764 2011 1005-2194 2012 10-0764 - 11 R584 A Interpretation of medical guidelines for clinical practice for the diagnosis and treatment of acromegaly - 2011 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 100730 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 2009 4 2004 AACE 2004 100730 gufeng3@ medmail. com. cn
2012 10 32 10 765 2006 61. 3% GH nmol /L ng /ml 1 ng = 0. 047 nmol /L 1 40 ~ prolactin 125 /100 3 ~ 4 /100 PRL GH 13 /10 IGF-1 1034 /100 2 40 4% ~ 14% 1 7 ~ 10 2. 3 GH GH -1 insulin-like growth factor 1 IGF-1 1 % 86 74 48 46 40 38 26 26 18 9 2. 2 20% 9% 45% 70% 50% 73% 87% 2. 3. 1 60% ~ 80% 75% bone mineral density BMD 2. 1 GH 40 > 10 mm 15 1196 77% 50% 23% D 55% GH GH 3. 5% 1 multiple endocrine adenomatosis MEN-1 CT 18% 2. 3. 2
766 2. 3. 6 64% 2. 3. 3 70% 2. 47 GH 90% 2. 3. 7 2 ~ 2. 5 GH < 0. 118 nmol /L < 0. 047 nmol /L GH GH GH 2. 3. 4 46% 56% 2 type 2 3 diabetes mellitus T2DM 40% 3. 1 GH IGF-1 IGF-1 oral glucose tolerance test OGTT GH 3. 2. 1 IGF-1 IGF-1 GH IGF-1 GH 40% IGF-1 GH IGF-1IGF-1 2. 3. 5 3. 2 IGF-1 IGF-1 OGTT GH 3. 2. 2 GH GH GH 20 min
2012 10 32 10 767 GH GH dopamine agonists DA 3. 2. 3 OGTT GH OGTT GH GH CT 30 min GH 120 min 75 g GH GHRH OGTT GH GH GH 0. 047 nmol /L 3. 2. 6 GH 0. 047 nmol /L GH IGF-1 MRI 2 GH 2000 4 GH < 0. 019 nmol /L IGF-1 GH 1 2 2005 GH < 3 0. 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. 2. 5 2 PRL 3 GH IGF-1 PRL 4 2 MRI MRI IGF-1 OGTT GH GH > 0. 047 nmol / L GH > 0. 019 nmol /L PRL GH < 0. 019 nmol /L IGF-1 GH SSA
768 a b c d DA e f DA GH IGF-1-1 SSA 1 4. 1. 2 3 GH GH 1 MRI 2 GH IGF-1 GH IGF-1 MRI GH IGF-1 80% 4. 1. 3 1 > 2 cm somatosatin analogues SSA 40 ~ 50% GH GH > 2 SSA 1. 41 nmol /L IGF-1 Abe 20% ~ 50% GH > 9. 4 nmol /L MRI 286 SSA SSA SSA 1 2
2012 10 32 10 769 GH 30% PRL 20% ~ 80% DA GH SSA SSA 4. 1. 4. 4 6 SSA 2 5% ~ 10% 5 ~ 14 d 10% 20% 2% ~ 7% SSA 6 ~ 12 4. 1. 4 4. 1. 4. 1 1 GH 1 4. 2 OGTT GH GH < 0. 019 nmol /L 4. 1. 1 IGF-1 3 ~ 6 50% ~ 3 ~ 6 IGF-1 70% OGTT GH < 0. 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. 1. 2 SSA DA 3 ~ 5 GH IGF-1 12 MRI GH 1 OGTT GH 4. 1. 4. 3 Ki-67 GH < 0. 047 nmol /L 2 30 min 3 h GH < 0. 047 nmol /L
770 GH 1. 88 nmol /L IGF-1 6 GH IGF-1 SSA IGF-1 SSA GH 2 somatostatin receptor subtype 2 SSTR2 GH SSTR 4. 1. 3 1 DA SSA 2 h DA GH 6 h SSA GH 2 SSA 1. 0 ~ 1. 75 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 3 2 3 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 < 0. 118 nmol /L OGTT GH 111 GH < 0. 047 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
2012 10 32 10 771 97% IGF-1 42 95% IGF-1 IGF-1 GH 0. 564 ~ 0. 658 nmol /L IGF-1 38% SSA SSA 17. 4 mg 40 mg IGF-1 1 2 SSA IGF-1 2 SSAs DA GH SSA GH MRI 6 1 1 58% 4. 3. 1 2 1. 6 ~ 1. 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. 470 nmol /L 80% 5 SSA > 10 ~ 15 GH < 0. 118 nmol /L SSA DA GH < 0. 047 nmol /L SSA IGF-1 SSA 19 8 10% ~ 60% 42% IGF-1 10 IGF-1 GH GH IGF-1 PRL SSA SSA SSA 10 ~ 20 IGF-1 SSA 90% 85% 50% 42 60 mg /
772 2 0 ~ 3% 8 ~ 10Gy MRI 90% GH < 0. 235 nmol /L 2% GH < 0. 118 nmol /L GH < 0. 047 nmol /L 0. 8% IGF-1 2 ~ 5 17% ~ 50% 5 2 GH GH 5 mm 5. 1 75% 5. 1. 1 GH IGF-1 GH GH GH GH IGF-1 IGF-1 GH IGF-1 IGF- 1 IGF-1 3 5. 1. 2 GH 5 ~ 10 50% PRL 5. 1. 3 6 GH IGF-1 GH 7% 14% Sherlock 501 GH 264 237 4 5. 2
2012 10 32 10 773 0. 6% 5. 2. 1 6. 1 37% 8% 5. 2. 2 6. 2 GH IGF-1 OGTT GH IGF-1 OGTT GH SSA 31% IGF-1 PRL 1 SSA GH McCune-Albright GH IGF-1 5. 2. 3 6. 3 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
774 7. 4 GH IGF-1 GH 2 GH D SSA MEN1 IGF-1 130 /80 mmhg 1 mmhg = 0. 133 kpa 6. 5% 7. 2 7. 5 GH 15 30% ~ 70% IGF-1 GH 7. 3 GH 7. 6 68 13 GH GH 2012-05 - 22