016 Nov;54(2):306-314. doi: 10.1007/s12020-016-1118-z. Epub 2016 Oct 4.
Despite recent advances in acromegaly treatment by surgery, drugs, and radiotherapy, hormonal control is still not achieved by some patients. The impairment of IGF-1 generation by estrogens in growth hormone deficient patients is well known. Patients on oral estrogens need higher growth hormone doses in order to achieve normal IGF-1 values. In the past, estrogens were one of the first drugs used to treat acromegaly. Nevertheless, due to the high doses used and the obvious side effects in male patients, this strategy was sidelined with the development of more specific drugs, as somatostatin receptor ligands and dopamine agonists. In the last 15 years, the antagonist of growth hormone receptor became available, making possible IGF-1 control of the majority of patients on this particular drug. However, due to its high cost, pegvisomant is still not available in many centers around the world. In this setting, the effect of estrogens and also of selective estrogen receptor modulators on IGF-1 control was reviewed, and proved to be an ancillary tool in the management of acromegaly. This review describes data concerning their efficacy and place in the treatment algorithm of acromegaly.
尽管近年来在肢端肥大症的手术、药物及放射治疗方面取得了进展，但仍有部分患者未能实现激素控制。雌激素对生长激素缺乏患者的IGF-1生成的损害是众所周知的。口服雌激素的患者需要更高剂量的生长激素才能达到正常的IGF-1值。过去，雌激素是最早用于治疗肢端肥大症的药物之一。然而，由于使用剂量高以及对男性患者有明显副作用，随着更具特异性的药物如生长抑素受体配体和多巴胺激动剂的出现，这种治疗策略被搁置。在过去15年里，生长激素受体拮抗剂问世，使得大多数使用这种特定药物的患者能够实现IGF-1的控制。然而，由于其成本高昂，培维索孟在世界上许多中心仍无法使用。在此背景下，对雌激素以及选择性雌激素受体调节剂对IGF-1控制的作用进行了综述，结果证明它们是肢端肥大症治疗中的辅助工具。这篇综述描述了有关它们在肢端肥大症治疗算法中的疗效和地位的数据。
