肢端肥大症

10.6666/ClinMed.2017.80.3.096

王愷君；翁錦興

肢端肥大症(acromegaly) ； 生長激素(growth hormone) ； 類胰島素生長因子-1(insulinlike growth factor 1, IGF-1)

臨床醫學月刊

80卷3期（2017 / 09 / 29）

511 - 522

繁體中文

肢端肥大症(acromegaly)多肇因於垂體體促素腺瘤(somatotroph adenoma)分泌過多生長激素(growth hormone)，使骨骼、軟組織、器官過度增生，產生特殊的型貌，並影響內分泌與新陳代謝系統。診斷的方式除了仔細檢視外觀，也應進行生化檢驗及影像學檢查。第一線治療為手術，並輔以諸如體抑素受器配位體(somatostatin receptor ligands, SRLs)、生長激素受器拮抗劑(growth hormone receptor antagonist)、多巴胺促效劑(dopamine agonist)等藥物及放射線治療，方能緩解相關症狀及減少病患的死亡率。

1. Bevan, JS(2005).Clinical review: The antitumoral effects of somatostatin analog therapy in acromegaly.J Clin Endocrinol Metab,90,1856-1863.
2. Davi', MV,Dalle Carbonare, L,Giustina, A(2008).Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease.Eur J Endocrinol,159,533-540.
3. Drange, MR,Fram, NR,Herman-Bonert, V(2000).Pituitary tumor registry: a novel clinical resource.J Clin Endocrinol Meta,85,168-174.
4. Dworakowska, D,Gueorguiev, M,Kelly, P(2010).Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines.Eur J Endocrinol,163,21-28.
5. Giustina, A,Chanson, P,Bronstein, MD(2010).A consensus on criteria for cure of acromegaly.J Clin Endocrinol Metab,95,3141-3148.
6. Giustina, A,Chanson, P,Kleinberg, D(2014).Expert consensus document: A consensus on the medical treatment of acromegaly.Nat Rev Endocrinol,10,243-248.
7. Gutt, B,Hatzack, C,Morrison, K(2001).Conventional pituitary irradiation is effective in normalising plasma IGF-I in patients with acromegaly.Eur J Endocrinol,144,109-116.
8. Higham, CE,Atkinson, AB,Aylwin, S(2012).Effective combination treatment with cabergoline and low-dose pegvisomant in active acromegaly: a prospective clinical trial.J Clin Endocrinol Metab,97,1187-1193.
9. Holdaway, IM,Bolland, MJ,Gamble, GD(2008).A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly.Eur J Endocrinol,159,89-95.
10. Holdaway, IM,Rajasoorya, C(1999).Epidemiology of acromegaly.Pituitary,2,29-41.
11. Katznelson, L,Laws, ER, Jr,Melmed, S(2014).Acromegaly: an endocrine society clinical practice guideline.Clin Endocrinol Metab,99,3933-3951.
12. Mazziotti, G,Biagioli, E,Maffezzoni, F(2015).Bone turnover, bone mineral density, and fracture risk in acromegaly: a metaanalysis.J Clin Endocrinol Metab,100,384-394.
13. Melmed, S(2006).Medical progress: Acromegaly.N Engl J Med,355,2558-2573.
14. Melmed, S(2016).New therapeutic agents for acromegaly.Nat Rev Endocrinol,12,90-98.
15. Mestron, A,Webb, SM,Astorga, R(2004).Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA).Eur J Endocrinol,151,439-446.
16. Neggers, SJ,de Herder, WW,Janssen, JA(2009).Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients.Eur J Endocrinol,160,529-533.
17. Rajasoorya, C,Holdaway, IM,Wrightson, P(1994).Determinants of clinical outcome and survival in acromegaly.Clin Endocrinol,41,95-102.
18. Ribeiro-Oliveira, A, Jr,Barkan, A(2012).The changing face of acromegaly--advances in diagnosis and treatment.Nat Rev Endocrinol,8,605-611.
19. Sandret, L,Maison, P,Chanson, P(2011).Place of cabergoline in acromegaly: a meta-analysis.J Clin Endocrinol Metab,96,1327-1335.
20. Sherlock, M,Ayuk, J,Tomlinson, JW(2010).Mortality in patients with pituitary disease.Endocr Rev,31,301-342.
21. Stoffel-Wagner, B,Springer, W,Bidlingmaier, F(1997).A comparison of different methods for diagnosing acromegaly.Clin Endocrinol,46,531-537.
22. Trainer, PJ,Drake, WM,Katznelson, L(2000).Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant.N Engl J Med,342,1171-1177.
23. van der Lely, AJ,Hutson, RK,Trainer, PJ(2001).Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist.Lancet,358,1754-1759.
24. Vitale, G,Pivonello, R,Lombardi, G(2004).Cardiac abnormalities in acromegaly. Pathophysiology and implications for management.Treat Endocrinol,3,309-318.

1. 蘇淑芬,蘇宣穎,吳孟珊(2019)。肢端肥大症之治療趨勢與護理。台灣專科護理師學刊，6(1)，34-40。