Page 40 - GALENIKA MEDICAL JOURNAL

Kod preko 50% pacijenata sa akromegalijom, potrebno osnovu kojih se primenjuje odgovarajuća terapija individu-
je sprovesti kombinaciju svih modaliteta lečenja akromega- alno za svakog pacijenta . Adekvatna multimodalna terapi-
49
lije. Prema svakom pacijentu je potreban individualan pri- ja akromegalije omogućava remisiju bolesti kod skoro svih
stup u odabiru terapije . Personalizovani tretman u akro- pacijenata.
48
megaliji se zasniva na poznavanju prognostičkih faktora, na

Zaključak

U poslednje dve decenije značajno se podigla svest o prepoznavanju kliničkih znakova akromegalije,
ranijeg postavljanja dijagnoze, komorbiditeta i pravovremenog lečenja. Novi medikamenti koji
su u širokoj kliničkoj upotrebi u svetu i kod nas, ostavljaju malo prostora da akromegalija bude
perzistentna bolest. Osim somatostatinskih analoga prve generacije (oktreotid, lanreotid), primena
pasireotida i pegvisomanta je dala ogroman doprinos u lečenju obolelih. To je smanjilo stopu
mortaliteta ovih pacijenata i približilo je onoj u opštoj populaciji. Oralni somatostatinski analozi
će uskoro biti i rutinski primenjivani u kliničkoj praksi, pa se očekuje dalji pomak u tom smislu.
Individualan pristup svakom pacijentu od strane miltidisciplinarnog tima specijalista je ključ uspeha

terapije akromegalije.

Abstract

During the past two decades, the discovery of new drugs in the treatment of acromegaly contributed to the remission of
this disease in about 95% of patients. In addition to the availability of new drugs, recent years have also seen advances
in surgical techniques in pituitary surgery. Newer drugs have contributed to a decrease in the use of radiotherapy for
tumors that secrete growth hormone and a lower frequency of somatotropinoma reoperations. Raising awareness about
this disease, early diagnosis and accompanying comorbidities, enabled timely treatment. All of this led to a reduction in
the mortality rate of patients, to the level in the general population. In the treatment of acromegaly, a multidisciplinary
approach is very important, in addition to endocrinologists and neurosurgeons, radiologists, pathologists and geneticists
play an active role. The most common complications of acromegaly are: cardiovascular diseases, metabolic abnormalities
such as diabetes and dyslipidemia, respiratory dysfunction, joint deformities, vertebral fractures and the appearance of
tumors.

The diagnosis of acromegaly is based on the characteristic clinical picture of enlarged hands and feet, nose and ears,
increased levels of IGF-I for age, insuppressibility of growth hormone (GH) in the glucose load test (OGTT), as well as
imaging of the pituitary gland by magnetic resonance (MRI). Acromegaly therapy involves a combination of several
modalities: surgery for growth hormone-secreting pituitary adenoma, medical therapy and radiotherapy. Medical therapy
includes three groups of drugs: 1) somatostatin receptor ligands (SRLs) of the first generation (octreotide LAR and
lanreotide Autogel) and second generation (pasireotide LAR), 2) dopamine-DA agonists (bromocriptine and cabergoline)
and 3) growth hormone receptor antagonists (pegvisomant).

The goal of writing this review paper is to point out the importance of timely diagnosis of acromegaly and adequate
treatment of patients in order to reduce comorbidities, prolong life and improving their quality of life.

Keywords: acromegaly, pituitary tumor, first and second generation of somatostatin analogues, pegvisomant, cabergoline

38 DOI: 10.5937/Galmed2412075D