Rochette Claire, Graillon Thomas, Albarel Frederique, Morange Isabelle, Dufour Henry, Brue Thierry, Castinetti Frederic
Aix-Marseille Université, Centre National de la Recherche Scientifique, CRN2M Unité Mixte de Recherche 7286 and Assistance Publique-Hopitaux de Marseille, Department of Endocrinology, La Conception Hospital, National Reference Center for Rare Pituitary Diseases, 13005 Marseille, France.
Aix-Marseille Université, and Assistance Publique-Hopitaux de Marseille, Department of Neurosurgery, La Timone Hospital, 13005 Marseille, France.
J Endocr Soc. 2017 Nov 24;1(12):1531-1539. doi: 10.1210/js.2017-00334. eCollection 2017 Dec 1.
Combining surgery and medical treatments allows the control of growth hormone hypersecretion in 80% of cases. Our objective was to determine the rate of acromegaly comorbidities once hypersecretion of growth hormone is controlled.
Our retrospective monocentric study was based on 130 patients followed on a regular basis, with acromegaly controlled by medical treatments or cured by surgery or radiation technique. Our main outcome measures were the prevalence of major metabolic complications of acromegaly (diabetes, hypertension, low-density lipoprotein cholesterol, triglycerides) at diagnosis and last follow-up in comparison with French epidemiological data.
As expected, controlling hypersecretion significantly improved the metabolic complications of acromegaly. However, the proportion of patients having at least one metabolic complication of acromegaly at last follow-up (mean, 72 months after remission) was 27% for altered glucose tolerance or diabetes, 39% for hypertension, 34.3% for hypercholesterolemia, and 13.3% for hypertriglyceridemia. Interestingly, our data showed that diabetes was the only comorbidity different with a higher prevalence in patients in remission versus a general population of a similar median age (21.6% vs 6.9%, respectively).
The follow-up of glucose disorders needs to be maintained on a long-term basis in patients controlled for acromegaly.
手术与药物治疗相结合可使80%的肢端肥大症患者生长激素分泌亢进得到控制。我们的目标是确定生长激素分泌亢进得到控制后肢端肥大症合并症的发生率。
我们的回顾性单中心研究基于130例定期随访的患者，这些患者的肢端肥大症通过药物治疗得到控制，或通过手术或放射技术治愈。我们的主要观察指标是肢端肥大症主要代谢并发症（糖尿病、高血压、低密度脂蛋白胆固醇、甘油三酯）在诊断时和末次随访时的患病率，并与法国流行病学数据进行比较。
正如预期的那样，控制分泌亢进显著改善了肢端肥大症的代谢并发症。然而，在末次随访时（缓解后平均72个月），至少有一种肢端肥大症代谢并发症的患者比例分别为：糖耐量异常或糖尿病27%，高血压39%，高胆固醇血症34.3%，高甘油三酯血症13.3%。有趣的是，我们的数据显示，糖尿病是唯一一种与缓解期患者患病率高于年龄中位数相似的普通人群不同的合并症（分别为21.6%和6.9%）。
对于肢端肥大症得到控制的患者，需要长期持续监测血糖紊乱情况。
