Dieguez C, Page M D, Peters J R, Scanlon M F
Department of Medicine, University of Wales College of Medicine, Cardiff.
J R Coll Physicians Lond. 1988 Apr;22(2):84-91.
Our knowledge of the mechanisms involved in the regulation of somatotroph cell growth is scanty and much work is still needed to elucidate the role of different growth factors and the mechanisms involved in oncogene activation in both normal and tumour cell growth. However, there are several recent, important clinical ramifications from our improved understanding of GH neuroregulation. The use of long-acting SS analogues is valuable in the treatment of acromegaly, probably in acute variceal haemorrhage and it also produces symptomatic improvement in patients with vipomas and glucagonomas. GHRH may be of value in the treatment of short stature due to hypothalamic GHRH deficiency but further definitive studies are now required to provide convincing evidence that this line of treatment is of greater benefit than the use of synthetic recombinant human GH. Inhibition of GH release may be of value in prevention of both acute and chronic complications of insulin-dependent diabetes mellitus. The use of cholinergic muscarinic receptor blockade in this context may be particularly useful because of a probably sparing of the counter-regulatory GH response to hypoglycaemia. In view of the relative ease with which nocturnal GH secretion can be abolished, we think it reasonable to consider the possible existence of a permissive or mediating role of GH in other disease states, either directly or by maintaining production of either local tissue or circulating growth factors or both.
我们对生长激素细胞生长调节所涉及机制的了解尚少，仍需开展大量工作以阐明不同生长因子在正常及肿瘤细胞生长中的作用以及原癌基因激活所涉及的机制。然而，我们对生长激素神经调节认识的提高带来了一些近期重要的临床影响。长效生长抑素类似物在肢端肥大症治疗中具有重要价值，可能对急性静脉曲张出血也有效，并且对患有血管活性肠肽瘤和胰高血糖素瘤的患者也能改善症状。生长激素释放激素可能对治疗因下丘脑生长激素释放激素缺乏所致的身材矮小有价值，但现在需要进一步的确定性研究，以提供令人信服的证据，证明这种治疗方法比使用合成重组人生长激素更有益。抑制生长激素释放可能对预防胰岛素依赖型糖尿病的急性和慢性并发症有价值。在这种情况下，使用胆碱能毒蕈碱受体阻滞剂可能特别有用，因为这可能会保留对低血糖的反调节生长激素反应。鉴于夜间生长激素分泌相对容易被消除，我们认为有理由考虑生长激素在其他疾病状态中可能存在的许可或介导作用，无论是直接作用，还是通过维持局部组织或循环生长因子或两者的产生来发挥作用。
