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[肢端肥大症相关的心血管并发症。最新进展]

[Cardiovascular complications associated with acromegaly. A state-of-the-art].

作者信息

Concepción-Zavaleta Marcio, Muñoz-Moreno Juan, Quispe-Flores María, Rafael-Robles Luciana, Lobato-Jeri Carlos, Ramos-Yataco Anthony, Concepción-Urteaga Luis, Paz-Ibarra José

机构信息

Servicio de Endocrinología, Clínica Stella Maris, Lima, Perú.

Servicio de Cardiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.

出版信息

Arch Cardiol Mex. 2022 Oct 21;92(4):513-521. doi: 10.24875/ACM.21000339.

Abstract

Acromegaly is a rare disease, mainly caused by a pituitary tumor secreting growth hormone. It is characterized by slow progression and is associated with a multisystemic involvement, being the cardiovascular system, one of the most involved, even reaching, more than 10 years ago, to represent the main cause of death. Cardiovascular complications develop as a result of elevated blood concentrations of growth hormone and insulin-like growth factor 1, which exert direct and indirect effects on the endothelium, large vessels, kidney and cardiomyocytes; causing arterial hypertension, valve disease, cardiac arrhythmia and a specific heart disease called acromegalic cardiomyopathy. After the literature overview related to the pathophysiology, clinical manifestations, diagnosis and treatment of cardiovascular involvement, we found that from a cardiovascular point of view, patients with acromegaly can range from an asymptomatic state to severe cardiac dysfunction, being the biochemical markers and imaging studies diagnostic tools that allow assessment the degree of cardiovascular disease in order to provide individualized treatment. The normalization of growth hormone and insulin-like growth factor 1 levels improves cardiovascular parameters, and therefore its prognosis.

摘要

肢端肥大症是一种罕见疾病,主要由分泌生长激素的垂体瘤引起。其特点是进展缓慢,并伴有多系统受累,心血管系统是受累最严重的系统之一,甚至在十多年前,它就是主要死因。心血管并发症是由于血液中生长激素和胰岛素样生长因子1浓度升高所致,这些物质对内皮、大血管、肾脏和心肌细胞产生直接和间接影响;导致动脉高血压、瓣膜病、心律失常以及一种名为肢端肥大症性心肌病的特殊心脏病。在对心血管受累的病理生理学、临床表现、诊断和治疗相关文献进行综述后,我们发现,从心血管角度来看,肢端肥大症患者的病情可从无症状状态发展到严重的心功能不全,而生化标志物和影像学检查是诊断工具,可用于评估心血管疾病的程度,以便提供个体化治疗。生长激素和胰岛素样生长因子1水平的正常化可改善心血管参数,从而改善其预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e7d6/9681516/f53ed1ec0c7e/6936AX214-ACM-92-513-g001.jpg

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