% GH nmol /L ng /ml 1 ng = nmol /L 1 40 ~ prolactin 125 /100 3 ~ 4 /100 PRL GH 13 /10 IGF / % ~ 14%

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1 R584 A Interpretation of medical guidelines for clinical practice for the diagnosis and treatment of acromegaly update. TIAN Dan CEN Jing GU Feng. Key Laboratory of Endocrinology of the Ministry of Health Department of Endocrinology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Summary Acromegaly is a rarely encountered endocrine disease featured by growth hormone hypersecretion and multisystem involvement. Subjects often had to resort to multiple departments and may even be misdiagnosed as a result of insidious onset and non-specific clinical manifestations. Pituitary macroadenoma has not been uncommon in patients with newly diagnosed acromegaly. The cardiovascular and respiratory complications may lead to markedly reduced quality of life rendering it difficult to cure and an increasing mortality rate. That most studies have addressed biochemical diagnostic criteria and individualized treatment protocol of acromegaly has resulted in an optimal amelioration in terms of biochemical parameters via the treatment using medications particularly the combination with surgery. More attention should be attached to acromegaly leading to improved capacity of the diagnosis and treatment. Keywords acromegaly biochemical remission guidelines growth hormone GH AACE gufeng3@ medmail. com. cn

Beijing 100730 China Summary Acromegaly is a rarely encountered endocrine disease featured by growth hormone hypersecretion and multisystem involvement.

2 % GH nmol /L ng /ml 1 ng = nmol /L 1 40 ~ prolactin 125 /100 3 ~ 4 /100 PRL GH 13 /10 IGF / % ~ 14% 1 7 ~ GH GH -1 insulin-like growth factor 1 IGF-1 1 % % 9% 45% 70% 50% 73% 87% % ~ 80% 75% bone mineral density BMD 2. 1 GH 40 > 10 mm % 50% 23% D 55% GH GH 3. 5% 1 multiple endocrine adenomatosis MEN-1 CT 18%

3 GH GH -1 insulin-like growth factor 1 IGF-1 1 % 86 74 48 46 40 38 26 26 18 9 2.

3 % % GH 90% ~ 2. 5 GH < nmol /L < nmol /L GH GH GH % 56% 2 type 2 3 diabetes mellitus T2DM 40% 3. 1 GH IGF-1 IGF-1 oral glucose tolerance test OGTT GH IGF-1 IGF-1 GH IGF-1 GH 40% IGF-1 GH IGF-1IGF IGF-1 IGF-1 OGTT GH GH GH GH 20 min

1 GH IGF-1 IGF-1 oral glucose tolerance test OGTT GH 3. 2.

4 GH GH dopamine agonists DA OGTT GH OGTT GH GH CT 30 min GH 120 min 75 g GH GHRH OGTT GH GH GH nmol /L GH nmol /L GH IGF-1 MRI 2 GH GH < nmol /L IGF-1 GH GH < nmol /L GH GH GH GHBP GH IGF-1 30% GH IGF-1 IGF-1 GH GH IGF-1 1 GH IGF GH IGF-1 MRI GH PRL 3 GH IGF-1 PRL 4 2 MRI MRI IGF-1 OGTT GH GH > nmol / L GH > nmol /L PRL GH < nmol /L IGF-1 GH SSA

019 nmol /L 4 5 3. 2. 4 GH GH GH GHBP GH IGF-1 30% GH IGF-1 IGF-1 GH GH IGF-1 1 GH IGF-1 4. 1 4. 1. 1 1 GH IGF-1 MRI GH 3.

5 768 a b c d DA e f DA GH IGF-1-1 SSA GH GH 1 MRI 2 GH IGF-1 GH IGF-1 MRI GH IGF-1 80% > 2 cm somatosatin analogues SSA 40 ~ 50% GH GH > 2 SSA nmol /L IGF-1 Abe 20% ~ 50% GH > 9. 4 nmol /L MRI 286 SSA SSA SSA 1 2

4. 1. 3 1 > 2 cm somatosatin analogues SSA 40 ~ 50% GH GH >

6 GH 30% PRL 20% ~ 80% DA GH SSA SSA SSA 2 5% ~ 10% 5 ~ 14 d 10% 20% 2% ~ 7% SSA 6 ~ GH OGTT GH GH < nmol /L IGF-1 3 ~ 6 50% ~ 3 ~ 6 IGF-1 70% OGTT GH < nmol /L < SSA SSA 70% nmol /L 30% GH 75% 12 IGF-1 25% IGF-1 GH SSA IGF-1 OGTT GH SSA GH MRI T SSA DA 3 ~ 5 GH IGF-1 12 MRI GH 1 OGTT GH Ki-67 GH < nmol /L 2 30 min 3 h GH < nmol /L

047 nmol /L < SSA SSA 70% 0. 019 nmol /L 30% GH 75% 12 IGF-1 25% IGF-1 GH SSA IGF-1 OGTT GH SSA 4. 1. 4. 2 GH MRI T1 4.

7 770 GH nmol /L IGF-1 6 GH IGF-1 SSA IGF-1 SSA GH 2 somatostatin receptor subtype 2 SSTR2 GH SSTR DA SSA 2 h DA GH 6 h SSA GH 2 SSA 1. 0 ~ mg / 3 ~ 40 40% GH IGF-1 7 mg / IGF-1 4 ~ 6 GH PRL IGF-1 DA SSA SSA 36. 6% SSA 10% > 45% IGF-1 SSA 50% SSA 2 SSA SSA GH SSA SSA 3 ~ 4 1 SSA SSA GH SSA 0. 1 mg GH 1 ~ 3 GH GH SSA 50% ~ 70% GH IGF-1 30% IGF-1 SSA IGF-1 GH 2 GH IGF-1 SSA 57% GH GH < nmol /L OGTT GH 111 GH < nmol /L 67% IGF-1 IGF-1 20 mg IGF-1 60% 3 IGF-1 6 GH IGF- 1 SSA 60 mg 89% IGF-1 IGF- 1 SSA 12 90

6% SSA 10% > 45% IGF-1 SSA 50% SSA 2 SSA SSA GH SSA SSA 3 ~ 4 1 SSA SSA GH SSA 0.

8 % IGF % IGF-1 IGF-1 GH ~ nmol /L IGF-1 38% SSA SSA mg 40 mg IGF SSA IGF-1 2 SSAs DA GH SSA GH MRI % ~ 1. 8 Gy 4 ~ 5 5 ~ 6 45 ~ 50 Gy 4 GH IGF-1 SSA 4. 3 / 60 6 /7 IGF GH IGF-1 GH 1995 GH < ~ nmol /L 80% 5 SSA > 10 ~ 15 GH < nmol /L SSA DA GH < nmol /L SSA IGF-1 SSA % ~ 60% 42% IGF-1 10 IGF-1 GH GH IGF-1 PRL SSA SSA SSA 10 ~ 20 IGF-1 SSA 90% 85% 50% mg /

8 Gy 4 ~ 5 5 ~ 6 45 ~ 50 Gy 4 GH IGF-1 SSA 4. 3 / 60 6 /7 IGF-1 8 4. 3. 2 1 2 GH IGF-1 GH 1995 GH < 0. 235 ~ 0.

9 ~ 3% 8 ~ 10Gy MRI 90% GH < nmol /L 2% GH < nmol /L GH < nmol /L 0. 8% IGF-1 2 ~ 5 17% ~ 50% 5 2 GH GH 5 mm % GH IGF-1 GH GH GH GH IGF-1 IGF-1 GH IGF-1 IGF- 1 IGF GH 5 ~ 10 50% PRL GH IGF-1 GH 7% 14% Sherlock 501 GH

10 % % 8% GH IGF-1 OGTT GH IGF-1 OGTT GH SSA 31% IGF-1 PRL 1 SSA GH McCune-Albright GH IGF MRI GH IGF-1 SSA DA GH PRL SSA DA IGF-1 MRI 7 SSA GH 2 ~ 3 SSA GH IGF-1 6 GH 7. 1 GH

11 GH IGF-1 GH 2 GH D SSA MEN1 IGF /80 mmhg 1 mmhg = kpa 6. 5% GH 15 30% ~ 70% IGF-1 GH 7. 3 GH GH GH

16385.mps

16385.mps 第三章家庭常用护理技术护理技术是挽救生命减轻痛苦恢复功能延缓衰老的服务手段这些技术不仅在医院中经常运用, 在家庭保健工作中也是不可缺少的学习一些常用的家庭护理技术, 可以满足家庭成员卫生保健的需要第一节生命体