van Lindert E, Hey O, Boecher-Schwarz H, Perneczky A
Department of Neurosurgery, Johannes Gutenberg University, Mainz, Federal Republic of Germany.
Acta Neurochir (Wien). 1997;139(10):905-12; discussion 912-3. doi: 10.1007/BF01411298.
Results of treatment of acromegaly are often incomparable due to the different criteria which have been used for defining cure or control of disease. At the present time it is widely accepted, that the main criteria of cure must be normalization of IGF-1 and a GH in the OGTT < 2 ng/ml. In this retrospective study we investigated the endocrinological results of 56 patients, who were surgically treated because of a GH-producing pituitary adenoma, by different criteria. Twelve of our patients had had additional medical treatment after surgery, two received radiotherapy. At a mean follow-up of 34 months after surgery 66% of patients had a basal GH < 5 ng/ml, 64% had a GH in the OGTT < 2 ng/ml and 73% had normalization of IGF-1. The combined criteria of OGTT < 2 ng/ml and IGF-1 normalization have been fulfilled in 59% of patients. None of these latter patients developed a clinical recurrence during the follow-up period. An optimal result (endocrinological cure, no permanent surgical complications and intact pituitary function) was achieved in 43% of patients. Although surgery was responsible for 19 new pituitary axis deficiencies (7 corticotropic axis, 8 thyrotropic axis and gonadotropic axis), 22 partial deficiencies improved to normalization after surgery (respectively 6, 3, and 13). Pre-operatively 55% of patients had no pituitary deficiency, after surgery this was 61%, leaving a net positive result of 6% less pituitary deficiencies. The authors conclude that normalization of IGF-1 combined with an OGTT < 2 ng/ml are adequate criteria for the definition of cure of acromegaly. However, the authors propose to include post-treatment hypopituitarism as an additional criterion by which treatment of acromegaly should be evaluated.
由于用于定义疾病治愈或控制的标准不同，肢端肥大症的治疗结果往往无可比性。目前，人们普遍认为，治愈的主要标准必须是IGF-1正常化以及口服葡萄糖耐量试验（OGTT）中的生长激素（GH）<2 ng/ml。在这项回顾性研究中，我们采用不同标准调查了56例因生长激素分泌型垂体腺瘤接受手术治疗患者的内分泌学结果。我们的患者中有12例术后接受了额外的药物治疗，2例接受了放射治疗。术后平均随访34个月时，66%的患者基础GH<5 ng/ml，64%的患者OGTT中的GH<2 ng/ml，73%的患者IGF-1正常化。59%的患者满足OGTT<2 ng/ml和IGF-1正常化的联合标准。在随访期间，这些患者均未出现临床复发。43%的患者获得了最佳结果（内分泌治愈、无永久性手术并发症且垂体功能完整）。尽管手术导致了19例新的垂体轴功能减退（7例促肾上腺皮质激素轴、8例促甲状腺激素轴和促性腺激素轴），但22例部分功能减退在术后改善至正常（分别为6例、3例和13例）。术前55%的患者无垂体功能减退，术后这一比例为61%，垂体功能减退净减少6%。作者得出结论，IGF-1正常化与OGTT<2 ng/ml相结合是定义肢端肥大症治愈的充分标准。然而，作者建议将治疗后垂体功能减退作为评估肢端肥大症治疗的一项额外标准。
