Clinical applications of somatostatin analogs for growth hormone-secreting pituitary adenomas.
Clinical applications of somatostatin analogs for growth hormone-secreting pituitary adenomas.
复制标题
生长抑素类似物治疗生长激素分泌型垂体腺瘤的临床应用
DOI：
10.2147/ppa.s53930
复制
发表时间：
2014-01-06
影响因子：
2.2
通讯作者：
Wang HJ
中科院分区：
文献类型：
--
作者：
Wang JW;Li Y;Mao ZG;Hu B;Jiang XB;Song BB;Wang X;Zhu YH;Wang HJ
生长激素（GH）分泌过多的垂体腺瘤通常会导致青少年肥胖症或成人肢端肥大症。肢端肥大症的临床并发症涉及心血管、呼吸和代谢系统，导致发病率升高。通过手术或药物治疗控制血清GH和胰岛素样生长因子（IGF）1的高分泌可降低发病率。目前的药物治疗包括生长抑素类似物（SA）和GH受体拮抗剂;前者包括兰瑞肽Autogel（ATG）和奥曲肽长效释放剂（LAR），后者是指培维索曼。作为主要药物治疗，兰瑞肽ATG和奥曲肽LAR可以以长效制剂形式提供，通过每4-6周皮下注射实现GH和IGF-1的生化控制。兰瑞肽ATG和奥曲肽LAR为GH分泌型垂体腺瘤的治疗提供了有效的药物治疗，无论是作为主要治疗还是次要治疗;然而，为了以最小的成本获得最大的获益，在应用SA之前应强调几点。应提前完成全面评估，特别是对临床预测因素的观察和SA治疗的预选。应实施持续至少3个月的治疗过程，以达到长期稳定的血药浓度。术前SA治疗非侵袭性大腺瘤可能获得更满意的手术结果，尽管这种辅助治疗存在争议。在某些特定情况下，SA与培维索芒或卡麦角林联合使用显示出优势。因此，应在充分评估风险和获益的情况下为每位患者制定个体化治疗方案。
Excessive growth hormone (GH) is usually secreted by GH-secreting pituitary adenomas and causes gigantism in juveniles or acromegaly in adults. The clinical complications involving cardiovascular, respiratory, and metabolic systems lead to elevated morbidity in acromegaly. Control of serum GH and insulin-like growth factor (IGF) 1 hypersecretion by surgery or pharmacotherapy can decrease morbidity. Current pharmacotherapy includes somatostatin analogs (SAs) and GH receptor antagonist; the former consists of lanreotide Autogel (ATG) and octreotide long-acting release (LAR), and the latter refers to pegvisomant. As primary medical therapy, lanreotide ATG and octreotide LAR can be supplied in a long-lasting formulation to achieve biochemical control of GH and IGF-1 by subcutaneous injection every 4–6 weeks. Lanreotide ATG and octreotide LAR provide an effective medical treatment, whether as a primary or secondary therapy, for the treatment of GH-secreting pituitary adenoma; however, to maximize benefits with the least cost, several points should be emphasized before the application of SAs. A comprehensive assessment, especially of the observation of clinical predictors and preselection of SA treatment, should be completed in advance. A treatment process lasting at least 3 months should be implemented to achieve a long-term stable blood concentration. More satisfactory surgical outcomes for noninvasive macroadenomas treated with presurgical SA may be achieved, although controversy of such adjuvant therapy exists. Combination of SA and pegvisomant or cabergoline shows advantages in some specific cases. Thus, an individual treatment program should be established for each patient under a full evaluation of the risks and benefits.