Beauregard H, Somma M, Rasio E, Serri O, Aris-Jilwan N, Comtois R, Long H, Abribat T, Boucher A, Hardy J
Service d'endocrinologie, hôpital Notre-Dame, Université de Montréal, Québec.
Union Med Can. 1993 Nov-Dec;122(6):489-95.
Acromegaly is a rare disease which can significantly reduce life expectancy. Clinical features are diverse and the patient may consult a variety of medical and surgical specialists before the diagnosis is suspected. However, the disease is easily confirmed by the appropriate laboratory tests, namely GH and IGF1 measurements. In most cases, acromegaly is secondary to a micro or macrosomatotrope pituitary adenoma. Those lesions are easily visualized by a pituitary CT Scan or Magnetic Resonance Imaging. Visual fields have to be evaluated by a neuro-ophthalmologist, and a thorough evaluation of other pituitary functions have to be performed. Selective removal of the adenoma by the transsphenoidal route is the treatment of choice for acromegaly. When performed by an experienced neurosurgeon, normalization of GH secretion can be expected in approximately 75% of cases. The surgical outcome is modulated by the volume, the extension of the tumor and the preoperative GH level. Octreotide, radiotherapy or bromocriptine are indicated whenever the patient remains with an elevated level of GH with persistency of symptoms.
肢端肥大症是一种罕见疾病，可显著缩短预期寿命。其临床特征多样，患者在怀疑诊断之前可能会咨询各种医学和外科专家。然而，通过适当的实验室检查，即生长激素（GH）和胰岛素样生长因子1（IGF1）测量，该病很容易得到确诊。在大多数情况下，肢端肥大症继发于微腺瘤或大腺瘤性生长激素细胞垂体腺瘤。这些病变通过垂体CT扫描或磁共振成像很容易显现出来。视野必须由神经眼科医生进行评估，并且必须对其他垂体功能进行全面评估。经蝶窦途径选择性切除腺瘤是肢端肥大症的首选治疗方法。由经验丰富的神经外科医生进行手术时，预计约75%的病例生长激素分泌可恢复正常。手术结果受肿瘤体积、范围以及术前生长激素水平的影响。每当患者生长激素水平持续升高且症状持续存在时，就需要使用奥曲肽、放射治疗或溴隐亭。
