Treatment of acromegaly
Endocrinology / / August 12, 2017
Most eosinophilic cell pituitary adenomas are highly sensitive to radiation therapy.Radiotherapy acromegaly spend more - "tumoroznymi» (5000-6000 p per treatment) doses of the same procedure as the treatment of hormonally inactive pituitary tumors.In the absence of signs of remission, treatment should be repeated after one year.What matters is not only the total dose of X-rays, but the intensity of the therapy.With the success of applied intensive radiotherapy - 600 p three fields daily for 5 days.Courses of treatment repeated 2 or 3 times at intervals of 2 months.
Improvement with radiotherapy occurs within the next few weeks and months after treatment.It improves the general condition of patients, usually reduced or terminated headaches.Often it is restored menstrual cycle, and in the case of diabetes is marked more favorable for him.Expanding the field of view.Although the return of the bone changes occur, and only stops their progression, due to the decrease pastosity and soft tissue hypertroph
question of repeated X-ray after the main course of treatment is decided depending on the appearance of signs of revitalization process.
Recently, more and more are being applied other types of radiation therapy - radioactive cobalt kilocuritherapy or implantation of radioactive gold into the tumor, or yttrium.The advantage of the latter is that it emits beta-rays are harmless to the nervous tissue.
Because eosinophilic cell adenomas typically X rays, the indications for surgical treatment agromegalii are rare.Among the 246 patients, 17 patients required surgery - 7%.The indication for surgical removal of the adenoma is the presence of a sharp narrowing of the visual field, making risky radiotherapy, and no remission after properly conducted radiation treatment.Given the possibility of overt or covert adrenal insufficiency in patients with acromegaly with a large pituitary tumor, it is recommended during surgery and postoperatively administered to patients glucocorticoid as in operations of patients with chronic adrenal insufficiency.When applied to patients with acromegaly cortisone dose of more than 100 mg per day, there is a risk of edema and increased intracranial pressure;therefore, steroid therapy should be used with caution, and to avoid the introduction of large amounts of salt.
mortality in surgical treatment is 5-10%.Sometimes there are recurrences.As an auxiliary method of hormone therapy is used by some authors estrogen treatment of female patients in large doses - stilbestrol 25-50 mg per day, or in moderate doses - 5.1 mg of estradiol per day.It is noted decrease in headaches, improve overall health.
estrogen therapy does not replace or radiation therapy - in the presence of appropriate indications - surgery - and can be used as an auxiliary method of treatment specifically shown in the cases where in the absence of other signs of acromegaly activity Reserved severe headaches.
In the case of acromegaly complications of diabetes being treated by diet, peroralnymiantidiabeticheskimi agents or insulin, as in the treatment of diabetes, not combined with acromegaly.With the development in patients with acromegaly toxic goiter, they should be treated with antithyroid drugs and other methods, such as patients with toxic goiter without acromegaly.
If you have adrenal insufficiency, revealed, for example, a breakdown of SU-4885, steroid therapy should be administered for acute infection, trauma and other stress situations.
- pituitary dwarfism
- Diagnosis and differential diagnosis
- clinical picture of acromegaly
- Morgagni syndrome - Stewart - Morel (MORGAGNI - MOREL - STEWART)
- tumors of the anterior lobe pituitary
presence of intracranial tumor patients with limited ability to work even in the absence of signs of activity, in particular, makes it necessary to release from work-related physical strain.More significantly limit the ability to work with the pathological changes of the organ of vision and other symptoms associated with pituitary tumors pressure on the surrounding tissue, articular lesions, diabetes.The presence of these complications can lead to permanent disability.