Az acromegalia a növekedési hormon, ennélfogva az inzulinszerű növekedési faktor-1 tartós túltermelése következtében kialakuló betegség felnőttekben, amely számos szövődménnyel jár és megfelelő kezelés nélkül a mortalitás növekedéséhez vezet. Jellegzetes tünetei ellenére, valamint a korszerű biokémiai és képalkotó diagnosztikai módszerek mellett is általában több év telik el a betegség kialakulásának kezdete és a diagnózis felállítása között. Terápiás lehetőségként sebészi beavatkozás, gyógyszeres (dopaminagonista, szomatosztatinanalóg és növekedésihormonreceptor-antagonista) kezelés és radioterápia áll rendelkezésre. A kezelés célja a biztonságos növekedési hormon- és inzulinszerű növekedési faktor-1-szintek elérése, a tumor eltávolítása vagy méretének csökkentése, valamint a betegség szövődményeinek kezelése, végső fokon a mortalitás csökkentése. Az eredményes kezelés több különböző diszciplína képviselőjének megfelelő együttműködésén alapszik. A közleményben a szerző az acromegalia gyógyszeres kezelési lehetőségeit tekinti át. Orv. Hetil., 2013, 154, 1527–1534.
Góth, M., Korbonits, M.: Acromegaly. In: Leövey, A., Nagy, E., Paragh, G., et al. (szerk.): Practical handbook of endocrine and metabolic diseases. [Acromegalia. In: Leövey, A., Nagy, E., Paragh, G., et al. (szerk.): Az endokrin- és anyagcsere-betegségek gyakorlati kézikönyve.] Medicina Könyvkiadó, Budapest, 2011, 85–104. [Hungarian]
Korbonits M. , '', in Practical handbook of endocrine and metabolic diseases. [Az endokrin- és anyagcsere-betegségek gyakorlati kézikönyve.] , (2011 ) -.
Daly, A. F., Rixhon, M., Adam, C., et al.: High prevalence of pituitary adenomas: a cross-sectional study in the province of Liège, Belgium. J. Clin. Endocrinol. Metab., 2006, 91, 4769–4775.
Adam C. , 'High prevalence of pituitary adenomas: a cross-sectional study in the province of Liège, Belgium ' (2006 ) 91 J. Clin. Endocrinol. Metab. : 4769 -4775 .
Fernandez, A., Karavitaki, N., Wass, J. A.: Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin. Endocrinol. (Oxf.), 2010, 72, 377–382.
Wass J. A. , 'Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK) ' (2010 ) 72 Clin. Endocrinol. (Oxf.) : 377 -382 .
Góth, M., Korbonits, M.: Treatment of acromegaly. [Az acromegalia kezelése.] Orv. Hetil., 2004, 145, 867–871. [Hungarian]
Korbonits M. , 'Treatment of acromegaly. [Az acromegalia kezelése.] ' (2004 ) 145 Orv. Hetil. : 867 -871 .
Giustina, A., Chanson, P., Bronstein, M. D., et al.: A consensus on criteria for cure of acromegaly. J. Clin. Endocrinol. Metab., 2010, 95, 3141–3148.
Bronstein M. D. , 'A consensus on criteria for cure of acromegaly ' (2010 ) 95 J. Clin. Endocrinol. Metab. : 3141 -3148 .
Dekkers, O. M., Biermasz, N. R., Pereira, A. M., et al.: Mortality in acromegaly: a metaanalysis. J. Clin. Endocrinol. Metab., 2008, 93, 61–67.
Pereira A. M. , 'Mortality in acromegaly: a metaanalysis ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 61 -67 .
Melmed, S., Colao, A., Barkan, A., et al.: Guidelines for acromegaly management: an update. J. Clin. Endocrinol. Metab., 2009, 94, 1509–1517.
Barkan A. , 'Guidelines for acromegaly management: an update ' (2009 ) 94 J. Clin. Endocrinol. Metab. : 1509 -1517 .
Dénes, J., Korbonits, M., Hubina, E., et al.: Treatment of acromegaly. [Az acromegalia kezelése.] Orv. Hetil., 2010, 151, 1384–1393. [Hungarian]
Hubina E. , 'Treatment of acromegaly. [Az acromegalia kezelése.] ' (2010 ) 151 Orv. Hetil. : 1384 -1393 .
Trainer, P. J., Barth, J., Sturgeon, C., et al.: Consensus statement on standardisation of GH assays. Eur. J. Endocrinol., 2006, 155, 1–2.
Sturgeon C. , 'Consensus statement on standardisation of GH assays ' (2006 ) 155 Eur. J. Endocrinol. : 1 -2 .
Bidlingmaier, M.: Problems with GH assays and strategies toward standardization. Eur. J. Endocrinol., 2008, 159, S41–S44.
Bidlingmaier M. , 'Problems with GH assays and strategies toward standardization ' (2008 ) 159 Eur. J. Endocrinol. : S41 -S44 .
Carmichael, J. D., Bonert, V. S., Mirocha, J. M., et al.: The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. J. Clin. Endocrinol. Metab., 2009, 94, 523–527.
Mirocha J. M. , 'The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly ' (2009 ) 94 J. Clin. Endocrinol. Metab. : 523 -527 .
Trainer, P. J., Drake, W. M., Katznelson, L., et al.: Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N. Engl. J. Med., 2000, 342, 1171–1177.
Katznelson L. , 'Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant ' (2000 ) 342 N. Engl. J. Med. : 1171 -1177 .
Alexopoulou, O., Bex, M., Abs, R., et al.: Divergence between growth hormone and insulin-like growth factor-1 concentrations in the follow-up of acromegaly. J. Clin. Endocrinol. Metab., 2008, 93, 1324–1330.
Abs R. , 'Divergence between growth hormone and insulin-like growth factor-1 concentrations in the follow-up of acromegaly ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 1324 -1330 .
Freda, P. U.: Monitoring of acromegaly: what should be performed when GH and IGF-1 levels are discrepant? Clin. Endocrinol. (Oxf.), 2009, 71, 166–170.
Freda P. U. , 'Monitoring of acromegaly: what should be performed when GH and IGF-1 levels are discrepant? ' (2009 ) 71 Clin. Endocrinol. (Oxf.) : 166 -170 .
Kovács, G. L., Dénes, J., Hubina, E., et al.: Consensus on the change of criteria for cure of acromegaly during the last decade. [Konszenzus a kritériumok változásáról az acromegalia gyógyulásának megítélésében – nemzetközi ajánlás, 2010.] Orv. Hetil., 2011, 152, 703–708. [Hungarian]
Hubina E. , 'Consensus on the change of criteria for cure of acromegaly during the last decade. [Konszenzus a kritériumok változásáról az acromegalia gyógyulásának megítélésében – nemzetközi ajánlás, 2010.] ' (2011 ) 152 Orv. Hetil. : 703 -708 .
Biermasz, N. R., van Thiel, S. W., Pereira, A. M., et al.: Decreased quality of life in patients with acromegaly despite long-term cure of growth hormone excess. J. Clin. Endocrinol. Metab., 2004, 89, 5369–5376.
Pereira A. M. , 'Decreased quality of life in patients with acromegaly despite long-term cure of growth hormone excess ' (2004 ) 89 J. Clin. Endocrinol. Metab. : 5369 -5376 .
Claessen, K. M. J. A., Ramautar, S. R., Pereira, A. M., et al.: Increased clinical symptoms of acromegalic arthropathy in patients with long-term disease control: a prospective follow-up study. Pituitary, 2013 Jan 24. [Epub ahead of print]
Tiemensma, J., Kaptein, A. A., Pereira, A. M., et al.: Affected illness percepcions and the association with impaired quality of life in patients with long term remission of acromegaly. J. Clin. Endocrinol. Metab., 2011, 96, 3550–3558.
Pereira A. M. , 'Affected illness percepcions and the association with impaired quality of life in patients with long term remission of acromegaly ' (2011 ) 96 J. Clin. Endocrinol. Metab. : 3550 -3558 .
Wassenaar, M. J. E., Biermasz, N. R., Hamdy, N. A. T., et al.: High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur. J. Endocrinol., 2011, 164, 475–483.
Hamdy N. A. T. , 'High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly ' (2011 ) 164 Eur. J. Endocrinol. : 475 -483 .
Davi, M. V., Dalle Carbonare, L., Giustina, A., et al.: Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur. J. Endocrinol., 2008, 159, 533–540.
Giustina A. , 'Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease ' (2008 ) 159 Eur. J. Endocrinol. : 533 -540 .
Wass, J. A. H., Trainer, P. J., Korbonits, M.: Acromegaly. In: Wass, J. A. H., Stewart, P. (eds.): Oxford Textbook of Endocrinology and Diabetes. Oxford University Press, Oxford, 2011, 197–209.
Korbonits M. , '', in Oxford Textbook of Endocrinology and Diabetes , (2011 ) -.
Selvarajah, D., Webster, J., Ross, R., et al.: Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly. Eur. J. Endocrinol., 2005, 152, 569–574.
Ross R. , 'Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly ' (2005 ) 152 Eur. J. Endocrinol. : 569 -574 .
Sandret, L., Maison, P., Chanson, P.: Place of cabergoline in acromegaly: a meta-analysis. J. Clin. Endocrinol. Metab., 2011, 96, 1327–1335.
Chanson P. , 'Place of cabergoline in acromegaly: a meta-analysis ' (2011 ) 96 J. Clin. Endocrinol. Metab. : 1327 -1335 .
Astruc, B., Marbach, P., Bouterfa, H., et al.: Long-acting octreotide and prolonged release lanreotide formulations have different pharmacokinetic. J. Clin. Pharmacol., 2005, 45, 836–844.
Bouterfa H. , 'Long-acting octreotide and prolonged release lanreotide formulations have different pharmacokinetic ' (2005 ) 45 J. Clin. Pharmacol. : 836 -844 .
Fedele, M., De Martino, I., Pivonello, R.: SOM230, a new somatostatin analogue, is highly effective in the therapy of growth hormone/prolactin-secreting pituitary adenomas. Clin. Cancer Res., 2007, 13, 2738–2744.
Pivonello R. , 'SOM230, a new somatostatin analogue, is highly effective in the therapy of growth hormone/prolactin-secreting pituitary adenomas ' (2007 ) 13 Clin. Cancer Res. : 2738 -2744 .
Bevan, J. S.: The antitumoral effects of somatostatin analog therapy in acromegaly. J. Clin. Endocrinol. Metab., 2005, 90, 1856–1863.
Bevan J. S. , 'The antitumoral effects of somatostatin analog therapy in acromegaly ' (2005 ) 90 J. Clin. Endocrinol. Metab. : 1856 -1863 .
Colao, A., Pivonello, R., Auriemma, R. S., et al.: Growth hormone-secreting tumor shrinkage after 3 months of octreotide-long-acting release therapy predicts the response at 12 months. J. Clin. Endocrinol. Metab., 2008, 93, 3436–3442.
Auriemma R. S. , 'Growth hormone-secreting tumor shrinkage after 3 months of octreotide-long-acting release therapy predicts the response at 12 months ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 3436 -3442 .
Amato, G., Mazziotti, G., Rotondi, M., et al.: Long-term effects of lanreotide SR and octreotid LAR® on tumour shrinkage and GH hypersecretion in patients with previously untreated acromegaly. Clin. Endocrinol. (Oxf.), 2002, 56, 65–71.
Rotondi M. , 'Long-term effects of lanreotide SR and octreotid LAR® on tumour shrinkage and GH hypersecretion in patients with previously untreated acromegaly ' (2002 ) 56 Clin. Endocrinol. (Oxf.) : 65 -71 .
Chieffo, C., Ryan, M., Malott, C., et al.: Rates of biochemical response in patients with acromegaly treated with a subcutaneous octreotide hydrogel implant. ENDO 2011 Annual Meeting, Boston. Endocr. Rev., 2011, 32 (03_MeetingAbstracts), P3–291.
Malott C. , 'Rates of biochemical response in patients with acromegaly treated with a subcutaneous octreotide hydrogel implant. ENDO 2011 Annual Meeting, Boston ' (2011 ) 32 Endocr. Rev. : P3 -291 .
Fleseriu, M.: Clinical efficacy and safety results for dose escalation of somatostatin receptor lingands in patients with acromegaly: a literature review. Pituitary, 2011, 14, 184–193.
Fleseriu M. , 'Clinical efficacy and safety results for dose escalation of somatostatin receptor lingands in patients with acromegaly: a literature review ' (2011 ) 14 Pituitary : 184 -193 .
Colao, A., Lombardi, G.: Dose optimization of somatostatin analogues for acromegaly patients. J. Endocrinol. Invest., 2010, 33, 125–127.
Lombardi G. , 'Dose optimization of somatostatin analogues for acromegaly patients ' (2010 ) 33 J. Endocrinol. Invest. : 125 -127 .
Giustina, A., Bonadonna, S., Bugari, G., et al.: High-dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomized controlled trial. Eur. J. Endocrinol., 2009, 161, 331–338.
Bugari G. , 'High-dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomized controlled trial ' (2009 ) 161 Eur. J. Endocrinol. : 331 -338 .
Petersenn, S., Farrall, A. J., Block, C., et al.: Erratum to: Long-term efficacy and safety of subcutaneous pasireotide in acromegaly: results from an open-ended, multicenter Phase II extension study. Pituitary, 2013 May 30. [Epub ahead of print]
Colao, A., Bronstein, M., Freda, P., et al.: Pasireotide LAR is significantly more effective than octreotide LAR at inducing biochemical control in patients with acromegaly: results of a 12-month randomized, double-blind, multicenter, Phase III study. ICE/ECE 2012, Florence. Endocrine Abstracts, 2012, 29, .
Freda P. , 'Pasireotide LAR is significantly more effective than octreotide LAR at inducing biochemical control in patients with acromegaly: results of a 12-month randomized, double-blind, multicenter, Phase III study. ICE/ECE 2012, Florence ' (2012 ) 29 Endocrine Abstracts : OC1.1 -.
Dénes, J., Korbonits, M., Hubina, E., et al.: Familial isolated pituitary adenoma syndrome. [Familiáris izolált hypophysisadenoma.] Orv. Hetil., 2011, 152, 722–730. [Hungarian]
Hubina E. , 'Familial isolated pituitary adenoma syndrome. [Familiáris izolált hypophysisadenoma.] ' (2011 ) 152 Orv. Hetil. : 722 -730 .
Grasso, L. F., Pivonello, R., Colao, A.: Somatostatin analogs as a first-line treatment in acromegaly: when is it appropriate. Curr. Opin. Endocrinol. Diabetes Obes., 2012, 19, 288–294.
Colao A. , 'Somatostatin analogs as a first-line treatment in acromegaly: when is it appropriate ' (2012 ) 19 Curr. Opin. Endocrinol. Diabetes Obes. : 288 -294 .
Karavitaki, N., Turner, H. E., Adams, C. B., et al.: Surgical debulking of pituitary macroadenomas causing acromegaly improves control by lanreotide. Clin. Endocrinol. (Oxf.), 2008, 68, 970–975.
Adams C. B. , 'Surgical debulking of pituitary macroadenomas causing acromegaly improves control by lanreotide ' (2008 ) 68 Clin. Endocrinol. (Oxf.) : 970 -975 .
Carlsen, S. M., Lund-Johansen, M., Schreiner, T., et al.: Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J. Clin. Endocrinol. Metab., 2008, 93, 2984–2990.
Schreiner T. , 'Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 2984 -2990 .
Maiza, J. C., Vezzosi, D., Matta, M., et al.: Long-term (up to 18 years) effects on GH/IGF-1 hypersecretion and tumour size of primary somatostatin analogue (SSTa) therapy in patients with GH-secreting pituitary adenoma responsive to SSTa. Clin. Endocrinol., 2007, 67, 282–289.
Matta M. , 'Long-term (up to 18 years) effects on GH/IGF-1 hypersecretion and tumour size of primary somatostatin analogue (SSTa) therapy in patients with GH-secreting pituitary adenoma responsive to SSTa ' (2007 ) 67 Clin. Endocrinol. : 282 -289 .
Mao, Z. G., Zhu, Y. H., Tang, H. L., et al.: Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur. J. Endocrinol., 2010, 162, 661–666.
Tang H. L. , 'Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial ' (2010 ) 162 Eur. J. Endocrinol. : 661 -666 .
Nemes, O., Mezősi, E.: Role of somatostatin receptor ligands in the treatment of acromegaly. [Szomatosztatinreceptor-ligandok helye az acromegalia kezelésében.] Orv. Hetil., 2011, 152, 715–721. [Hungarian]
Mezősi E. , 'Role of somatostatin receptor ligands in the treatment of acromegaly. [Szomatosztatinreceptor-ligandok helye az acromegalia kezelésében.] ' (2011 ) 152 Orv. Hetil. : 715 -721 .
Colao, A., Auriemma, R. S., Galdiero, M., et al.: Effects of initial therapy for five years with somatostatin analogs for acromegaly on growth hormone and insulin-like growth factor-I levels, tumor shrinkage, and cardiovascular disease: a prospective study. J. Clin. Endocrinol. Metab., 2009, 94, 3746–3756.
Galdiero M. , 'Effects of initial therapy for five years with somatostatin analogs for acromegaly on growth hormone and insulin-like growth factor-I levels, tumor shrinkage, and cardiovascular disease: a prospective study ' (2009 ) 94 J. Clin. Endocrinol. Metab. : 3746 -3756 .
Saveanu, A., Jaquet, P., Brue, T., et al.: Relevance of coexpression of somatostatin and dopamine D2 receptors in pituitary adenomas. Mol. Cell. Endocrinol., 2008, 286, 206–213.
Brue T. , 'Relevance of coexpression of somatostatin and dopamine D2 receptors in pituitary adenomas ' (2008 ) 286 Mol. Cell. Endocrinol. : 206 -213 .
Kopchick, J. J., Parkinson, C., Stevens, E. C., et al.: Growth hormone receptor antagonists: discovery, development, and use in patients with acromegaly. Endocr. Rev., 2002, 23, 623–646.
Stevens E. C. , 'Growth hormone receptor antagonists: discovery, development, and use in patients with acromegaly ' (2002 ) 23 Endocr. Rev. : 623 -646 .
Hubina, E., Tóth, Á., Kovács, G. L., et al.: Growth hormone receptor antagonist in the treatment of acromegaly. [Növekedésihormonreceptor-antagonista alkalmazásának lehetőségei acromegaliában.] Orv. Hetil., 2011, 152, 709–714. [Hungarian]
Kovács G. L. , 'Growth hormone receptor antagonist in the treatment of acromegaly. [Növekedésihormonreceptor-antagonista alkalmazásának lehetőségei acromegaliában.] ' (2011 ) 152 Orv. Hetil. : 709 -714 .
Van der Lely, A. J., Biller, B. M. K., Brue, T., et al.: Long-term safety of pegvisomant in patients with acromegaly: comprehensive review of 1288 subjects in ACROSTUDY. J. Clin. Endocrinol. Metab., 2012, 97, 1589–1597.
Brue T. , 'Long-term safety of pegvisomant in patients with acromegaly: comprehensive review of 1288 subjects in ACROSTUDY ' (2012 ) 97 J. Clin. Endocrinol. Metab. : 1589 -1597 .
Jimenez, C., Burman, P., Abs, R., et al.: Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials. Eur. J. Endocrinol., 2008, 159, 517–523.
Abs R. , 'Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials ' (2008 ) 159 Eur. J. Endocrinol. : 517 -523 .
Buhk, J.-H., Jung, S., Psychogios, M. N., et al.: Tumor volume of growth hormone-secreting pituitary adenomas during treatment with pegvisomant: a prospective multicenter study. J. Clin. Endocrinol. Metab., 2010, 95, 552–558.
Psychogios M. N. , 'Tumor volume of growth hormone-secreting pituitary adenomas during treatment with pegvisomant: a prospective multicenter study ' (2010 ) 95 J. Clin. Endocrinol. Metab. : 552 -558 .
Neggers, S. J. C. M. M., de Herder, W. W., Janssen, J. A. M. J. L., et al.: Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients. Eur. J. Endocrinol., 2009, 160, 529–533.
Janssen J. A. M. J. L. , 'Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients ' (2009 ) 160 Eur. J. Endocrinol. : 529 -533 .
Trainer, P. J., Ezzat, S., D’Souza, G. A., et al.: A randomized, controlled, multicentre trial comparing pegvisomant alone with combination therapy of pegvisomant and long-acting octreotide in patients with acromegaly. Clin. Endocrinol. (Oxf.), 2009, 71, 549–557.
D’Souza G. A. , 'A randomized, controlled, multicentre trial comparing pegvisomant alone with combination therapy of pegvisomant and long-acting octreotide in patients with acromegaly ' (2009 ) 71 Clin. Endocrinol. (Oxf.) : 549 -557 .
Neggers, S. J., van Aken, M. O., de Herder, W. W., et al.: Quality of life in acromegalic patients during long-term somatostatin analog treatment with and without pegvisomant. J. Clin. Endocrinol. Metab., 2008, 93, 3853–3859.
Herder W. W. , 'Quality of life in acromegalic patients during long-term somatostatin analog treatment with and without pegvisomant ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 3853 -3859 .