Analysis of the Effectiveness of Various Schemes of Treatment of Acromegaly Taking into Account Modern Requirements to the State of Clinical and Hormonal Control

Mykytyuk M.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The analysis of the effectiveness of various treatment regimens 268 patients with acromegaly (includ­ ing 47 patients with de novo). The age of patients – from 15 to 75 years (Me 45,0), mean (44,0+/­12,5) years. The total duration of the disease (TDD) ranged from 1 to 38 years, mean (145,44 +/­ 103,45) months. Assessment of clinical and hormonal disease control conducted according to the recommendations of the in­ ternational consensus 2009. Surgical treatment (ST), as the primary method of treatment, was carried out in 166 patients, primary medical treatment (MT) – 21 patient, adjuvant medication and radiation therapy (RT) 69 and 6 patients, respectively, com­ plex treatment of 20 patients. The period of time from diagnosis of acromegaly to ST was 0­4,5 years. The growth hormone (GH) in the blood before ST was Me 27 (from 7,6 to 720) ng/ml, concentration insulin­like growth factor­1%UNL – Me 316 (from 184 to 536) ng/ml. In 90 % of patients diameter pituitary adenomas according to magnetic resonance therapy to was > 10 mm. The period from ST to assessing its effectiveness was Me 1,2 (from 0. 3 to 7,6) years. Complete remission after ST occurred in 30 % of patients. After unsuccessful ST 69 patients was appointed as adjuvant treatment with dopamine agonist with bromocriptine or cabergoline and/or somatostatin analog (SA), six patients was conducted RT and 37 patients underwent repeated surgical interventions concerning the prolonged growth pituitary adeno­ mas. GH­secreting pituitary adenomas patients who had repeated surgical intervention was characterized by a high proliferative activity, which was indicated frequency of surgical interventions for minor TDD. Analysis of GH in the blood to ST and after repeated surgical interventions found a significant positive dynamics. The decline GH happened (from 59,48 to 35,99) (Me 51,4 [8,5­159,00]) to (from 28,23 to 25,71) ng/ml (Me 28,45 [0,75­130,0]) (P = 0,00003). In general, the level of GH in the blood decreased by 44. 7 %. Complications ST occurred in 16. 4 % of patients with acromegaly (12,8 % hypopituitarism). Most often met iso­ lated hypopituitarism – secondary hypothyroidism (n = 10) or hypogonadism (n = 3) (6,9 % patients), in five patients partial hypopituitarism (secondary hypothyroidism + hypogonadism) (2. 7 %) and six patients – total hypopituita­ rism (3. 2 %). Adjuvant RT was used in 26 patients with acromegaly: six patients after ineffective ST and in 20 patients after the ineffectiveness of the ST and MT. Remission of acromegaly after RT was reached 42. 3 % of patients: 6 patients after the stereotactic radiotherapy (SRT) in the structure of the complex treatment in 4 patients after protonotherapy in the structure of complex treatment and in one patient after distance γ­therapy in the structure of combined treat­ ment. In patients with active form of acromegaly at the time of the survey, the level of GH in the blood after RT de­ creased by 51. 4 %, the concentration of IGF­1 – 39. 3 %, in patients in remission on 95,7 and 73,2 %, respectively. Remission of acromegaly after the SRT has developed through 1,7­2,5 years, after protonotherapy and distance γ­therapy after 8­15 years. On the background of primary medical treatment, remission of acromegaly was reached 23. 8 % of patients therapy somatostatin analog – octreotide­LAR. After treatment with octreotide­LAR 20 mg (average duration of 18 months) level decreased by 92. 5 %, the concentration of IGF­1 in the blood – by 68. 2 %. The results of the study demonstrate the need to review approaches to the treatment of patients with acro­ megaly in Ukraine.

acromegaly, growth hormone, insulin­like growth factor­1, surgical treatment, radiation therapy, octreotide­LAR.

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