Garvan Institute of Medical Research; Department of Endocrinology, St Vincent's Hospital; and St Vincent's Clinical School, Faculty of Medicine, the University of New South Wales, Sydney, Australia.
Eur J Endocrinol. 2020 May;182(5):R67-R82. doi: 10.1530/EJE-19-1023.
Gonadal steroids modulate the effects of GH, with oestrogens attenuating and androgens augmenting GH action. Whether these divergent effects influence the clinical manifestation, management and prognosis of acromegaly have not been carefully reviewed. This review examines whether there is a gender difference in epidemiology, presentation, quality of life (QoL), morbidity, treatments and mortality of acromegaly. Acromegaly is more common in women who present at an older age with longer diagnostic delay. At presentation, women have a higher GH relative to IGF-1 level than men. QoL is more adversely affected in women both before and after treatment. Prevalence of hypertension and diabetes are greater in women than in men with acromegaly. Treatment outcomes with SSAs are comparable between sexes, but women may require a higher dose of pegvisomant for equivalent response. Mortality in untreated acromegaly is more profoundly affected in women; however, improved treatments in recent decades have resulted in normalisation of standard mortality ratios in both sexes. We conclude that gender does matter in the management of acromegaly, with women presenting later in life, with greater diagnostic delay, higher prevalence of comorbidities and experiencing worse QoL.
性腺类固醇调节 GH 的作用，雌激素减弱，雄激素增强 GH 的作用。这些不同的影响是否会影响肢端肥大症的临床表现、治疗和预后尚未得到仔细审查。本文综述了肢端肥大症的流行病学、表现、生活质量（QoL）、发病率、治疗和死亡率是否存在性别差异。女性肢端肥大症更为常见，发病年龄更大，诊断延迟时间更长。在发病时，女性的 GH 相对于 IGF-1 的水平高于男性。女性在治疗前后的生活质量都受到更大的影响。肢端肥大症女性的高血压和糖尿病患病率高于男性。SSA 治疗的疗效在性别之间相当，但女性可能需要更高剂量的培维索孟才能达到等效反应。未经治疗的肢端肥大症女性的死亡率受影响更大；然而，近几十年来治疗方法的改进导致两性的标准死亡率比值正常化。我们得出结论，性别在肢端肥大症的治疗中确实很重要，女性发病年龄更大，诊断延迟时间更长，合并症的患病率更高，生活质量更差。
