Kyriakakis Nikolaos, Seejore Khyatisha, Hanafy Ahmed, Murray Robert D
Department of Endocrinology Leeds Centre for Diabetes & Endocrinology Leeds Teaching Hospitals NHS Trust Leeds UK.
Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds UK.
Endocrinol Diabetes Metab. 2020 Jun 9;3(3):e00158. doi: 10.1002/edm2.158. eCollection 2020 Jul.
Acromegaly is the clinical consequence of chronic exposure of the tissues to excess GH and IGF-I. It is almost exclusively the result of a GH-secreting pituitary adenoma. In addition to the somatic features, uncontrolled acromegaly is associated with a number of complications and excess mortality. Management is aimed at control of the tumour; normalization of GH and IGF-I secretion and relief of symptoms. Initial management of GH-secreting pituitary adenoma is widely accepted as endonasal trans-sphenoidal surgery, with second-line therapy where disease is uncontrolled in most cases being somatostatin analogue therapy. With the combination of surgery and somatostatin analogue therapy, control is achieved in around 75% of patients; however, this leaves a significant proportion of patients requiring multimodality therapy to achieve remission. Within the UK, the health system has finite resources, and decisions for management require consideration of efficacy and cost-effectiveness. To add to the complexity, subtle differences exist in availability of high-cost medications used in the treatment of patients with acromegaly across the devolved nations of the UK. In this article, we discuss options for the management of persistent acromegaly following initial surgery and somatostatin analogue therapy, and explore earlier use of dopaminergics and conservative management.
肢端肥大症是组织长期暴露于过量生长激素（GH）和胰岛素样生长因子-1（IGF-I）的临床后果。几乎完全是由分泌GH的垂体腺瘤所致。除了躯体特征外，未得到控制的肢端肥大症还与多种并发症及过高的死亡率相关。治疗目标是控制肿瘤、使GH和IGF-I分泌正常化并缓解症状。分泌GH的垂体腺瘤的初始治疗被广泛认为是经鼻蝶窦手术，在大多数疾病未得到控制的情况下，二线治疗是生长抑素类似物治疗。通过手术和生长抑素类似物治疗相结合，约75%的患者可实现病情控制；然而，这仍使很大一部分患者需要多模式治疗才能实现缓解。在英国，卫生系统资源有限，治疗决策需要考虑疗效和成本效益。更复杂的是，在英国各下放国家，用于治疗肢端肥大症患者的高成本药物的可及性存在细微差异。在本文中，我们讨论了初始手术和生长抑素类似物治疗后持续性肢端肥大症的治疗选择，并探讨了多巴胺能药物的早期使用和保守治疗。
