Ezzat S, Wilkins G E, Patel Y, Ur E, Rorstad O, Serri O
Department of Medicine, University of Toronto, Ont.
Clin Invest Med. 1996 Aug;19(4):259-70.
To reach a Canadian consensus on the diagnosis and management of acromegaly.
documenting autonomous growth-hormone hypersecretion and imaging of the pituitary.
surgical resection, adjunctive therapy with bromocriptine or octreotide and radiation therapy.
Reduction of the morbidity and mortality associated with acromegaly.
Review of international literature.
Achievement of consensus among a panel of Canadian endocrinologists.
BENEFITS, HARMS AND COSTS: Acromegaly is a chronic debilitating condition that is associated with morbidity and mortality. This consensus statement is designed to improve the diagnosis and management of this rare condition in order to minimize the negative outcomes. Costs were not considered.
The diagnosis of acromegaly is established by documenting autonomous growth-hormone hypersecretion and by imaging the pituitary. Surgical resection is the cornerstone of treatment; however, adjunctive therapy is often needed. Although growth-hormone reduction is often associated with alleviation of symptoms, an attempt should also be made to normalize levels of growth hormone and its target growth factor, insulin-like growth factor-I (IGF-I). Persistent secretion of excess growth hormone and IGF-I may pose significant long-term health risks. A suggested therapeutic algorithm is provided. The ease of administration of bromocriptine should prompt a trial of therapy with this agent. The subcutaneous use of octreotide is of particular benefit to those patients with persistently high levels of growth hormone and IGF-I that cannot be suppressed by other means. Because acromegaly is relatively rare and complex, its diagnosis and treatment require the concerted efforts of an endocrinologist, an neurosurgeon and a radiation oncologist.
就肢端肥大症的诊断和管理达成加拿大共识。
记录自主性生长激素分泌过多及垂体成像。
手术切除、溴隐亭或奥曲肽辅助治疗及放射治疗。
降低与肢端肥大症相关的发病率和死亡率。
对国际文献的综述。
在一组加拿大内分泌学家中达成共识。
益处、危害和成本：肢端肥大症是一种慢性衰弱性疾病，与发病率和死亡率相关。本共识声明旨在改善对这种罕见疾病的诊断和管理，以尽量减少负面结果。未考虑成本。
肢端肥大症的诊断通过记录自主性生长激素分泌过多及垂体成像来确立。手术切除是治疗的基石；然而，通常需要辅助治疗。虽然生长激素水平降低往往与症状缓解相关，但也应努力使生长激素及其靶生长因子胰岛素样生长因子-I（IGF-I）水平正常化。持续分泌过多的生长激素和IGF-I可能带来重大的长期健康风险。提供了一种建议的治疗算法。溴隐亭给药方便，应促使试用该药物进行治疗。皮下使用奥曲肽对那些生长激素和IGF-I水平持续居高且无法通过其他方式抑制的患者特别有益。由于肢端肥大症相对罕见且复杂，其诊断和治疗需要内分泌学家、神经外科医生和放射肿瘤学家的共同努力。
