Acromegaly and comorbid conditions. New possibilities of diagnosis and treatment (literature review)

Abstract

Based on the data published in Russian and foreign reference sources, an analysis of clinical-hormonal peculiarities, modern methods of treatment of acromegaly combined with polyendocrinopathies (diabetes mellitus, diffuse and nodular goiter, hypocorticoidism) and cardiovascular diseases was conducted. According to different authors, a decline in the quality and duration of life of patients is associated with significant changes in the endocrine system caused by contrainsular and stimulating effect of somatotropic hormone (STH) and insulin-like growth factor 1 (IGF-1) on organs and tissues. Secondary diabetes mellitus was identified in 16-46% of patients, nodular goiter in 30-70%, secondary adrenal insufficiency in 11-20% of patients. The most common cause of acromegaly is an active pituitary tumor – somatotropinoma, rarely STH is overproduced by neuroendocrine cells, located endo- and extracranially. Recent achievements in neuroendocrinology provided significant improvement of management of patients. The aim of treatment for acromegaly is to achieve clinical and biochemical remission of the disease. At present three basic methods of treatment for acromegaly are used: surgical (endonasal transsphenoidal adenomectomy), drug therapy, radiation therapy and stereotactic radiosurgery (cyber knife). Differential and combined use of modern medical drugs in the form of monotherapy and in a combination with surgical and radiation treatment permits to achieve both clinical and hormonal remission of acromegaly improving in this way the quality and duration of life of patients. In the given review of literature modern concepts of etiology, pathogenesis, clinical peculiarities, modern methods of diagnosis and treatment of this disease are presented.