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вce журналы << Эндокринная хирургия << 2018 год << №1 <<
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Влияние предоперационной терапии аналогами соматостатина на исход хирургического лечения СТГ-продуцирующих макроаденом гипофиза: критический анализ

Баркан А. А.
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Баркан Ариэль - д.м.н., профессор медицины и нейрохирургии, cо-директор Центра нейроэндокринологии и заболеваний гипофиза, Мичиганский университет, abarkan@umich.edu, Энн Арбор

Тридцать лет назад была выдвинута гипотеза, согласно которой уменьшение размера макроаденом гипофиза, продуцирующих соматотропный гормон (СТГ), под действием аналогов соматостатина (АС) может улучшить исход хирургического лечения. С тех пор множество ретроспективных нерандомизированных исследований, а также четыре современных проспективных рандомизированных исследования были проведены для проверки истинности этой гипотезы. Oни критически разобраны в этой статье. За исключением единичных ретроспективных исследований, преобладающее большинство работ не подтверждают эту гипотезу. Также, хотя все проспективные исследования указывают на улучшение хирургического исхода через 3 мес после операции при проведении предоперационной подготовки АС, различия между пациентами, получавшими лечение до операции, и нелечеными пациентами из группы контроля исчезают через 6-12 мес. Таким образом, предоперационная терапия макросоматотропином АС с целью достижения полного удаления опухоли не оправдывает ожиданий и не может быть рекомендована.

Ключевые слова:
акромегалия, СТГ-продуцирующая аденома гипофиза, трансназальная аденомэктомия, аналоги соматостатина, acromegaly, growth hormone-secreting pituitary adenoma, octreotide, treatment outcome

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Preoperative treatment of growth hormone (GH) producing macroadenomas with somatostatin receptor ligands (SRLs) to improve surgical outcome: a critical analysis

Barkan Ariel

Thirty years ago, a hypothesis stating that preoperative shrinkage of growth hormone (GH) producing macroadenomas with somatostatin receptor ligands (SRLs) may improve surgical outcome was put forward. Since then, multiple retrospective, non-randomized studies as well as four contemporary prospective, randomized studies have been performed to evaluate the validity of that hypothesis and are critically reviewed in this manuscript. With the exception of an occasional retrospective study the great preponderance of evidence could not confirm this hypothesis. Similarly, while all prospective studies suggested better surgical outcome for SRL-pretreated tumors 3 months post surgery, the differences in outcomes between pretreated and untreated control patients disappeared after 6-12 months. Thus, preoperative treatment of macrosomatotropinomas with SRLs should not be relied upon as a means to achieve complete tumor removal and cannot be recommended.

Keywords:
акромегалия, СТГ-продуцирующая аденома гипофиза, трансназальная аденомэктомия, аналоги соматостатина, acromegaly, growth hormone-secreting pituitary adenoma, octreotide, treatment outcome

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