Akromegalia jako problem interdyscyplinarny

• Authors: Natalia Bożena Zawada , Jolanta Kunert-Radek

Title variants

EN

Acromegaly - an interdisciplinary problem

• Languages of publication: PL

Abstracts

PL

Praca omawia epidemiologię i patogenezę akromegalii ze szczególnym zwróceniem uwagi na naturę i patofizjologię hormonu wzrostu. Autorzy poruszają szeroko problem guzów przysadki z uwzględnieniem miejsca akromegalii w różnorodnych kryteriach podziału gruczolaków przysadki. Przedstawiają charakterystyczny obraz kliniczny i kryteria rozpoznania tej endokrynopatii, odnosząc się w szczególności do konsensusu Amerykańskiego Towarzystwa Endokrynologów Klinicznych z 2011 roku, dotyczącego diagnostyki i leczenia akromegalii. Podnoszą zagadnienie wciąż wiele lat opóźnionego rozpoznania choroby. Podkreślają interdyscyplinarny, złożony problem terapii tej endokrynopatii i zaangażowanie lekarzy wielu specjalności. Omawiają zasady etapowego leczenia akromegalii, podkreślając wciąż wiodącą rolę leczenia operacyjnego. Dużo uwagi poświęcają różnym formom farmakoterapii akromegalii, coraz szerzej stosowanym w inwazyjnych gruczolakach somatotropowych, również jako metody pierwszego wyboru. Autorzy podkreślają nadzieje związane z nowymi lekami oraz konieczność łączenia wielu metod terapeutycznych w celu wyleczenia akromegalii.

EN

The aim of this article is to review the epidemiology and pathogenesis of acromegaly with regard to the nature and pathophysiology of growth hormone. The authors give a broad view of pituitary tumours and especially focus on acromegaly. They pay attention to clinical presentation and criteria for diagnosis of this endocrinopathy with reference to the new guidelines of the American Association of Clinical Endocrinologists published in 2011 which focus on the diagnosis and treatment of acromegaly. The authors also raise a query about the diagnosis of acromegaly which is delayed for several years. They also highlight the interdisciplinary, complex problem of therapy of this endocrinopathy and the need for interdisciplinary collaboration of many medical specialists. They discuss the treatment of acromegaly step by step stressing the crucial role of surgery. They pay much attention to different forms of pharmacotherapy, more broadly used in invasive somatotroph adenomas, also as a treatment of choice. The authors discuss new forms of pharmacotherapy of acromegaly and stress that in some patients a combination of several treatment options is necessary to cure acromegaly.

Keywords

EN

acromegaly; akromegalia; analogisomatostatyny; growth hormone; guzy przysadki; hormon wzrostu; pituitary tumours; somatostatin analogs

Discipline

• MEDICINE: MEDICINE

• Publisher: Łódzkie Towarzystwo Naukowe
• Journal: Folia Medica Lodziensia
• Year: 2011
• Volume: 38
• Issue: 2
• Pages: 285-317

Contributors

author

Natalia Bożena Zawada

• Klinika Endokrynologii Katedry Endokrynologii Uniwersytet Medyczny w Łodzi

author

Jolanta Kunert-Radek

• Klinika Endokrynologii Katedry Endokrynologii Uniwersytet Medyczny w Łodzi

References

• Zgliczyński W. Postępy w rozpoznawaniu i leczeniu akromegalii. Postępy Nauk Medycznych 2008; 2: 64-68.
• Kałużny M, Bolanowski M. Akromegalia - od mitów do faktów. Endokrynol Pol. 2008; 59: 242-244.
• Gierach M, Gierach J, Pujanek M, Skowroń A, Rutkowska E, Junik R. Aberrations in carbohydrate metabolism in patients with diagnosed acromegaly, hospitalized in the Endocrinology and Diabetology Department of Collegium Medicum University of Nicolaus Copernicus in Bydgoszcz in the years 2001-2009. Endokrynol Pol. 2010;. 61: 260-263.
• Danzig J. New guidelines for the treatment of acromegaly, a serious growth hormone disorder. http: //www.news-medical.net/news/20110831/New-guidelines -for-the-treatment-of-acromegaly-a-serious-growth-hormone-disorder.aspx
• Zgliczyński W. Czy akromegalię da się wyleczyć? Endokrynol Pol. 2003; 54: 533.
• Herman V, Drazin NZ, Gonsky R, Melmed S. Molecular Screening of Pituitary Adenomas for Gene Mutations and Rearrangaments. J Clin Endocrinol Metab. 1993; 77: 50-55.
• Waśko R. Apoptoza w leczeniu guzów przysadki typu somatotropinoma i prolactinoma (rozprawa habilitacyjna). Poznań1999.
• Stępień H, Ławnicka H. Akromegalia - postępy w patogenezie, diagnostyce i terapii. Voice 2008; 17: 20-26.
• Bolanowski M, Naglik T. Postępowanie w przypadkowo stwierdzanych guzach przysadki - incidentaloma. Adv Clin Exp Med. 2004; 13: 1019-1022.
• Molich ME, Russell EJ. The pituitary 'incidentaloma'. Ann Intern Med. 1990; 112: 925-931.
• Katznelson L, Alexander JM, Klibanski NJ. Clinically nonfunctioning pituitary adenomas. J Clin Endocrinol Metab. 1993; 76: 1089-1094.
• Freda PU, Wardlaw SL, Post KD. Usual causes of sellar/parasellar masses in a large transsphenoidal surgical series. J Clin Endocrinol Metab. 1996; 81: 3455 3459.
• Bolanowski M. Guzy przysadki - możliwości diagnostyczne i terapeutyczne. Terapia 2001; 9: 37-39.
• Aron DC, Ross NS. Pituitary incidentaloma. Ann Intern Med. 1990; 113: 558 559.
• Molich ME. Evaluation and treatment of the patient with a pituitary incidentaloma. J Clin Endocrinol Metab. 1995; 80: 3-6.
• Colao A, Lombardi G. Growth hormone and prolactin excess. Lancet. 1998; 352: 1455–1461.
• Colao A, Ferone D, Marzullo P, Lombardi G. Systemic Complications of Acromegaly: Epidemiology, Pathogenesis and Management. Endocrine Reviews. 2004; 25: 102-152.
• Davis JR, Sheppard MC, Heath DA. Giant invasive prolactinoma: A case report and review of nine further cases. Q J Med. 1990; 74: 227-238.
• Ferrante E, Ferraroni M, Castrignano T, Menicatti L, Anagni M, Reimondo G i wsp. Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol. 2006; 155: 823 829.
• Sheehan JP, Kondziołka D, Flickinger J, Lunsford LD. Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg. 2002; 97: 408-414.
• Jaffe CA. Clinically non-functioning pituitary adenoma. Pituitary. 2006; 9: 317 321.
• Pawlikowski M, Kunert-Radek J, Radek A. Gonadotropinoma - a frequent subtype of the pituitary adenoma. Endokrynol Pol. 2000; 51: 77-81.
• Klibanski A, Zervas NT. Diagnosis and management of hormone-secreting pituitary adenomas. N Engl J Med. 1991; 324: 822-831.
• Pawlikowski M. Immunohistochemia guzów przysadki – odniesienia kliniczne. Fol Med Lodz. 2007; 34: 83-98.
• Pawlikowski M, Kunert-Radek J, Radek M. Plurihormonality of pituitary adenomas in the light of immunohistochemical studies. Endokrynol Pol. 2010; 61: 63-66.
• Davis JR, Wilson EM, Vidal ME, Johnson AP, Lynch SE, Shepard MC. Regulation of growth hormone secretion and messenger ribonucleic acid accumulation in human somatotropinoma cells in vitro. J Clin Endocrinol Metab. 1989; 69: 704-708.
• Gardner DG. Mechanism of hormone action. W: Basic and clinical endocrinology. Red. Greenspan FS, Strewler GJ. Wyd. 5. Stamford, Appleton and Lange, 1997, 58-76.
• Pradayrol L, Jonrvall H, Mutt V, Ribet A. N-Terminally extended somatostatin: the primary structure of somatostatin 28. FEBS Lett. 1980; 109: 55-58.
• Reisine T, Bell GI. Molecular biology of somatostatin receptors. Endocr Rev. 1995; 16: 427-442.
• Epelbaum J. Somatostatin receptors in the central nervous system. Basic Clin Aspects Neurosci. 1992; 4: 17-28.
• Viollet C, Prevost G, Maubert E, Faivre-Bauman A, Gardette R, Kordon C i wsp. Molecular pharmacotherapy of somatostatin receptors. Fundam Clin Pharmacol. 1995; 9: 107-113.
• Patel YC, Greenwood M, Panetta R, Hukowic N, Grigorakisn S, Robertson LA i wsp. Molecular biology of somatostatin receptor subtypes. Metabolism. 1996; 45: Supl.1: 31-38.
• Reichlin S. Neuroendocrine control of pituitary function. W: Clinical Endocrinology. Red.: Besser GM, Thorner MO. Wyd. 2. London, Mosby-Wolfe, 1994, 1,3-1,16.
• Aron DC, Findling JW, Tyrrel JB. Hypothalamus and pituitary. Basic and clinical endocrinology. Red.: Greenspan FS, Strewler GJ. Wyd. 5. Stamford, Appleton and Lange; 1997: 95-156.
• Ghigo E, Arvat E, Giordano R, Broglio F. Gianotti L, Maccario M. i wsp. Biologic activities of growth hormone secretagogues in humans. Endocrine. 2001; 14: 87-93.
• MacKenzie SJ, Yarwood SJ, Peden AH, Bolger GB, Vernon RG, Houslay MD. Stimulation of P70S6 kinase via a growth hormone-controlled fosfatidiloinositol 3-kinase pathway leads to the action of a PDE4A,3T3-F442A, preadipocites. Proc Natl Acad Sci. USA; 95: 3549-3554
• Bolanowski M, Bohdanowicz-Pawlak A, Bednarek-Tupikowska G i wsp. Serum glucose and insulin in acromegaly. The effect of treatment with Parlodel LAR. J Endocrin Invest. 1996; Supl.5: 20.
• Hwa V, Youngman OH, Rosenfeld RG. The insulin-like growth factor-binding protein (IGFBP) superfamily. Endocr Rev. 1999; 20: 761-787.
• Flier JS. Insulin-like growth factors. New Engl J Med. 1997; 336: 633-639.
• Pantanetti P, Sonino N, Arnaldi G, Boscaro M. Self image and quality of life in acromegaly. Pituitary. 2002; 5: 17-19.
• Stelmachowska-Banaś M, Zdunowski P, Zgliczyński W. Abnormalities in glucose homeostasis in acromegaly. Does the prevalence of glucose intolerance depends on the level of activity of the disease and the duration of the symptoms? Endokrynol Pol. 2009; 60: 20-24.
• Kasayama S, Otsuki M, Takagi M, Saito H, Sumitani S, Kouhara H i wsp. Impaired ß-cell function in the presence of reduced insulin sensitivity determines glucose tolerance status in acromegalic patients. Clin Endocrinol (Oxf) 2000; 27: 27-31.
• Bierin H, Knapie G, Gerl H. Prevalence of diabetes in acromegaly and Cushing syndorme. Acta Medica Austriaca. 2000; 27: 27-31.
• Katznelson L. Approach to the Patient with Persistent Acromegaly after Pituitary Surgery. J Clin Endocrinol Metab. 2010; 95: 4114-4123.
• Lombardi G, Galdiero M, Auriemma RS, Pivonello R, Colao A. Acromegaly and the cardiovascular system. Neuroendocrinology. 2006; 83: 211-217.
• Attal P, Chanson P. Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab. 2010; 95: 483-495.
• Popovic V, Damjanovic S, Micic D, Nesoviv M, Djurovic M, Petakov M i wsp. Increased incidence of neoplasia in patients with pituitary adenomas. The Pituitary Study Group. Clin Endocrinol. (Oxf) 1998; 49: 441-445.
• Renehan AG, O'Connell J, O'Hallorran D, Shanahan F, Potten CS, O'Dwyer ST i wsp. Acromegaly and colorectal cancer – a comprehensive review of epidemiology, biological mechanism and clinical implications. Horm Metab Res. 2003; 35: 712-735.
• Delhougne B, Deneux C, Abs R, Chanson P, Fierens H, Laurent-Puig P i wsp. The prevalence of colonic polyps in acromegaly: a prospective colonoscopic and pathological study in 103 patients. J Clin Endocrinol Metab. 1995; 80: 3223 3226.
• Freda PU, Reyes CM, Naruzzaman AT, Sundeen RE, Bruce J. Basal and glucose-supressed GH levels less than 1 microg/L in newly-diagnosed acromegaly. Pituitary. 2003; 6: 175-180.
• Nomicos P. Bufelder M, Fahlbusch R. The outcome of surgery in 688 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol. 2005; 152: 379-387.
• Melmed S. Medical progress: Acromegaly. N Engl J Med. 2006; 355: 2558-2573.
• Besser GM, Burman P, Daly AF. Predictors and rates of treatment - resistant tumour growth in acromegaly. Eur J Endocrinol. 2005; 153: 187-193.
• Arosio M, Ronchi CL, Epaminonda P, di Lembo S, Adda G. New therapeutic options for acromegaly. Minerva Endocrinol. 2004; 29: 225-239.
• Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg. 1998; 89: 353-358.
• Freda P. Somatostatin Analogs in Acromegaly. J Clin Endocrinol Metab. 2002; 87: 3013-3018.
• Chanson P, Salenave S. Diagnosis and treatment of pituitary adenomas. Minerva Endocrinol. 2004; 29: 241-275.
• Colao A, Martino E, Cappabianca P, Cozzi R, Scanarini M, Ghigo E. (A.L.I.C.E. Study Group). First-line therapy of acromegaly: a statement of A.L.I.C.E. (Acromegaly primary medical treatment Learning and Improvement with Continuous Medical Education) Study Group. J Endocrinol. Invest. 2006; 29: 1017-1020.
• Pickett CA. Diagnosis and management of pituitary tumors: recent advances. Prim Care. 2003; 30: 765-789.
• Colao A, Auriemma R, Galdiero M, Lombordi G, Pivonello R. Effects on Initial Therapy for Five Years with Somatostatin Analogs for Acromegaly on Growth Hormone and Insulin-Like Growth Factor-I Levels, Tumor Shrinkage, and Cardiovascular Disease: A Prospective Study. J Clin Endocrinol Metab. 2009; 94: 3746-3756.
• Omego JJ, Barkan AL. Pituitary disorders. Drug treatment options. Drugs. 2000; 59: 93-106.
• Abs R, Verhelst J, Maiter D, Van Acker K, Nobels F, Coolens JL i wsp. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998; 83: 374-378.
• Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G. Valvular heart disease and the use of dopamine agonists for Parkinson disease. N Engl J Med. 2007; 356: 39-46.
• Lamberts SW, van der Lely AJ, de Herder WW, Hofland LJ. Octreotide. N Engl J Med. 1996; 334: 246-254.
• Pawlikowski M, Meleń-Mucha G. Perspectives of new potential therapeutic applications of somatostatin analogs. Neuroendocrinol Lett. 2003; 24: 21-27.
• Colao A, Ferone D, Cappabianca P, del Basso De Care ML, Marzullo P, Monticelli A i wsp. Effects of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrinol Metab. 1997; 82: 3308-3314.
• Barnard LB, Grantham WG, Lamberton P, O'Dorisio TM, Jackson IM. Treatment of resistant acromegaly with a long-acting somatostatin analogue (SMS 201-995). Ann Intern Med. 1986; 105: 856-861.
• Katznelson L. The diagnosis and treatment of acromegaly. Endocrinologist. 2003; 13: 428-434.
• Aron DC, Tyrrel JB, Wilson CB. Current concepts in diagnosis and management of pituitary tumors. West J Med. 1995; 162: 340-352.
• Lancranjan I, Atkinson AB. Results of European multicentre study with Sandostatin LAR in acromegalic patients. Sandostatin LAR Group. Pituitary. 1999; 1: 105-114.
• Calao A, Ferrone D, Marzullo P, Cappabianca P, Cirillo S, Boerlin V i wsp. Long-Term Effects of Depot Long-Acting Somatostatin Analog Octreotide on Hormone Levels and Tumour Mass in Acromegaly. J Clin Endocrinol Metab. 2001; 86: 2779-2786.
• Arosio M, Cannavò S, Epaminonda P, Ronchi C, Chiodini I, Adda G. Therapy for the syndromes of GH excess. J Endocrinol Invest. 2003; 26,suppl.10: 36-43.
• Cozzi R, Montini M, Attanasio R, Albizzi M, Lasio G, Lodrini S i wsp. Primary Treatment of Acromegaly with Octreotide LAR: A Long-Term (Up to Nine Years) Prospective Study of Its Efficacy in the Control of Disease Activity and Tumor Shrinkage. J Clin Endocrinol Metab.2006; 91: 1397 1403.
• Paisley AN, Trainer AJ. Medical treatment in acromegaly. Curr Opin Pharmacol. 2003; 3: 672-677.
• Minniti G, Jaffrain-Rea ML, Baldelli R, Ferretti E, Caracciolo B, Bultrini A i wsp. Acute effects of octreotide, cabergoline and a combination of both drugs on GH secretion in acromegalic patients. Clin Ter. 1997; 148: 601-607.
• Pisarek H, Pawlikowski M, Kunert-Radek J, Radek M. Expression of somatostatin receptor subtypes in human pituitary adenomas – immuno-histochemical studies. Endokrynol Pol. 2009; 60: 240-251.
• Colao A, Cuocolo A, Marzullo P, Nicolai E, Ferone D, Florimonte L i wsp. Effects of 1-year treatment with octreotide on cardiac performance in patients with acromegaly. J Clin Endocrinol Metab. 1999; 84: 17-23.
• Grunstein RR, Ho KK, Sulivan CE. Effect of octreotide, a somatostatin analog, on sleep apnea in patients with acromegaly. Ann Intern Med. 1994; 121: 478-483.
• Barkan AL, Lloyd RV, Chandler WF, Hatfield MK, Gebarski SS, Kelch RP i wsp. Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201-995: shrinkage of invasive pituitary macroadenomas and improved surgical remission rate. J Clin Endocrinol Metab. 1988; 67: 1040-1048.
• Bolanowski M, Bar-Andziak E, Kos-Kudła B, Krzyżanowska-Świniarska B, Lewiński A, Łomna-Bogdanov E i wsp. Konsensus Polskiego Towarzystwa Endokrynologicznego. Przygotowanie analogami somatostatyny do leczenia operacyjnego akromegalii. Endokrynol Pol. 2007; 58: 350-355.
• Scarpignato C, Pelosini R. Somatostatin analogs for cancer treatment and diagnosis: an overeview. Chemotherapy. 2001; Suppl. 2: 1-29.
• Petersenn S. Efficacy and limits of somatostatin analogs. J Endocrinol Invest. 2005; 28, Suppl. 11: 53-57.
• Bruns C, Lewis I, Briner U, Meno-Tatang G, Weckbecker G. SOM230: a novel somatostatin peptidomimetic with broad somatotropin release inhibiting factor (SRIF) receptor binding and a unique antisecretory profile. Eur J of Endocrinol 2002; 146: 707-716.
• Patel YC. Somatostatin and its receptor family. Front Neuroendocrinol. 1999; 20: 157-198.
• Kulaksiz H, Eissele R, Rössler D, Schulz S, Höllt V, Cetin Y. Identification of somatostatin receptor subtypes 1, 2A, 3 and 5 in neuroendocrine tumours with subtype specific antibodies. Gut. 2002; 50: 52-60.
• di Bartolomeo M, Bajetta E, Buzzoni R, Mariani L, Carnaghi C, Somma L. Clinical efficacy of octreotide in the treatment of metastatic neuroendocrine tumors. A study by the Italian Trials in Medical Oncology Group. Cancer. 1996; 44: 402-408.
• Schally AV, Szepeshazi K, Nagy A, Comaru-Schally AM, Halmos G. New approaches to therapy of cancers of the stomach, colon and pancreas based on peptide analogs. Cell Mol Life Sci. 2004; 61: 1042-1068.
• Kopchick JJ, Parkinson C, Stevens EC, Trainer PJ. Growth hormone receptor antagonists: discovery, development, and use in patients with acromegaly. Endocrine Reviews. 2002; 23: 623-646.
• Trainer PJ, Drake WM, Katznelson L, Freda P, Herman-Bonert V, Lely A i wsp. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000; 342: 1171-1177.
• Buhk JH, Jung S, Psychogios MN, Goricke S, Hartz S, Schulz-Heise S i wsp. Tumour volume of growth-hormone secreting pituitary adenomas during treatment with pegvisomant: a prospective multicenter study. J Clin Endocrinol Metab. 2010; 95: 552-558.
• Marazuela M, Lucas T, Alvarez-Escola C, Puig-Domingo M, Garcia de la Torre N, Miguel-Novoa P i wsp. Long-term treatment of acromegalic patients resistant to somatostatin analogs with the GH receptor antagonist pegvisomant: its efficacy in relation to gender and previous radiotherapy. Eur J Endocrinol. 2009; 160: 535-542.
• Schreiber I, Buchfelder M, Droste M, Frossmann K, Mann K, Saller B i wsp. Treatment of acromegaly with the GH receptor antagonist pegvisomant in clinical practice: safety and efficacy evaluation from German Pegvisomant Observational Study. Eur J Endocrinol. 2007; 156: 75-82.
• Barkan AL. Radiotherapy in acromegaly: the argument against. Clin Endocrinol (Oxf). 2003; 58: 132-135.
• Jagannathan J, Sheehan JP, Pouration N, Laws Jr ER, Steiner L, Vance ML. Gamma knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery. 2008; 62: 1262-1269.

• Document Type: paper