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生长激素分泌性垂体腺瘤患者接受培维索孟治疗期间的瘤体体积变化

Tumor Volume of Growth Hormone-Secreting Pituitary Adenomas during Treatment with Pegvisomant: A Prospective Multicenter Study

Buhk J-H, Jung S, Psychogios MN 2010/6/30 19:21:13

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J Clin Endocrinol Metab, 2010,

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Context:
Clinical and biochemical remission in acromegaly can frequently be achieved with the recombinant GH receptor antagonist pegvisomant, even when other treatments fail. However, increases in tumor volume have been reported.

Objective:
Because previous studies suffer from inhomogenous magnetic resonance imaging (MRI) protocols, this prospective study examined the long-term course of adenoma volume during pegvisomant therapy by standardized MRI.

Design:
Five centers in Germany participated. High-resolution MRI was performed at baseline and 6, 12, and 24 months after enrollment.

Setting/Patients:
Patients were outpatients, and pegvisomant is third-line therapy in most of the cases.

Main Outcome Measures:
The primary end point was tumor volume at 24 month follow-up, measured by a single, double-blinded rater.

Results:
Forty-five of 61 patients completed 24 months' follow-up (73.8%). Tumor volume increase greater than 25%during the study was observed in three of 61 patients (4.9%), all during the first year of enrollment. All three patients had had octreotide treatment before initiation of pegvisomant; none of them had had radiotherapy. All volumetric findings were comparable with clinical radiological interpretations. ANOVA revealed no significant change in tumor volume after 24 months (n=45).

Conclusions:
This study shows that pegvisomant therapy infrequently coincides with tumor growth during long-term treatment of acromegaly. Because all significant tumor volume increases occurred during the first year, these changes might correlate to the change of medication and thus be the result of a rebound from somatostatin-induced shrinkage.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
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冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭

病例分析 [栏目介绍]

呼吸急促伴精神状态改变——《西氏内科学》病例

摘自：《西氏内科学》，第23版

患者男性，36岁，幼年有吸入性肺损伤史，因呼吸急促和精神状态改变来我院就诊。患者睡眠和运动时，吸氧流量基值为2 L/min，每天均进行肺功能康复训练。患者居住在美国中西部，入院5天前曾离家乘船来这里看望其兄弟。入院前一天，患者呼吸急促加剧，自觉发热并注意到其慢性咳嗽稍加重，但痰液无变化。当天晚上，家人注意到患者更加急躁并有点偏执。由于症状加重，患者于次日送我院就诊。

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