肢端肥大症诊断和药物治疗进展——2021年《垂体协会肢端肥大症诊治指南更新》解读

doi:10.12114/j.issn.1007-9572.2021.02.016

摘要/Abstract

摘要： 肢端肥大症是以生长激素（GH）分泌异常增多为特征的内分泌疾病，而过度分泌的GH和胰岛素样生长因子1（IGF-1）可对全身多个器官和系统产生广泛影响。肢端肥大症常起病隐匿、进展缓慢、临床症状复杂多样，其诊断和治疗有待进一步规范。2021年2月Pituitary发表了《垂体协会肢端肥大症诊治指南更新》，本文立足于最新的循证医学证据，对该指南提及的包括肢端肥大症的临床表现、流行病学情况、手术治疗的影响因素、患者的生活质量、药物治疗进展与更新、放射治疗为主的几个方面进行了解读，并着重介绍了美国食品药品监督管理局（FDA）批准的新型疗法的优势与局限性，以期能够提高广大全科医生及专科医师对于肢端肥大症的理解，更好地指导规范化诊疗，改善肢端肥大症患者预后。

关键词: 垂体肿瘤；肢端肥大症；指南；生长激素；胰岛素样生长因子Ⅰ；受体, 生长抑素；奥曲肽；培维索孟

Abstract: Acromegaly is a pituitary neuroendocrine disease characterized by abnormally increased secretion of growth hormone. Oversecreted growth hormone and insulin-like growth factor-1 may greatly influence various organs and systems of the whole body. Acromegaly often has hidden onset，slow progress and complicated clinical symptoms，so its diagnosis and treatment need to be further standardized. In February 2021，the Pituitary released the A Pituitary Society Update to Acromegaly Management Guidelines. Based on the latest evidence-based acromegaly management，this paper interprets the essentials of several aspects mentioned in the guidelines，including clinical manifestations，epidemiological conditions，influencing factors of surgical treatment，patients' quality of life，progress and update of drug treatment，and radiotherapy，with special highlights on the advantages and limitations of the new therapy approved by FDA. All is for improving general practitioners and specialists' understanding of acromegaly，and guiding the standardized diagnosis and treatment of acromegaly to improve patient prognosis.

Key words: Pituitary neoplasms；Acromegaly；Guidebook；Growth hormone；Insulin-like growth factor I；Receptors, somatostatin；Octreotide；Pegvisomant

谭惠文,覃萌,余叶蓉,等. 肢端肥大症诊断和药物治疗进展——2021年《垂体协会肢端肥大症诊治指南更新》解读[J]. 中国全科医学, 2021, 24(27): 3397-3403. DOI: 10.12114/j.issn.1007-9572.2021.02.016.
TAN Huiwen,QIN Meng,YU Yerong, et al. Recent Advances in Diagnosis and Medical Therapy for Acromegaly： Interpretation of A Pituitary Society Update to Acromegaly Management Guidelines in 2021　[J]. Chinese General Practice, 2021, 24(27): 3397-3403. DOI: 10.12114/j.issn.1007-9572.2021.02.016.

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