Best practice & research. Clinical endocrinology & metabolism最新文献_第2页

Best practice and research, clinical endocrinology and metabolism preface to the special issue: Diagnosis and treatment of acromegaly acromegaly, a paradigmatic disease second part: Treatment 最佳实践与研究，临床内分泌学与新陈代谢》特刊序言：肢端肥大症的诊断和治疗肢端肥大症，一种典型疾病第二部分：治疗。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101912

引用次数: 0

Surgical outcomes in patients with acromegaly: Microscopic vs. endoscopic transsphenoidal surgery 肢端肥大症患者的手术效果：显微镜与内窥镜经蝶手术

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101879

{"title":"Surgical outcomes in patients with acromegaly: Microscopic vs. endoscopic transsphenoidal surgery","authors":"","doi":"10.1016/j.beem.2024.101879","DOIUrl":"10.1016/j.beem.2024.101879","url":null,"abstract":"<div><p>Transsphenoidal resection of growth hormone-secreting pituitary neuroendocrine tumors remains the first-line treatment for acromegaly. This can be performed through microsurgery or endoscopic surgery. For the past decades, endoscopic surgery has become the preferred technique in an increasing number of centers worldwide. However, whether it offers superior clinical outcomes has yet to be determined. In this paper, we performed a narrative review of the literature comparing both techniques in the treatment of acromegaly. We critically assessed available comparative studies from an objective perspective to determine their suitability for defining superiority of either technique. Available evidence displays substantial methodological variations and reports conflicting findings. Although endoscopic surgery provides a wider exposure and enhanced visibility of the surgical field, this does not consistently translate into better clinical outcomes, as most tumors are equally accessible through both techniques. Postoperative outcomes such as remission and complication rates are similar between both techniques. The management of acromegaly should be performed by experienced pituitary neurosurgeons, regardless of the approach. The involvement of a multidisciplinary team in a dedicated pituitary center is critical to ensure optimal outcomes.</p></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"38 4","pages":"Article 101879"},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521690X24000216/pdfft?md5=cf28ee3a084f6bbf314196a15e16ae91&pid=1-s2.0-S1521690X24000216-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139873025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Growth hormone receptor antagonist pegvisomant and its role in the medical therapy of growth hormone excess 生长激素受体拮抗剂 pegvisomant 及其在生长激素过量医疗中的作用。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101910

{"title":"Growth hormone receptor antagonist pegvisomant and its role in the medical therapy of growth hormone excess","authors":"","doi":"10.1016/j.beem.2024.101910","DOIUrl":"10.1016/j.beem.2024.101910","url":null,"abstract":"<div><p>Pegvisomant is a growth-hormone (GH) receptor antagonist that prevents the formation of the active heterotrimer of the dimerised GH receptor and the GH molecule necessary for downstream signal transduction. Over the past 20 years, it has become a key therapeutic option for physicians treating syndromes of GH/IGF-1 excess. Sufficient longitudinal follow-up data suggest that it can be deemed both safe and effective. It is the drug with the greatest potential for achieving an amelioration of the biochemical effects of GH excess with a corresponding normalisation of IGF-1 levels; however, insufficient dose titration has lessened real-world therapeutic outcomes. Theoretical concerns about stimulating tumour growth have been resolved as this has not been observed, while derangement of liver enzymes and local skin-related adverse reactions may occur in a minority of the patients. It may be a particularly impactful medication for the treatment of children, young people, and those with inherited disorders of GH excess, where other treatment modalities often fail. Combination therapy of pegvisomant with first- and second-generation somatostatin receptor ligands or with dopamine agonists remains an ongoing area of interest and research. High cost remains a barrier to the use of pegvisomant in many settings.</p></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"38 4","pages":"Article 101910"},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521690X24000642/pdfft?md5=e748f729d02a49114f1b57a1096f2dfd&pid=1-s2.0-S1521690X24000642-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment of acromegaly with oral octreotide 用口服奥曲肽治疗肢端肥大症

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101888

引用次数: 0

Real-world value of cabergoline in the treatment of acromegaly 卡麦角林治疗肢端肥大症的实际价值

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101887

{"title":"Real-world value of cabergoline in the treatment of acromegaly","authors":"","doi":"10.1016/j.beem.2024.101887","DOIUrl":"10.1016/j.beem.2024.101887","url":null,"abstract":"<div><p>Cabergoline is an ergot derivative long-acting dopamine receptor 2 (DR2) selective agonist administered orally and widely used for the treatment of prolactin-secreting adenomas and Parkinson’s disease<strong>.</strong> DR2 is expressed in most somatotroph adenomas. In acromegaly, cabergoline is used off-label and its role is limited by the relatively modest efficacy for achieving hormonal remission and thus, it is largely indicated in patients with mild elevation of GH/IGF-I postoperatively. It can be given as monotherapy, usually at a higher weekly dose than usually required to treat prolactinomas, but also as an add-on treatment in patients partially responding to the somatostatin receptor ligands octreotide or lanreotide. IGF-1 normalization with cabergoline can be achieved in about a third of the patients. Low baseline IGF-1 level (below 1.5 x ULN) before cabergoline initiation is a good predictor for remission. Combination treatment with the GH receptor antagonist pegvisomant can also be beneficial. The inexpensive, well-tolerated and convenient oral administration of cabergoline makes it an attractive medical therapy for active acromegaly.</p></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"38 4","pages":"Article 101887"},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140011313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and safety of radiosurgery in acromegaly 放射外科治疗肢端肥大症的有效性和安全性。

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101898

{"title":"Efficacy and safety of radiosurgery in acromegaly","authors":"","doi":"10.1016/j.beem.2024.101898","DOIUrl":"10.1016/j.beem.2024.101898","url":null,"abstract":"<div><p>Stereotactic radiosurgery (SRS) more and more frequently plays a crucial role in the treatment of acromegaly. We provide a systematic review of the literature and meta-analysis, according to PRISMA, on SRS for the management of growth hormone (GH)-secreting pituitary adenomas, including several radiosurgical techniques, with the aim of describing efficacy and safety of this treatment. A weighted random effects model was used to calculate pooled outcome estimates. From 346 abstract reviews, 27 retrospective studies were included. Despite the variability in hormonal remission criteria and the heterogeneity between treatment guidelines among included studies, most of them reported an endocrine remission rate between 40% and 60%. Random effects meta-analysis for overall endocrine remission and 5-year probability of remission estimate after SRS were 46% (95% CI: 39–53%) and of 48% (95% CI: 38–57%), respectively. Random effects meta-analysis for new hypopituitarism estimate after SRS was 23% (95% CI: 17–29%). Furthermore, incidence of radiation induced optic neuropathy after SRS ranged between 0% and 6% This meta-analysis confirms and quantifies safety and effectiveness of SRS to achieve endocrine remission after surgical management in acromegaly.</p></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"38 4","pages":"Article 101898"},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment of acromegaly with the nonpeptide, highly selective somatostatin receptor type 2 agonist paltusotine 用非肽类高选择性体生长抑素受体 2 型激动剂帕妥索坦治疗肢端肥大症

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101906

引用次数: 0

Predictors of biochemical response to somatostatin receptor ligands in acromegaly 预测肢端肥大症患者对体生长抑素受体配体的生化反应

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101893

{"title":"Predictors of biochemical response to somatostatin receptor ligands in acromegaly","authors":"","doi":"10.1016/j.beem.2024.101893","DOIUrl":"10.1016/j.beem.2024.101893","url":null,"abstract":"<div><p>Although predictors of response to first-generation somatostatin receptor ligands (fg-SRLs), and to a lesser extent to pasireotide, have been studied in acromegaly for many years, their use is still not recommended in clinical guidelines. Is there insufficient evidence to use them? Numerous biomarkers including various clinical, functional, radiological and molecular markers have been identified. The first ones are applicable pre-surgery, while the molecular predictors are utilized for patients not cured after surgery. In this regard, factors predicting a good response to fg-SRLs are specifically: low basal GH, a low GH nadir in the acute octreotide test, T2 MRI hypointensity, a densely granulated pattern, high immunohistochemistry staining for somatostatin receptor 2 (SSTR2), and E-cadherin. However, there is still a lack of consensus regarding which of these biomarkers is more useful or how to integrate them into clinical practice. With classical statistical methods, it is complex to define reliable and generalizable cut-off values for a single biomarker. The potential solution to the limitations of traditional methods involves combining systems biology with artificial intelligence, which is currently providing answers to such long-standing questions that may eventually be finally included into the clinical guidelines and make personalized medicine a reality. The aim of this review is to describe the current knowledge of the main fg-SRLs and pasireotide response predictors, discuss their current usefulness, and point to future directions in the research of this field.</p></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"38 4","pages":"Article 101893"},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521690X24000472/pdfft?md5=a16abdeb32a7f3c68257d4af90b7a1e9&pid=1-s2.0-S1521690X24000472-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140201536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current role of pasireotide in the treatment of acromegaly 目前帕西瑞肽在治疗肢端肥大症中的作用

IF 6.1 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101875

引用次数: 0

“Micromegaly”: Acromegaly with apparently normal GH, an entity on its own? "小儿肢端肥大症肢端肥大症伴有明显正常的 GH，这是一个独立的实体吗？

IF 7.4 1区医学

Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-05-01 DOI: 10.1016/j.beem.2024.101878

Lucio Vilar , Luciana Ansaneli Naves , Manoel Ricardo Alves Martins , Antônio Ribeiro-Oliveira Jr

引用次数: 0