Albarel Frederique, Cuny Thomas, Graillon Thomas, Dufour Henry, Brue Thierry, Castinetti Frederic
Aix Marseille Univ, INSERM, MMG, Marseille, France.
J Endocr Soc. 2022 Aug 4;6(9):bvac114. doi: 10.1210/jendso/bvac114. eCollection 2022 Sep 1.
Transsphenoidal surgery is the first-line treatment for acromegaly. However, several factors can modify surgical remission rates, such as the initial hormone levels, the size and invasiveness of the tumor, and the degree of experience of the surgeon. Physicians treating patients with acromegaly should thus consider how to improve surgical remission rates. As stated in recent guidelines, the major point is to consider that any patient with acromegaly should be referred to an expert neurosurgeon to maximize the chances of surgical sure. The benefits of presurgical medical treatment, mainly using somatostatin receptor ligands (SRLs), given 3 to 6 months before surgery, remain controversial. By normalizing growth hormone and insulin-like growth factor 1 levels, SRLs may improve the overall condition of the patient, thus decreasing anesthetic and surgical complications. By decreasing the tumor size and modifying the consistency of the tumor, SRLs might also make surgical excision easier. This is however theoretical as published data are contradictory on both points, and only limited data support the use of a systematical presurgical medical treatment. The aim of this review is to analyze the potential benefits and pitfalls of using presurgical medical treatment in acromegaly in view of the contradictory literature data. We also attempt to determine the profile of patients who might most benefit from this presurgical medical treatment approach as an individualized therapeutic management of acromegaly.
经蝶窦手术是肢端肥大症的一线治疗方法。然而，有几个因素会影响手术缓解率，如初始激素水平、肿瘤大小和侵袭性以及外科医生的经验程度。因此，治疗肢端肥大症患者的医生应考虑如何提高手术缓解率。正如近期指南所述，关键在于要认识到任何肢端肥大症患者都应转诊至专业神经外科医生处，以最大程度提高手术成功几率。术前药物治疗（主要使用生长抑素受体配体（SRLs））在手术前3至6个月使用，其益处仍存在争议。通过使生长激素和胰岛素样生长因子1水平正常化，SRLs可能改善患者的整体状况，从而减少麻醉和手术并发症。通过减小肿瘤大小和改变肿瘤质地，SRLs或许还能使手术切除更容易。然而，这只是理论上的，因为已发表的数据在这两点上相互矛盾，仅有有限的数据支持系统性术前药物治疗的使用。鉴于文献数据相互矛盾，本综述的目的是分析肢端肥大症术前药物治疗的潜在益处和缺陷。我们还试图确定作为肢端肥大症个体化治疗管理，可能从这种术前药物治疗方法中获益最大的患者特征。
