- 期刊
Primary Therapy of Acromegaly with Octreotide LAR-A Case Report
以長效體抑制素作用類似物為第一線藥物治療肢端肥大症：病例報告
摘要
對於因腦下垂體的生長激素分泌腺瘤所致的肢端肥大症，傳統上都是先作手術，必要時再用放射線或藥物，如體抑制素治療。有時還需補充賀爾蒙，例如甲狀腺素、類固醇和性賀爾蒙。近年來有一些報告顯示可用長效體抑制素作用類似物做為第一線治療方式。我們報告一例五十二歲的女性病患，以長效體抑制素作用類似物，octreotide LAR做為第一線藥物，治療因腦下垂體的生長激素分泌腺瘤所致的肢端肥大症。以每月20-30毫克的octreotide LAR治療共十二個月。經治療後，病人的血中生長激素及第一型類胰島素生長因子濃度顯著下降，因肢端肥大症引起的症狀也明顯改善，而核磁共振影像追蹤顯示腫瘤逐漸縮小而看不見。病人在治療過程中，副作用少且耐受度佳。傳統上，手術摘除腫瘤被視為生長激素分泌腺瘤的首選治療方式，然而近年來有越來越多的報告提出以長效體抑制素作用類似物治療肢端肥大症也可以降低血清中的生長激素及第一型類胰島素生長因子濃度並改善肢端肥大症所引起的症狀。在某些特定的生長激素分泌腺瘤所致的肢端肥大症病人，可以考慮以長效體抑制素作用類似物作為第一線治療。
關鍵字
無資料並列摘要
Traditionally, the first line treatment for acromegaly caused by growth hormone (GH) secreting pituitary adenoma is transsphenoidal surgery. However, adjuvant radiotherapy or medical therapy has been applied when necessary, and complications of hypopituitarism may occur occasionally, requiring life-long hormone replacement therapy. In recent years, there is an increasing number of studies demonstrating that medical therapy with somatostatin analogues can be employed as the primary therapy in acromegalic patients with a successful outcome. We report a patient with GH secreting pituitary adenoma causing acromegaly treated primarily with somatostatin analogues, octreotide LAR. A 52-year-old woman had progressive enlarged and swollen hands and feet with joint pain and paresthesia for 2 years. Elevated GH and insulin-like growth factor-I (IGF-I) levels were noted. The magnetic resonance image (MRI) revealed a pituitary microadenoma. She was treated primarily with octreotide LAR 20-30 mg/month for one year. The symptoms of acromegaly ameliorated, her serum GH and IGF-I declined significantly and the post-treatment MRI showed disappearance of the adenoma after octreotide LAR therapy. Adverse effects were minimal and tolerable during the treatment period. While neurosurgery remains the treatment of choice for acromegaly, the use of octreotide EAR as primary therapy in acromegaly showed to be clinically and biochemically effective in selected patients.