Acromegalia: diagnóstico y tratamiento

Olga Lidia Pereira Despaigne, Maricela Silvia Palay Despaigne, Argenis Rodríguez Cascaret

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Resumen

La acromegalia es una enfermedad crónica multisistémica, de baja prevalencia, cuyo diagnóstico y tratamiento deben adecuarse a las realidades actuales.  No obstante, continúa siendo una enfermedad subdiagnosticada, que evoluciona con una elevada tasa de mortalidad, generalmente por causas cardiovasculares y cerebrovasculares, lo cual reduce la esperanza de vida de la persona que la padece.  En el presente artículo se describen las formas de presentación del hipersomatotropismo, los métodos de diagnóstico y las modalidades terapéuticas, que incluyen la quirúrgica, la farmacológica y la radioterapia.

Palabras clave

acromegalia, hipersomatotropismo, diagnóstico hormonal.

Referencias

Bidlingmaier M, Strasburger C. Growth hormone assays: current methodologies and their limitations. Pituitary. 2007; 10(2): 115-9.

Sata A, Ho KK. Growth hormone measurements in the diagnosis and monitoring. Pituitary. 2007; 10(2): 165-72.

Molitch ME. Clinical manifestations of acromegaly. Endocrinol Metab Clin North Am. 1992; 21(3): 597-614.

Colao A, Ferone D, Marzullo P, Lombarda G. Systemic complications of acromegaly: epidemiology, pathogenesis and management. Endocr Rev. 2004; 25(1): 102-5.

Mercado M, Espinosa de los Monteros AL, Sosa E, Cheng S, Mendoza V, Hernández I, et al. Clinical-biochemical correlations in acromegaly at diagnosis and the real prevalence of biochemically-discordant disease. Horm Res. 2004; 62(6): 293-9.

Mendoza V, Sosa E, Espinosa de los Monteros AL, Salcedo M, Guinto G, Cheng S, et al. GSPalpha mutations in Mexican patients with acromegaly: potential impact on long-term prognosis. Growth Horm IGF Res. 2005; 15(1): 28-32.

Terzolo M, Reimondo G, Gasperi M, Cozzi R, Pivonello R, Vitale G, et al. Colonoscopic screening and follow up in patients with acromegaly: a multicenter study in Italy. J Clin Endocrinol Metab. 2005; 90(1): 84-90.

Bogazzi F, Cosci C, Sardella C, Costa A, Manetti L, Gasperi M, et al. Identification of acromegalic patients at risk of developing colonic adenomas. J Clin Endocrinol Metab. 2006; 91(4): 1351-6.

Barkan A. Defining normalcy of the somatotropic axis: an attainable goal? Pituitary. 2007; 10(2): 135-9.

Brooke AM, Drake WM. Serum IGF-I levels in the diagnosis and monitoring of acromegaly. Pituitary. 2007; 10(2): 173-9.

Clemmons DR. IGF-I assays: Current assay methodologies and their limitations. Pituitary. 2007; 10(2): 121-8.

Espinosa-de-los-Monteros AL, Sosa E, Cheng S, Ochoa R, Sandoval C, Guinto G, et al. Biochemical evaluation of disease activity after pituitary surgery in acromegaly: a critical analysis of patients who spontaneously change disease status. Clin Endocrinol (Oxf). 2006; 64(3): 245-9.

Guinto Balanzar G, López Félix BE, Cohn Zurita F, Pérez Pérez VH, Nettel Rueda B, Domínguez Cortinas F. Macroadenomas de hipófisis. Un reto neuroquirúrgico. Cir Ciruj. 2003; 71: 350-8.

Lim EM, Pullan P. Biochemical assessment and long term monitoring in patients with acromegaly: Statement from a Joint Consensus Conference of The Growth Hormone Research Society and The Pituitary Society. Clin Biochem Rev. 2005; 26(2): 41–3.

Biermasz NR, Dekker FW, Pereira AM, van Thiel SW, Schutte PJ, van Dulken H, et al. Determinants of survival in treated acromegaly in a single center: Predictive value of serial insulin-like growth factor I measurements. J Clin Endocrinol Metab. 2004; 89(6): 2789-96.

Colao A, Attanasio R, Pivonello R, Cappabianca P, Cavallo LM, Lasio G, et al. Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly. J Clin Endocrinol Metab. 2006; 91(1): 85-92.

Abs R, Verhelst J, Maiter D, Van Acker K, Nobels F, Coolens JL, et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998; 83(2): 374-8.

Cozzi R, Attanasio R, Lodrini S, Lasio G. Cabergoline addition to depot somatostatin analogues in resistant acromegalic patients: efficacy and lack of predictive value of prolactin status. Clin Endocrinol (Oxf). 2004; 61(2): 209-15.

Freda PU. Somatostatin analogs in acromegaly. J Clin Endocrinol Metab. 2002; 87(7): 3013-8.

Caron P, Beckers A, Cullen DR, Goth MI, Gutt B, Laurberg P, et al. Efficacy of the new long-acting formulation of lanreotide (lanreotide Autogel) in the management of acromegaly. J Clin Endocrinol Metab. 2002; 87(1): 99-104.

Cozzi R, Montini M, Attanasio R, Albizzi M, Lasio G, Lodrini S, et al. Primary treatment of acromegaly with octreotide LAR: A long-term (Up to nine years) prospective study of its efficacy in the control of disease activity and tumor shrinkage. J Clin Endocrinol Metab. 2006; 91(4): 1397-403.

Colao A, Ferone D, Marzullo P, Cappabianca P, Cirillo S, Boerlin V, et al. Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab. 2001; 86(6): 2779-86.

Bevan JS. The antitumoral effects of somatostatin analog therapy in acromegaly. J Clin Endocrinol Metab. 2005; 90(3): 1856-63.

Sheppard MC. Primary medical therapy for acromegaly. Clin Endocrinol (Oxf). 2003; 58(4): 387-99.

Wass JA. Radiotherapy in acromegaly: a protagonists viewpoint. Clin Endocrinol (Oxf.). 2003; 58(2): 128-31.

Barkan AL. Radiotherapy in acromegaly: the argument against. Clin Endocrinol (Oxf). 2003; 58(2): 132-5.

Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, et al. Gamma-knife radiosurgery in acromegaly: a 4 year follow-up study. J Clin Endocrinol Metab. 2003; 88(7): 3105-12.

Castinetti F, Taieb D, Kuhn JM, Chanson P, Tamura M, Jaquet P, et al. Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab. 2005; 90(8): 4483-8.

Bondanelli M, Ambrosio MR, degli Uberti EC. Pathogenesis and prevalence of hypertension in acromegaly. Pituitary. 2001; 4(4): 239-49.

Aguilar SCA, Gómez PFJ, Lerman GI, Vázquez Chávez C, Pérez Méndez O, Posadas Romero C. Diagnóstico y tratamiento de las dislipidemias: posición de la Sociedad Mexicana de Nutrición y Endocrinología. Rev Soc Mex Nutr Endocrinol. 2004; 12: 7-41.

Barkan AL. Defining normalcy of the somatotropic axis: an attainable goal? Pituitary. 2007; 10(2): 135-9.

Freda P, Nuruzzaman A, Reyes C, Sundeen RE, Post KD. Significance of “abnormal” nadir growth hormone levels after oral glucose in postoperative patients with acromegaly in remission with normal insulin like growth factor-I levels. J Clin Endocrinol Metab. 2004; 89(2): 495-500.

Mercado M, Borges F, Bouterfa H, Chang TC, Chervin A, Farrall AJ, et al. A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR® (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol (Oxf). 2007; 66(6): 859-68.





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