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肢端肥大症四项临床实践指南的综合综述

A Comprehensive Review of Four Clinical Practice Guidelines of Acromegaly.

作者信息

Ogedegbe Oboseh J, Cheema Asfand Yar, Khan Muhammad Ali, Junaid Syeda Zeenat S, Erebo Jolomi K, Ayirebi-Acquah Ewuradjoa, Okpara Jennifer, Bofah Daramfon, Okon Jennifer G, Munir Mishaal, Alugba Gabriel, Ezekiel Aaron, Okun Ohikhuare, Ojo Tioluwani K, Mejulu Eunice O, Jimoh Abdulmalik

机构信息

Internal Medicine, Lifeway Medical Center, Abuja, NGA.

Medicine, Services Hospital Lahore, Lahore, PAK.

出版信息

Cureus. 2022 Sep 3;14(9):e28722. doi: 10.7759/cureus.28722. eCollection 2022 Sep.

Abstract

Acromegaly is an endocrine disorder characterized by dysregulated hypersecretion of growth hormone (GH), leading to an overproduction of insulin-like growth factor 1 (IGF-1). The etiology is usually a GH-secreting pituitary adenoma with the resultant presentation of coarse facial features, frontal bossing, arthritis, prognathism (protrusion of the mandible), and impaired glucose tolerance, among others. Most pituitary adenomas arise due to sporadic mutations that lead to unregulated cellular division, subsequent tumor formation, and resultant GH hypersecretion. Major scientific organizations and authorities in endocrinology release regularly updated guidelines for diagnosing and managing acromegaly. We have holistically evaluated four data-driven and evidentiary approaches in the management of acromegaly to compare and contrast these guidelines and show their salient differences. These guidelines have been reviewed because they are major authorities in acromegaly management. In this comprehensive article, differences in the diagnosis and treatment recommendations of the discussed guidelines have been highlighted. Our findings showed that diagnosing modalities were similar among the four approaches; however, some guidelines were more specific about additional supporting investigations to confirm a diagnosis of acromegaly. For management options, each guideline had suggestions about ideal therapeutic outcomes. Treatment options were identical but salient differences were noticed, such as the addition of combination therapy and alternative therapy in the setting of failure to respond to first and second-line treatments. Reviewing clinical guidelines for various pathologies encourages sharing ideas among medical practitioners and ensures that global best practices are adopted. Therefore, a constant review of these clinical practice guidelines is necessary to keep clinicians up to date with the latest trends in patient management.

摘要

肢端肥大症是一种内分泌紊乱疾病,其特征是生长激素(GH)分泌失调、分泌过多,导致胰岛素样生长因子1(IGF-1)产生过多。病因通常是分泌GH的垂体腺瘤,会导致面部特征粗糙、额头突出、关节炎、下颌前突(下颌骨突出)以及葡萄糖耐量受损等症状。大多数垂体腺瘤是由散发性突变引起的,这些突变导致细胞分裂失控、随后形成肿瘤,并导致GH分泌过多。内分泌学领域的主要科学组织和权威机构定期发布关于肢端肥大症诊断和管理的更新指南。我们全面评估了肢端肥大症管理中的四种数据驱动和基于证据的方法,以比较和对比这些指南,并展示它们的显著差异。之所以对这些指南进行审查,是因为它们是肢端肥大症管理方面的主要权威。在这篇全面的文章中,突出了所讨论指南在诊断和治疗建议方面的差异。我们的研究结果表明,四种方法中的诊断方式相似;然而,一些指南对于用于确诊肢端肥大症的额外辅助检查更为具体。对于管理选项,每个指南都对理想的治疗结果提出了建议。治疗选项相同,但也注意到了显著差异,例如在对一线和二线治疗无反应的情况下增加联合治疗和替代治疗。审查各种病症的临床指南有助于医学从业者之间分享想法,并确保采用全球最佳实践。因此,有必要持续审查这些临床实践指南,以使临床医生了解患者管理的最新趋势。

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