肢端肥大症的综合治疗（附43例临床分析）
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摘要
目的分析总结肢端肥大症的诊断和治疗特点,提高肢端肥大症的治疗效果。
方法回顾分析2003年8月到2006年2月收治的43例肢端肥大症,采取以经口鼻蝶手术治疗为中心的综合治疗。
结果本组病例男23例,女20例,平均年龄36.7岁,随访时间为3月~2.5年。肢端肥大症的治愈标准,随机血GH<2.5μg/L (或口腹糖耐量试验可抑制<1.0μg/L)和与年龄一致的IGF-1水平。手术前GH值平均33.5μg/L,术后33例降至正常,仍有10例>10μg/L,3例辅以药物治疗,7例给予伽玛刀治疗,GH逐渐下降并得以控制。并有糖尿病者10例血糖恢复正常;5例并有肢端肥大性心肌病术后心脏全部恢复正常,全组无死亡率。
结论经口鼻蝶手术治疗仍是首选的治疗方法,随着药物和放射治疗的进步能使肢端肥大症得到更好的控制。单一疗法常难取得满意疗效,我们提倡以手术治疗为主的综合治疗。
Objective To study the diagnostic and therapeutiic features of acromegaly and improve the effect of acromegaly treatment.
Method 43 cases of acromegaly from August 2003 to February 2006 were analyzed retrospectively, who received treatment consists of surgery, medical treatment and radiotherapy. The follow-up time was 3-30 months.
Results The cohort consisted of 43 patients(23 men, 20 women, average age 36.7years.)who had been followed for 0.3–2.5 years (mean 2 years). Remission criteria were a normalized IGF-I concentration, a nadir GH level during oral glucose load of<1.0μg/L, and a random GH value of <2.5μg/L. Average serum GH was 33.5μg/L, after transsphenoidal surgery, the average serum GH decreased to normal ,but 10 of which GH>10μg/L, 3 had assisted of medical and 7 assisted of radiotherapy, then GH was to be controlled. The concentration of blood glucose returned to normal in 10 patients accompanied by diabetes. The cardiac function came to normal in all 5 cases with acromegalic cardiomy opathy after operation. There was no death in this series.
Conclusion Transsphenoidal surgery remains the first-line reference treatment, Advances in pharmacological treatment (i.e. use of pegvisomant and selective somatostatin receptor agonists) and radiotherapy (radiosurgery) may result in further improvement of disease control. Results of a single therapy were with less satisfaction, We advocate integrated therapy around operation.
方法回顾分析2003年8月到2006年2月收治的43例肢端肥大症,采取以经口鼻蝶手术治疗为中心的综合治疗。
结果本组病例男23例,女20例,平均年龄36.7岁,随访时间为3月~2.5年。肢端肥大症的治愈标准,随机血GH<2.5μg/L (或口腹糖耐量试验可抑制<1.0μg/L)和与年龄一致的IGF-1水平。手术前GH值平均33.5μg/L,术后33例降至正常,仍有10例>10μg/L,3例辅以药物治疗,7例给予伽玛刀治疗,GH逐渐下降并得以控制。并有糖尿病者10例血糖恢复正常;5例并有肢端肥大性心肌病术后心脏全部恢复正常,全组无死亡率。
结论经口鼻蝶手术治疗仍是首选的治疗方法,随着药物和放射治疗的进步能使肢端肥大症得到更好的控制。单一疗法常难取得满意疗效,我们提倡以手术治疗为主的综合治疗。
Objective To study the diagnostic and therapeutiic features of acromegaly and improve the effect of acromegaly treatment.
Method 43 cases of acromegaly from August 2003 to February 2006 were analyzed retrospectively, who received treatment consists of surgery, medical treatment and radiotherapy. The follow-up time was 3-30 months.
Results The cohort consisted of 43 patients(23 men, 20 women, average age 36.7years.)who had been followed for 0.3–2.5 years (mean 2 years). Remission criteria were a normalized IGF-I concentration, a nadir GH level during oral glucose load of<1.0μg/L, and a random GH value of <2.5μg/L. Average serum GH was 33.5μg/L, after transsphenoidal surgery, the average serum GH decreased to normal ,but 10 of which GH>10μg/L, 3 had assisted of medical and 7 assisted of radiotherapy, then GH was to be controlled. The concentration of blood glucose returned to normal in 10 patients accompanied by diabetes. The cardiac function came to normal in all 5 cases with acromegalic cardiomy opathy after operation. There was no death in this series.
Conclusion Transsphenoidal surgery remains the first-line reference treatment, Advances in pharmacological treatment (i.e. use of pegvisomant and selective somatostatin receptor agonists) and radiotherapy (radiosurgery) may result in further improvement of disease control. Results of a single therapy were with less satisfaction, We advocate integrated therapy around operation.
引文
1 Orme SM, McNally RJ, Cartwright RA, et al. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab.1998, 83(8):2730-2734
2 Buchfelder M, Fahlbusch R, Merz T, et al. Clinical correlates in acromegalic patients with pituitary tumors expressing GSP oncogenes. Pituitary. 1999, 1(3-4):181-185
3 Lei T, Adams EF, Buchfelder M, et al. Relationship between protein kinase C and adenylyl cyclase activity in the regulation of growth hormone secretion by human pituitary somatotrophinomas. Neurosurgery. 1996, 39(3):569-575
4 雷霆, 薛德麟, Adama EF 等. PKC 在人垂体肿瘤增生中的作用研究. 同济医科大学学报, 1998, 27:39-41
5 雷霆, 张华楸, 舒凯等. 垂体生长激素腺瘤的诊断与治疗. 中国现代神经疾病杂志, 2005, 5(1):26-33
6 Muller AF, Van Der Lely AJ. Pharmacological therapy for acromegaly: a critical review. Drugs. 2004, 64(16):1817-1838
7 Abs R, Verhelst J, Maiter D,et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998, 83(2):374-378
8 Hofland LJ, Lamberts SW. The pathophysiological consequences of somatostatin receptor internalization and resistance. Endocr Rev. 2003, 24(1):28-47
9 Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001, 30(3):565-583
10 Kreutzer J, Vance ML, Lopes MB,et al. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab.2001, 86(9):4072-4077
11 Peacey SR, Shalet SM. Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly. Ann Clin Biochem. 2001, 38(Pt 4):297-303
12 Newman CB. Medical therapy for acromegaly. Endocrinol Metab Clin North Am. 1999, 28(1):171-190
13 Davies PH, Stewart SE, Lancranjan L, et al. Long-term therapy with long-acting octreotide (Sandostatin-LAR) for the management of acromegaly. Clin Endocrinol (Oxf). 1998, 48(3):311-316
14 Attanasio R, Barausse M, Cozzi R. GH/IGF-I normalization and tumor shrinkage during long-term treatment of acromegaly by lanreotide. J Endocrinol Invest. 2001, 24(4):209-16
15 Colao A, Marzullo P, Lombardi G. Effect of a six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. Eur J Endocrinol. 2002, 146(3):303-309
16 Trainer PJ, Drake WM, Katznelson L,et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000, 20;342(16):1171-1177
17 van der Lely AJ, Hutson RK, Trainer PJ, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet. 2001, 24;358(9295):1754-1759
18 Freda PU. How effective are current therapies for acromegaly? Growth Horm IGF Res. 2003, 13 Suppl A:S144-151
19 Abe T, Ludecke DK. Transnasal surgery for prolactin-secreting pituitary adenomas in childhood and adolescence. Surg Neurol. 2002, 57(6):369-378
20 Derome PJ, Visot A. Surgery of pituitary adenoma. Rev Prat. 1996, 15;46(12):1515-1519
21 Jho HD, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg. 2001, 44(1):1-12
22 Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol. 2005, 152(3):379-387
23 De P, Rees DA, Davies N, et al. Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab. 2003, 88(8):3567-3572
24 Saito K, Kuwayama A, Yamamoto N, et al. The transsphenoidal removal of nonfunctioning pituitary adenomas with suprasellar extensions: the open sella method and intentionally staged operation. Neurosurgery. 1995, 36(4):668-75; discussion 675-676
25 Barker FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab. 2003, 88(10):4709-4719
26 Shiley SG, Limonadi F, Delashaw JB,et al. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope. 2003, 113(8):1283-1288
27 Izawa M, Hayashi M, Nakaya K, et al. Gamma knife radiosurgery for pituitary adenomas. J Neurosurg. 2000, 93 Suppl 3:19-22
28 Zhang N, Pan L, Wang EM, et al. Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg. 2000, 93 Suppl 3:6-9
29 Castinetti F, Taieb D, Kuhn JM,et al. Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab. 2005, 90(8):4483-4488
30 Gutt B, Wowra B, Alexandrov R, et al. Gamma-knife surgery is effective in normalising plasma insulin-like growth factor I in patients with acromegaly. Exp Clin Endocrinol Diabetes. 2005, 113(4):219-224
31 Essais O, Bouguerra R, Hamzaoui J,et al. Efficacy and safety of bromocriptine in the treatment of macroprolactinomas. Ann Endocrinol (Paris). 2002, 63(6 Pt 1):524-531
32 Martins AN, Hayes GJ, Kempe LG.. Invasive pituitary adenoma. J Neurosurg 1965, 22:268-276
33 Thapar K, Kovacs K, Scheithauer BW,et al. Proliferative activity and invasiveness among pituitary adenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery. 1996, 38(1):99-106
34朱芳, 周义成, 王承缘等. 侵袭性垂体瘤的MRI 和病理研究. 临床放射学杂志, 2001, 20(9):653-656 24
1 Orme SM, McNally RJ, Cartwright RA, et al. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab.1998, 83(8):2730-2734
2 Buchfelder M, Fahlbusch R, Merz T, et al. Clinical correlates in acromegalic patients with pituitary tumors expressing GSP oncogenes. Pituitary. 1999, 1(3-4):181-185
3 Lei T, Adams EF, Buchfelder M, et al. Relationship between protein kinase C and adenylyl cyclase activity in the regulation of growth hormone secretion by human pituitary somatotrophinomas. Neurosurgery. 1996, 39(3):569-575
4 雷霆, 薛德麟, Adama EF 等. PKC 在人垂体肿瘤增生中的作用研究. 同济医科大学学报, 1998, 27:39-41
5 Freda PU. How effective are current therapies for acromegaly? Growth Horm IGF Res. 2003, 13 Suppl A:S144-151
6 Abe T, Ludecke DK. Transnasal surgery for prolactin-secreting pituitary adenomas in childhood and adolescence. Surg Neurol. 2002, 57(6):369-378
7 Derome PJ, Visot A. Surgery of pituitary adenoma. Rev Prat. 1996, 15;46(12):1515-1519
8 Jho HD, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg. 2001, 44(1):1-12
9 Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol. 2005, 152(3):379-387
10 De P, Rees DA, Davies N, et al. Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab. 2003, 88(8):3567-3572
11 Muller AF, Van Der Lely AJ. Pharmacological therapy for acromegaly: a criticalreview. Drugs. 2004, 64(16):1817-1838
12 Abs R, Verhelst J, Maiter D,et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998, 83(2):374-378
13 Hofland LJ, Lamberts SW. The pathophysiological consequences of somatostatin receptor internalization and resistance. Endocr Rev. 2003, 24(1):28-47
14 Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001, 30(3):565-583
15 Kreutzer J, Vance ML, Lopes MB,et al. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab.2001, 86(9):4072-4077
16 Peacey SR, Shalet SM. Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly. Ann Clin Biochem. 2001, 38(Pt 4):297-303
17 Newman CB. Medical therapy for acromegaly. Endocrinol Metab Clin North Am. 1999, 28(1):171-190
18 Davies PH, Stewart SE, Lancranjan L, et al. Long-term therapy with long-acting octreotide (Sandostatin-LAR) for the management of acromegaly. Clin Endocrinol (Oxf). 1998, 48(3):311-316
19 Attanasio R, Barausse M, Cozzi R. GH/IGF-I normalization and tumor shrinkage during long-term treatment of acromegaly by lanreotide. J Endocrinol Invest. 2001, 24(4):209-16
20 Colao A, Marzullo P, Lombardi G. Effect of a six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. Eur J Endocrinol. 2002, 146(3):303-309
21 Trainer PJ, Drake WM, Katznelson L,et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000, 20;342(16):1171-1177
22 van der Lely AJ, Hutson RK, Trainer PJ, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet. 2001, 24;358(9295):1754-1759
23 Castinetti F, Taieb D, Kuhn JM, et al. Outcome of gamma knife radiosurgery in 82patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab. 2005, 90(8):4483-4488
24 Gutt B, Wowra B, Alexandrov R, et al. Gamma-knife surgery is effective in normalising plasma insulin-like growth factor I in patients with acromegaly. Exp Clin Endocrinol Diabetes. 2005, 113(4):219-224
2 Buchfelder M, Fahlbusch R, Merz T, et al. Clinical correlates in acromegalic patients with pituitary tumors expressing GSP oncogenes. Pituitary. 1999, 1(3-4):181-185
3 Lei T, Adams EF, Buchfelder M, et al. Relationship between protein kinase C and adenylyl cyclase activity in the regulation of growth hormone secretion by human pituitary somatotrophinomas. Neurosurgery. 1996, 39(3):569-575
4 雷霆, 薛德麟, Adama EF 等. PKC 在人垂体肿瘤增生中的作用研究. 同济医科大学学报, 1998, 27:39-41
5 雷霆, 张华楸, 舒凯等. 垂体生长激素腺瘤的诊断与治疗. 中国现代神经疾病杂志, 2005, 5(1):26-33
6 Muller AF, Van Der Lely AJ. Pharmacological therapy for acromegaly: a critical review. Drugs. 2004, 64(16):1817-1838
7 Abs R, Verhelst J, Maiter D,et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998, 83(2):374-378
8 Hofland LJ, Lamberts SW. The pathophysiological consequences of somatostatin receptor internalization and resistance. Endocr Rev. 2003, 24(1):28-47
9 Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001, 30(3):565-583
10 Kreutzer J, Vance ML, Lopes MB,et al. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab.2001, 86(9):4072-4077
11 Peacey SR, Shalet SM. Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly. Ann Clin Biochem. 2001, 38(Pt 4):297-303
12 Newman CB. Medical therapy for acromegaly. Endocrinol Metab Clin North Am. 1999, 28(1):171-190
13 Davies PH, Stewart SE, Lancranjan L, et al. Long-term therapy with long-acting octreotide (Sandostatin-LAR) for the management of acromegaly. Clin Endocrinol (Oxf). 1998, 48(3):311-316
14 Attanasio R, Barausse M, Cozzi R. GH/IGF-I normalization and tumor shrinkage during long-term treatment of acromegaly by lanreotide. J Endocrinol Invest. 2001, 24(4):209-16
15 Colao A, Marzullo P, Lombardi G. Effect of a six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. Eur J Endocrinol. 2002, 146(3):303-309
16 Trainer PJ, Drake WM, Katznelson L,et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000, 20;342(16):1171-1177
17 van der Lely AJ, Hutson RK, Trainer PJ, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet. 2001, 24;358(9295):1754-1759
18 Freda PU. How effective are current therapies for acromegaly? Growth Horm IGF Res. 2003, 13 Suppl A:S144-151
19 Abe T, Ludecke DK. Transnasal surgery for prolactin-secreting pituitary adenomas in childhood and adolescence. Surg Neurol. 2002, 57(6):369-378
20 Derome PJ, Visot A. Surgery of pituitary adenoma. Rev Prat. 1996, 15;46(12):1515-1519
21 Jho HD, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg. 2001, 44(1):1-12
22 Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol. 2005, 152(3):379-387
23 De P, Rees DA, Davies N, et al. Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab. 2003, 88(8):3567-3572
24 Saito K, Kuwayama A, Yamamoto N, et al. The transsphenoidal removal of nonfunctioning pituitary adenomas with suprasellar extensions: the open sella method and intentionally staged operation. Neurosurgery. 1995, 36(4):668-75; discussion 675-676
25 Barker FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab. 2003, 88(10):4709-4719
26 Shiley SG, Limonadi F, Delashaw JB,et al. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope. 2003, 113(8):1283-1288
27 Izawa M, Hayashi M, Nakaya K, et al. Gamma knife radiosurgery for pituitary adenomas. J Neurosurg. 2000, 93 Suppl 3:19-22
28 Zhang N, Pan L, Wang EM, et al. Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg. 2000, 93 Suppl 3:6-9
29 Castinetti F, Taieb D, Kuhn JM,et al. Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab. 2005, 90(8):4483-4488
30 Gutt B, Wowra B, Alexandrov R, et al. Gamma-knife surgery is effective in normalising plasma insulin-like growth factor I in patients with acromegaly. Exp Clin Endocrinol Diabetes. 2005, 113(4):219-224
31 Essais O, Bouguerra R, Hamzaoui J,et al. Efficacy and safety of bromocriptine in the treatment of macroprolactinomas. Ann Endocrinol (Paris). 2002, 63(6 Pt 1):524-531
32 Martins AN, Hayes GJ, Kempe LG.. Invasive pituitary adenoma. J Neurosurg 1965, 22:268-276
33 Thapar K, Kovacs K, Scheithauer BW,et al. Proliferative activity and invasiveness among pituitary adenomas and carcinomas: an analysis using the MIB-1 antibody. Neurosurgery. 1996, 38(1):99-106
34朱芳, 周义成, 王承缘等. 侵袭性垂体瘤的MRI 和病理研究. 临床放射学杂志, 2001, 20(9):653-656 24
1 Orme SM, McNally RJ, Cartwright RA, et al. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab.1998, 83(8):2730-2734
2 Buchfelder M, Fahlbusch R, Merz T, et al. Clinical correlates in acromegalic patients with pituitary tumors expressing GSP oncogenes. Pituitary. 1999, 1(3-4):181-185
3 Lei T, Adams EF, Buchfelder M, et al. Relationship between protein kinase C and adenylyl cyclase activity in the regulation of growth hormone secretion by human pituitary somatotrophinomas. Neurosurgery. 1996, 39(3):569-575
4 雷霆, 薛德麟, Adama EF 等. PKC 在人垂体肿瘤增生中的作用研究. 同济医科大学学报, 1998, 27:39-41
5 Freda PU. How effective are current therapies for acromegaly? Growth Horm IGF Res. 2003, 13 Suppl A:S144-151
6 Abe T, Ludecke DK. Transnasal surgery for prolactin-secreting pituitary adenomas in childhood and adolescence. Surg Neurol. 2002, 57(6):369-378
7 Derome PJ, Visot A. Surgery of pituitary adenoma. Rev Prat. 1996, 15;46(12):1515-1519
8 Jho HD, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg. 2001, 44(1):1-12
9 Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol. 2005, 152(3):379-387
10 De P, Rees DA, Davies N, et al. Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab. 2003, 88(8):3567-3572
11 Muller AF, Van Der Lely AJ. Pharmacological therapy for acromegaly: a criticalreview. Drugs. 2004, 64(16):1817-1838
12 Abs R, Verhelst J, Maiter D,et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab. 1998, 83(2):374-378
13 Hofland LJ, Lamberts SW. The pathophysiological consequences of somatostatin receptor internalization and resistance. Endocr Rev. 2003, 24(1):28-47
14 Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am. 2001, 30(3):565-583
15 Kreutzer J, Vance ML, Lopes MB,et al. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab.2001, 86(9):4072-4077
16 Peacey SR, Shalet SM. Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly. Ann Clin Biochem. 2001, 38(Pt 4):297-303
17 Newman CB. Medical therapy for acromegaly. Endocrinol Metab Clin North Am. 1999, 28(1):171-190
18 Davies PH, Stewart SE, Lancranjan L, et al. Long-term therapy with long-acting octreotide (Sandostatin-LAR) for the management of acromegaly. Clin Endocrinol (Oxf). 1998, 48(3):311-316
19 Attanasio R, Barausse M, Cozzi R. GH/IGF-I normalization and tumor shrinkage during long-term treatment of acromegaly by lanreotide. J Endocrinol Invest. 2001, 24(4):209-16
20 Colao A, Marzullo P, Lombardi G. Effect of a six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. Eur J Endocrinol. 2002, 146(3):303-309
21 Trainer PJ, Drake WM, Katznelson L,et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000, 20;342(16):1171-1177
22 van der Lely AJ, Hutson RK, Trainer PJ, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet. 2001, 24;358(9295):1754-1759
23 Castinetti F, Taieb D, Kuhn JM, et al. Outcome of gamma knife radiosurgery in 82patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab. 2005, 90(8):4483-4488
24 Gutt B, Wowra B, Alexandrov R, et al. Gamma-knife surgery is effective in normalising plasma insulin-like growth factor I in patients with acromegaly. Exp Clin Endocrinol Diabetes. 2005, 113(4):219-224