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首页> 外文期刊>Internal medicine journal >Newer options in the management of acromegaly.
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Newer options in the management of acromegaly.

机译：肢端肥大症管理中的新选项。

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Paradigms for managing acromegaly have undergone major changes in the past two decades. This has been brought about by combining surgical, pharmacological and radiotherapeutic approaches that provide tight biochemical control to reduce mortality to that of the general population. The biochemical targets for treatment are a growth hormone of <2.5 ng/mL (approximately 7.5 mU/L) and a normal, age-adjusted insulin-like growth factor-1. Until 20 years ago, dopamine agonists were the only class of pharmaceutical agents available to control acromegaly. They have a limited adjunctive role, even with the development of second-generation selective agonists such as cabergoline. Surgery and radiotherapy were the mainstay of acromegaly management before the advent of the effective pharmacological therapies of the modern era: somatostatin analogues and pegvisomant, a growth hormone receptor antagonist. Somatostatin analogues achieve biochemical control in approximately 60% of patients. Pegvisomant, which is available in the USA and Europe and has just been registered in Australia, normalizes insulin-like growth factor-1 in nearly all patients but has no effect on tumour mass. Surgery is an appropriate first-line therapy for microadenomas as the chance of success is high. For large and/or invasive tumours where the prospect of surgical cure is remote, first-line therapy is somatostatin analogue treatment with debulking surgery having an adjunctive role to achieve tight control or to alleviate compression of the optic chiasm. Although acromegaly remains a challenging disease to manage, the expanding range of therapeutic options is likely to result in a better outcome for patients and offers the potential to tailor therapy based on a patient's individual requirements.
机译：在过去的二十年中，用于肢端肥大症治疗的范例发生了重大变化。这是通过结合外科，药理和放射治疗方法来实现的，这些方法提供了严格的生化控制，可将死亡率降低至普通人群的死亡率。治疗的生化指标是生长激素<2.5 ng / mL（约7.5 mU / L）和正常的，经过年龄调整的胰岛素样生长因子-1。直到20年前，多巴胺激动剂是唯一可用于控制肢端肥大症的药物。即使在第二代选择性激动剂如卡麦角林的开发中，它们的辅助作用也很有限。在现代有效药物治疗出现之前，外科手术和放疗是肢端肥大症治疗的主要手段：生长抑素类似物和生长激素受体拮抗剂pegvisomant。生长抑素类似物可在约60％的患者中实现生化控制。 Pegvisomant在美国和欧洲都有销售，并且刚刚在澳大利亚注册，它使几乎所有患者的胰岛素样生长因子-1均正常化，但对肿瘤质量没有影响。手术是治疗微腺瘤的合适的一线治疗方法，因为成功的机会很高。对于手术治愈前景不大的大型和/或浸润性肿瘤，一线治疗是生长抑素类似物治疗和减重手术，具有辅助作用，以实现严格控制或减轻视交叉的压迫。尽管肢端肥大症仍然是一种具有挑战性的疾病，但治疗选择的范围不断扩大可能会为患者带来更好的结果，并有可能根据患者的个人需求量身定制治疗方案。

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