Emory University School of Medicine, Atlanta, Georgia, USA.
Curr Opin Endocrinol Diabetes Obes. 2021 Aug 1;28(4):419-426. doi: 10.1097/MED.0000000000000650.
Discuss recent literature regarding clinical manifestations and comorbidities in acromegaly, with focus on early diagnosis and customized care.
The mean interval between onset of clinical manifestations and diagnosis is currently 3-5 years. Women, especially younger than 50 years of age, experience longer delays, have lower insulin-like growth factor 1 (IGF-1) levels and larger tumors than men. Development of comorbidities usually precedes the diagnosis and is influenced by age, sex, and biochemical disease activity. Comorbidities other than irreversible osteoarticular structural changes usually improve after acromegaly treatment. In patients with diabetes, the course of hyperglycemia not only depends on biochemical control but also on specific acromegaly therapies. Quality of life is influenced by sex, as well as by acromegaly symptoms, biochemical activity, and treatment. Quality of life remains lower than general population despite biochemical remission.
Early diagnosis can be achieved by suspecting acromegaly based on suggestive clinical scenarios rather than obvious changes in appearance. Personalized care entails a proactive multidisciplinary approach to identify and treat comorbidities while carefully monitoring the effects of acromegaly treatment.
讨论肢端肥大症临床表现和合并症的最新文献，重点关注早期诊断和个体化治疗。
目前，从临床表现出现到诊断的平均间隔为 3-5 年。女性，尤其是年龄小于 50 岁的女性，延迟时间更长，IGF-1 水平更低，肿瘤更大。合并症的发展通常先于诊断，并受年龄、性别和生化疾病活动的影响。除不可逆的骨关节炎结构改变外，其他合并症通常在肢端肥大症治疗后改善。在糖尿病患者中，高血糖的病程不仅取决于生化控制，还取决于特定的肢端肥大症治疗方法。生活质量受性别以及肢端肥大症症状、生化活性和治疗的影响。尽管生化缓解，但生活质量仍低于一般人群。
通过基于提示性临床情况而不是明显的外观改变来怀疑肢端肥大症，可以实现早期诊断。个性化治疗需要采取积极主动的多学科方法来识别和治疗合并症，同时仔细监测肢端肥大症治疗的效果。
