Antsiferov M B, Pronin V S, Alekseeva T M, Ionova O A, Martynova E Y, Poteshkin Yu E, Chubrova N A, Zherebchikova K Y
Endocrinological dispensary of Moscow Healthcare Department.
Russian medical Academy of continuing professional education.
Probl Endokrinol (Mosk). 2021 Jan 8;67(1):20-30. doi: 10.14341/probl12699.
Backgraund: Acromegaly is a multi-organ disabling disease, the effectiveness of treatment of which directly depends on timely diagnosis. Latent course and delayed diagnosis increase the exposure of pathological hypersecretion of growth hormone and insulin-like growth factor-1, contributing to the development of irreversible systemic and metabolic changes in the body that negatively affect survival.
Aims: The aim of the study was to clinically test a comprehensive diagnostic approach using selective screening to detect cases of acromegaly in patients with combined somatic diseases.
Materials and methods: The diagnostic search algorithm included a 2-stage questionnaire, expert assessment of the clinical status, laboratory and instrumental examination. The inpatient examination included the use of additional laboratory and instrumental methods and expert evaluation of the results obtained by filling out a doctor’s questionnaire. When the score was higher than 18 points, a more specific examination was performed: double determination of the insulin-like growth factor-1 level, oral glucose tolerance test with determination of the nadir of growth hormone value, and MRI of the brain with contrast enhancement. The diagnosis of acromegaly was made on the basis of personal data, expert assessment of the clinical status, results of laboratory and instrumental examinations.
Results: A survey of 1249 patients with combined systemic and metabolic disorders conducted using the point system allowed us to suspect acromegaly in 367 patients (29.4%), who were offered further examination. The majority of patients were previously seen by specialists for diabetes mellitus (79.3%) or thyroid pathology (10%). In the result of inpatient examination of 329 patients, 35 (10.6%) patients showed an increase in the blood level of IGF-I. In 19 patients, a persistent increase in the level of IGF-I was combined with the absence of GH suppression of less than 0.4 ng/ml against the background of glucose load. During MRI in 9 patients, pituitary adenoma was detected (in 2 — microadenoma and 7 — macroadenoma).
Conclusions: As a result of the study, among the group of 1249 patients (mean age 58±13 years) with the presence of concomitant diseases, 9 newly identified patients with acromegaly were found who were prescribed adequate treatment. The introduction of selective screening technology into the practice of an endocrinologist will improve the effectiveness of diagnostic search for patients with acromegaly, more accurately assess the prevalence of the disease in Russia and the need for specialized medical care.
肢端肥大症是一种多器官功能障碍性疾病，其治疗效果直接取决于及时诊断。病程隐匿和诊断延迟会增加生长激素和胰岛素样生长因子-1病理性分泌过多的暴露时间，导致机体出现不可逆的全身和代谢变化，对生存产生负面影响。
本研究的目的是临床测试一种综合诊断方法，通过选择性筛查来检测合并躯体疾病患者中的肢端肥大症病例。
诊断搜索算法包括两阶段问卷调查、临床状况专家评估、实验室和仪器检查。住院检查包括使用额外的实验室和仪器方法，以及通过填写医生问卷对所得结果进行专家评估。当得分高于18分时，进行更具体的检查：两次测定胰岛素样生长因子-1水平、口服葡萄糖耐量试验并测定生长激素值最低点，以及增强磁共振成像脑部检查。肢端肥大症的诊断基于个人数据、临床状况专家评估、实验室和仪器检查结果。
使用积分系统对1249例合并全身和代谢紊乱的患者进行调查，我们怀疑其中367例（29.4%）患有肢端肥大症，并对其进行了进一步检查。大多数患者之前因糖尿病（79.3%）或甲状腺疾病（10%）看过专科医生。对329例患者进行住院检查后，35例（10.6%）患者的胰岛素样生长因子-I血水平升高。在19例患者中，胰岛素样生长因子-I水平持续升高，且在葡萄糖负荷情况下生长激素抑制未达到低于0.4 ng/ml。在9例患者的磁共振成像检查中检测到垂体腺瘤（2例为微腺瘤，7例为大腺瘤）。
研究结果显示，在1249例（平均年龄58±13岁）患有合并症的患者群体中，发现了9例新确诊的肢端肥大症患者，并为其开具了适当的治疗方案。将选择性筛查技术引入内分泌科医生的实践中将提高肢端肥大症患者诊断搜索的有效性，更准确地评估俄罗斯该病的患病率以及对专科医疗护理的需求。
