Vol 70, No 1 (2019)
Guidelines / Expert consensus
Published online: 2019-02-22
The content of this article is also available in the following languages:
Polski
Polski
Diagnostics and treatment of acromegaly — updated recommendations of the Polish Society of Endocrinology [Rozpoznanie i leczenie akromegalii — aktualizacja rekomendacji Polskiego Towarzystwa Endokrynologicznego]
Abstract
Akromegalia jest rzadką chorobą spowodowaną nadmiernym wydzielaniem hormonu wzrostu (GH), zwykle przez guz przysadki. Rozpoznanie jest zwykle stawiane z opóźnieniem, w związku z czym często dochodzi do rozwoju różnych powikłań choroby będących przyczyną zwiększonego zagrożenia zgonem. U chorych z nadciśnieniem, niewydolnością serca, cukrzycą, artropatiami, nietypowymi dla wieku, należy zwrócić uwagę na występowanie objawów akromegalii. Oznaczanie stężenia insulinopodobnego czynnika wzrostu 1 (IGF-1) powinno być stosowane jako badanie przesiewowe przy podejrzeniu akromegalii. Dalsza diagnostyka i leczenie powinny być prowadzone w wyspecjalizowanych ośrodkach. Leczeniem pierwszego rzutu jest wybiórcze usunięcie gruczolaka przysadki z dostępu przez zatokę klinową. Pacjentów, u których jest szansa na wyleczenie w wyniku operacyjnego usunięcia guza przysadki, po przygotowaniu farmakologicznym należy kierować do ośrodków mających doświadczenie w tego typu zabiegach. U pozostałych chorych oraz u pacjentów, u których leczenie neurochirurgiczne było nieskuteczne, należy stosować przewlekłe leczenie, w pierwszej kolejności analogami somatostatyny pierwszej generacji. W leczeniu drugiego rzutu należy rozważyć pazyreotyd, pegwisomant, kabergolinę lub ich kombinacje. W każdym przypadku chorych należy objąć obserwacją przez całe życie w celu monitorowania i aktywnego leczenia następstw akromegalii. Obecne zalecenia są uaktualnioną wersją rekomendacji publikowanych w Endokrynologii Polskiej w 2014 roku. Uwzględniają one krajowe realia i powinny być pomocne w postępowaniu z pacjentami chorymi na akromegalię.
Keywords: akromegaliadiagnostykaleczeniezalecenia
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