Analysis On Diagnosis And Treatment In22Patients With Acromegaly

Acromegaly is a kind of endocrine disease that pituitary adenoma secretesexcess growth hormone, hidden onset and chronic progress. Long-term andexcessive secretion of growth hormone causes excessive proliferation of softtissue, bone and cartilage, the patient looks ugly and leading to increasedinternal organs, joint disease and soft sleep breath pause syndrome, etc. At thesame time, the clinical manifestations of repression surrounding tissue ofpituitary tumor, diabetes, hypertension, cardiovascular disease and respiratorydiseases will increase. These metabolic disorder and complications seriouslyaffect the patient’s quality of life, shorten the life, increase mortality. At presentthe treatment of acromegaly is not satisfactory, in-depth study about the mainclinical features, diagnosis and effective treatment methods of acromegaly hasimportant clinical value.Objective:To analyze and summarize the clinical diagnosis and comprehensivetreatment methods of acromegaly, in order to improve the treatment of thisdisease.Methods：Retrospectively analyzed the data of22cases of patients were diagnosedas acromegaly from the Nerve Tumor Surgery, First Hospital of Jilin Universityduring the period of between January2013and June2014. All patients haveclinical manifestations of acromegaly, through GH determination and pituitary MRI for comprehensive evaluation.All patients accepted transsphenoidal microsurgery for pituitary adenomaresection, comprehensive treatment of radiotherapy (gamma knife). The curestandards of acromegaly: random serum GH levels control <2.5μ g/L[OGTTvalley value of GH＜1μg/L]、IGF-1down to match the age and gender of thenormal range. Serum GH levels≤5μg/L is biology cure;5~10μg/L belongs toclinical alleviate; GH>10μg/L, the disease is still in the activity. Bycomparing the preoperative and postoperative GH values and clinicalsymptoms, the effect of the surgical treatment of acromegaly was observed.Results:In22patients of acromegaly,8patients were male,14patients were female, theoldest was59years old, the youngest was17years old, with an average age of40.7years, Follow-up of6months to2years, GH levels: before surgery, GHvalues in7cases of patients exceeded maximum measurable34.6μg/L, theaverage GH values were13.9μg/L in the rest of15cases. After surgery, GHvalues were less than5μg/L in17patients, the means was:2.6μg/L, GH levelswere between5and10μg/L in3cases of patients, GH values were>10μg/L in2cases, as11.586μg/L and12.875μg/L, respectively. In postoperation, totalclinical remission rates were90%，The remission rates in I and II grade were100%, III grade,83%，IV grade,50%. Five cases of postoperative patients weregiven gamma knife treatment, their growth hormone levels were satisfactorilycontrolled. After6months follow-up: the soft tissues swell largely disappearedpostoperatively in all patients, the rest symptoms obviously alleviated also,9cases were easing from preoperative headache in13cases, decreased vision,visual field defect were improved significantly, amenorrhea, hypogonadismsymptoms disappeared. GH levels: GH>10μg/L in1patient, the rest GH levels were normal or slightly higher than normal ceiling (follow-up failed toget the specific number), reexamination of magnetic resonance imaging (MRI)was not seen obvious abnormity.Conclusions：The GH levels can be significantly improved, and good postoperativesymptoms, slight trauma through transsphenoidal microsurgery for pituitaryadenoma resection. Surgical treatment is the preferred treatment for patientswith acromegaly, cure rate is high. Some patients with poor efficacy, usuallygiven further treatment such as drugs or radiation therapy. In some largerinvasive tumor or residual tumor and intolerance patients drug treatment,radiotherapy is an important option, clinical individualized treatment should betaken.