Department of Neurosurgery, Kantonsspital Aarau, 5001, Aarau, Switzerland.
Division of Endocrinology, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Acta Neurochir (Wien). 2021 Nov;163(11):3171-3180. doi: 10.1007/s00701-021-04846-8. Epub 2021 Apr 15.
Acromegaly is associated with various comorbidities, such as arterial hypertension (aHT), type 2 diabetes mellitus (DM2), obstructive sleep apnoea syndrome (OSAS), carpal tunnel syndrome (CTS) and polyposis coli. For therapeutic decisions, it is essential to know if, and to what extent, these associated morbidities are reversible or preventable. The aim of this study is to assess the prevalence and course of aHT, obesity, OSAS, CTS, DM2 and polyposis coli in acromegalic patients.
The following criteria for inclusion in this database study were used: treatment for acromegaly at the authors' institutions; full endocrinological and radiological work- and follow-up; screening for aHT, DM2, CTS, OSAS, obesity and polyposis coli. All patients were followed-up for > 3 months, and treatments were indicated with the intent of biochemical remission (normal IGF-1 and random growth hormone level).
Sixty-three patients were included. Twelve (19%), 45 (71%) and 6 (10%) patients harboured micro-, macro- and giant adenomas, respectively. Nineteen tumours (30%) invaded the cavernous sinus. Mean tumour volume was 5.4 cm. Mean follow-up time was 42 months. Sixty-one (97%) patients had transsphenoidal surgery; two patients only had drug therapy. Surgery led to remission in 31 (51%) patients. Intracavernous growth and larger tumour volume were negative predictors for cure. Drug therapy lead to remission in 22 (73%) patients within a mean follow-up of 54 months. The pretherapeutic prevalence of associated morbidities was as follows: aHT, 56%; DM2, 25%; OSAS, 29%; CTS, 29%; polyposis coli, 5%. There were neither age nor gender preferences for the respective prevalences. Surgery leads to remission of aHT and DM2 in 6% and 25%, respectively. Additional drug therapy resulted in remission of aHT, DM2 and CTS in 17%, 14% and 14%, respectively. Other associated morbidities persisted regardless of therapeutic efforts. Even if criteria for remission were not met, no new comorbidities of acromegaly developed during follow-up.
Treating acromegaly may relieve threatening associated morbidities such as aHT and DM2; nevertheless, only few comorbidities are reversible, which highlights the importance of treating acromegaly as early as possible.
肢端肥大症与多种合并症相关，如动脉高血压（aHT）、2 型糖尿病（DM2）、阻塞性睡眠呼吸暂停综合征（OSAS）、腕管综合征（CTS）和结肠息肉病。为了治疗决策，了解这些相关合并症是否可逆转或可预防至关重要。本研究旨在评估肢端肥大症患者中 aHT、肥胖、OSAS、CTS、DM2 和结肠息肉病的患病率和病程。
本数据库研究纳入标准为：作者所在机构治疗的肢端肥大症；完整的内分泌和放射学工作和随访；筛查 aHT、DM2、CTS、OSAS、肥胖和结肠息肉病。所有患者的随访时间均>3 个月，治疗目的是生化缓解（正常 IGF-1 和随机生长激素水平）。
共纳入 63 例患者。分别有 12 例（19%）、45 例（71%）和 6 例（10%）患者存在微腺瘤、大腺瘤和巨大腺瘤。19 例肿瘤（30%）侵犯海绵窦。平均肿瘤体积为 5.4cm。平均随访时间为 42 个月。61 例（97%）患者接受了经蝶窦手术；2 例仅接受药物治疗。手术使 31 例（51%）患者获得缓解。海绵窦内生长和更大的肿瘤体积是无法治愈的负预测因素。药物治疗使 22 例（73%）患者在平均 54 个月的随访中获得缓解。治疗前合并症的患病率如下：aHT，56%；DM2，25%；OSAS，29%；CTS，29%；结肠息肉病，5%。各自的患病率与年龄和性别无关。手术使 aHT 和 DM2 的缓解率分别达到 6%和 25%。额外的药物治疗使 aHT、DM2 和 CTS 的缓解率分别达到 17%、14%和 14%。其他合并症无论治疗与否都持续存在。即使未达到缓解标准，在随访期间也没有新的肢端肥大症合并症发生。
治疗肢端肥大症可能会缓解威胁生命的合并症，如 aHT 和 DM2；然而，只有少数合并症是可逆转的，这凸显了尽早治疗肢端肥大症的重要性。
