Epidemiology of acromegaly.
Epidemiology of acromegaly.
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DOI：
10.1023/a:1009965803750
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发表时间：
1999-06-01
期刊：
影响因子：
3.8
通讯作者：
Rajasoorya, C
中科院分区：
文献类型：
--
作者：
Holdaway, I M;Rajasoorya, C
肢端肥大症是慢性生长激素（GH）过量的结果，在大多数情况下是由于GH分泌垂体腺瘤，并且发生的人口患病率为60/百万，发病率为每年3-4/百万。男性和女性似乎同样受到影响，平均发病年龄为44岁。年轻的患者可能有更多的侵袭性肿瘤和更高的GH浓度。大约三分之一的病例同时存在高催乳素血症，不同比例的肿瘤似乎存在gsp基因的激活突变或其他遗传异常。急性并发症，如腕管综合征，出汗和阻塞性睡眠呼吸暂停通常是可逆的治疗条件，但慢性并发症，如高血压，糖尿病和心脏病是不容易纠正和治疗后生长激素水平< 2.5微克/升（5 mU/L）需要达到在一般社区发现的患病率。这种GH的“治愈性”水平仅在约50%的采用当前疗法的患者中实现，并且因此存在持续过量的患有肢端肥大症的慢性并发症的患者，导致该病症的发病率和死亡率增加，其中预测与预期的死亡率比范围为1.6-3.3，并且仅在治疗后生长激素水平< 2.5 μ g/L的那些患者中接近统一。在一些研究中，预后因素包括诊断前糖尿病和高血压的存在，以及暴露于术前血清GH产物产生的过量生长激素的测量值和从首次症状到治疗的时间。然而，总体而言，最重要的预后变量似乎是通过治疗达到的血清GH浓度，越来越多的共识是，这需要< 2.5 μ g/L（5 mU/L）才能实现治愈。
Acromegaly is a consequence of chronic growth hormone (GH) excess, due in the majority of cases to a GH-secreting pituitary adenoma, and occurring with a population prevalence of 60 per million and an incidence of 3-4 per million per year. Males and females appear to be equally affected with an average age of presentation of 44 years. Younger patients may have more aggressive tumours and higher GH concentrations. There is co-existent hyperprolactinaemia in about one third of cases, and a variable proportion of [figure: see text] tumours appear to have activating mutations of the gsp gene or other genetic abnormalities. Acute complications such as carpal tunnel syndrome, sweating and obstructive sleep apnoea are usually readily reversible with treatment of the condition, but chronic complications such as hypertension, diabetes and heart disease are less readily corrected and post-treatment GH levels of < 2.5 ug/L (5 mU/L) are needed to achieve the prevalence found in the general community. Such 'curative' levels of GH are achieved in only about 50% of patients with current therapies, and as a result there is an ongoing excess of patients with chronic complications of acromegaly leading to increased morbidity and mortality from the disorder, with observed-to-expected mortality ratios ranging from 1.6-3.3 and only approaching unity in those with growth hormone levels < 2.5 ug/L following treatment. Prognostic factors include in some studies the presence of diabetes and [table: see text] hypertension prior to diagnosis as well as measures of exposure to excessive growth hormone derived from the product of preoperative serum GH and the time from first symptoms to treatment. Overall, however, the most important prognostic variable appears to be the serum GH concentration achieved by treatment, with an increasing consensus that this needs to be < 2.5 ug/L (5 mU/L) to achieve cure of the condition.