Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Neurol India. 2020 May-Jun;68(Supplement):S44-S51. doi: 10.4103/0028-3886.287664.
Growth hormone (GH) hypersecretion from a pituitary adenoma results in acromegaly, an endocrinological disorder with multiple systemic manifestations that presents several unique challenges in terms of perioperative management and long term outcomes. Current guidelines provide stringent criteria for determining biochemical remission, necessitating an aggressive approach to management. Despite the development of several non-surgical therapies, transsphenoidal surgery, the endoscopic approach in particular, remains the primary line of treatment for rapid normalization of GH and Insulin-like growth factor with a low incidence of perioperative morbidity. Tumor size and invasiveness are important factors predicting surgical outcomes with better rates of postoperative remission seen in smaller and non-invasive tumors. Postoperative remission rates reported in literature with the 2020 consensus criteria vary from 30 to 85% probably reflecting varying prevalence rates of invasive tumors. Thus, a significant proportion of patients fail to achieve remission after surgery for whom treatment options for residual disease must be carefully considered. This review article discusses the surgical management of acromegaly and provides a summary of contemporary outcomes and current treatment controversies.
生长激素（GH）分泌腺瘤导致肢端肥大症，这是一种内分泌紊乱，具有多种全身表现，在围手术期管理和长期结果方面带来了一些独特的挑战。目前的指南为生化缓解的确定提供了严格的标准，需要采取积极的管理方法。尽管已经开发出了几种非手术治疗方法，但经蝶窦手术，特别是内镜方法，仍然是快速使 GH 和胰岛素样生长因子正常化的主要治疗方法，其围手术期发病率较低。肿瘤大小和侵袭性是预测手术结果的重要因素，较小和非侵袭性肿瘤的术后缓解率更高。文献中报道的 2020 年共识标准的术后缓解率在 30%至 85%之间，这可能反映了侵袭性肿瘤的不同流行率。因此，相当一部分患者在手术后未能缓解，必须仔细考虑残留疾病的治疗选择。本文讨论了肢端肥大症的手术治疗，并总结了当代的结果和当前的治疗争议。
