Retrospektivna analiza uspješnosti liječenja akromegalije u KBC-u Zagreb

master's thesis

• Title (english): Retrospective analysis of therapeutic outcomes in patients with acromegaly in UHC Zagreb
• Author: Tina Božiković
• Mentor: Tina Dušek (mentor)
• Committee member: Darko Kaštelan (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Tina Dušek (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Akromegalija nastaje kao posljedica prevelikog lučenja hormona rasta nakon zatvaranja epifiznih pukotina u kostima. Najčešći uzrok tom stanju je adenom hipofize koji luči hormon rasta, a uglavnom zahvaća ljude srednjih godina. S obzirom na veličinu adenomi se dijele na mikroadenome (<10mm) i makroadenome (>10mm). Prema invazivnosti se dijele na neinvazivne i invazivne, koji invadiraju kavernozni sinus. Simptomi akromegalije su posljedica djelovanja hormona rasta na tkiva, ali i kompresije okolnih struktura tumorom. Akromegalija se najčešće prezentira povećanjem šaka, stopala, usnica, makroglosijom, te protruzijom mandibule. Prva terapijska linija je transsfenoidalna operacija somatotropinoma, a u slučaju neuspjeha liječi se radioterapijom i medikametnom terapijom. Cilj ovog rada je bilo prikazati uspješnost liječenja akromegalije korištenjem operativnog liječenja kao prve terapijske linije. Kriteriji remisije akromegalije su bili normalizacija lučenja IGF-I za dob i supresija GH<1 μg/L u oGT testu. U periodu od 2011. do 2017. akromegalija je dijagnosticirana kod 31 pacijenta i svi su uključeni u studiju. Transsfenoidalna operacija je bila metoda izbora kod 96,8% pacijenata. Remisija je postignuta u 61,3% pacijenata. Remisija je bila značajno viša kod osoba koje su imale mikroadenom (83,3%) u odnosu na osobe sa makroadenomom (56%). Pacijenti sa invazivnim tumorom su imali još nižu stopu remisije (52,9%). U slučaju neuspjeha korištene su druge metode liječenja koje uključuju radioterapiju, analoge somatostatina i agoniste dopamina. Na zadnjoj kontroli 90,3% pacijenata je u remisiji. Transsfenoidalna operacija se pokazala adekvatnom prvom linijom terapije kod osoba sa somatotropinomima, a ostale metode liječenja se mogu primjenjivati u slučaju neuspjeha postizanja remisije operativnim liječenjem.

Abstract (english)

Acromegaly is the result of excessive secretion of growth hormone after the epiphyseal plates have closed. The most common cause of this condition is the pituitary adenoma that excites growth hormone, and it mainly affects middle-aged people. Given the size of the adenomas, they are divided into microadenoma (<10mm) and macroadenoma (> 10mm). According to invasion, they are divided into noninvasive and invasive invading the cavernous sinus. Symptoms are a consequence of the growth hormone activity on the tissues, but also the compression of surrounding structures by tumor. Acromegaly is most often presented by increasing hands, feet, lips, macroglossia, and protrusion of the lower jaw. The first therapeutic line is a transsphenoidal surgery and, in the case of failure, it is treated by radiotherapy and medical therapy.
The aim of this paper was to demonstrate the success of acromegaly treatment using surgical treatment as the first therapeutic line. The remission criteria included normal age-related IGF-I levels and suppression of GH <1 μg /L after oGTT. Since 2011. until 2017. 31 patient was diagnosed with acromegaly and all were included in the study. Transsphenoidal surgery was the method of choice in 96.8% of patients. Remission was achieved in 61.3% of patients. The remission was significantly higher in the subjects who had microadenoma (83.3%) than those with macroadenoma (56%). Patients with invasive tumor had even lower remission rate (52.9%). In the event of failure, other methods of treatment were used including radiotherapy, somatostatin analogs and dopamine agonists. At the last check, 90.3% of patients are in remission.Transsphenoidal surgery has proved to be an adequate first line therapy for persons with somatotropinoma and the other treatment methods can be used in the event of failure to achieving the remission through operational treatment.

• Keywords: akromegalija; transsfenoidalna operacija; rezultati liječenja
• Keywords (english): acromegaly; transsphenoidal surgery; therapeutic outcomes
• Language: croatian
• URN:NBN: urn:nbn:hr:105:821019
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-08 13:38:48