Melmed S, Braunstein G D, Horvath E, Ezrin C, Kovacs K
Endocr Rev. 1983 Summer;4(3):271-90. doi: 10.1210/edrv-4-3-271.
This review discusses the pathophysiology of acromegaly. Acromegaly has been classified in this paper into distinct entities based on etiology, ultrastructural features of the pituitary, and cytogenesis. This classification has been proposed based on clinical signs, immunoperoxidase techniques, transmission electromicroscopy and immunoelectron microscopy. Pituitary causes of acromegaly include densely granulated adenomas, sparsely granulated adenomas, mixed growth hormone and prolactin cell adenomas, acidophil stem cell adenomas, mammosomatotroph cell adenomas, and pleurihormonal adenomas. GH cell hyperplasia and GH cell carcinoma are also discussed. Extrapituitary causes of acromegaly include eutopic GH cell adenoma in the sphenoid sinus or parapharyngeal region and excess GHRF secretion which may be eutopic or ectopic. The pathological, clinical, and biochemical evidence in favor of a pituitary or hypothalamic etiology of acromegaly has been reviewed. Finally, a multistage theory of GH cell tumorigenesis has been proposed as a model in an attempt to unify the genetic, environmental and biochemical factors implicated in the pathogenesis of acromegaly.
本综述讨论了肢端肥大症的病理生理学。本文根据病因、垂体的超微结构特征和细胞发生情况，将肢端肥大症分为不同的类型。这种分类是基于临床体征、免疫过氧化物酶技术、透射电子显微镜和免疫电子显微镜提出的。肢端肥大症的垂体病因包括密集颗粒型腺瘤、稀疏颗粒型腺瘤、生长激素和催乳素混合细胞腺瘤、嗜酸性干细胞腺瘤、促乳腺生长素细胞腺瘤和多激素腺瘤。还讨论了生长激素细胞增生和生长激素细胞癌。肢端肥大症的垂体外病因包括蝶窦或咽旁区域的异位生长激素细胞腺瘤以及生长激素释放因子分泌过多，后者可能是异位的或正常位置的。本文回顾了支持肢端肥大症的垂体或下丘脑病因的病理、临床和生化证据。最后，提出了生长激素细胞瘤发生的多阶段理论作为一个模型，试图统一与肢端肥大症发病机制相关的遗传、环境和生化因素。
