Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotica 13, Belgrade 11000, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia.
Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotica 13, Belgrade 11000, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia.
Growth Horm IGF Res. 2024 Oct;78:101608. doi: 10.1016/j.ghir.2024.101608. Epub 2024 Aug 2.
Medical treatment of acromegaly is generally positioned as a second line of treatment after pituitary adenoma surgery. With the rising availability and variety of medications for acromegaly increases our understanding of their effectiveness and safety. Volume of the published data on the impact of medical therapy on biochemical control of acromegaly, contrasts a relative lack of publications which comprehensively address pituitary tumor alterations under different drug modalities. Assessment of changes in GH-secreting adenoma volume is often overshadowed by clinicians' focus on GH and IGF-I levels during acromegaly treatment. Close analysis of studies published in the last two decades, reveals that both an increase and decrease in somatotropinoma volume are possible during treatment with any of available drugs for acromegaly. Changes in pituitary tumor size may arise from the biological nature of adenoma itself, independently of the administered medications. Therefore, an individual approach is necessary in the treatment of patients with acromegaly, based on repeated insight to their clinical, biochemical, pathological and imaging characteristics. In this review, we summarize and comment how pituitary tumor size is affected by the treatment with all currently available drugs in acromegaly: long-acting somatostatin receptor ligands of the first generation (octreotide LAR and lanreotide autogel) and the second generation (pasireotide-LAR), as well as pegvisomant (PEG) and cabergoline (CAB).
肢端肥大症的治疗通常被定位为垂体腺瘤手术后的二线治疗。随着针对肢端肥大症的药物的可及性和种类的增加，我们对其疗效和安全性的理解也在不断提高。关于药物治疗对肢端肥大症生化控制影响的已发表数据量与全面探讨不同药物模式下垂体肿瘤变化的相对缺乏出版物形成鲜明对比。在肢端肥大症治疗期间，临床医生通常关注 GH 和 IGF-I 水平，因此对 GH 分泌性腺瘤体积变化的评估常常被忽视。对过去二十年发表的研究进行仔细分析后发现，在使用任何一种现有的肢端肥大症治疗药物时，生长激素腺瘤的体积都可能增加或减少。垂体肿瘤大小的变化可能源于腺瘤本身的生物学性质，而与所使用的药物无关。因此，基于对患者的临床、生化、病理和影像学特征的反复深入了解，对肢端肥大症患者的治疗需要采取个体化的方法。在本文中，我们总结并评论了目前可用于肢端肥大症的所有药物（第一代长效生长抑素受体配体（奥曲肽 LAR 和兰瑞肽微球）和第二代（培维索孟和帕瑞肽 LAR）以及培维索孟（PEG）和卡麦角林（CAB））对垂体肿瘤大小的影响。
