Palabras clave
género
grupos etarios
cirugía
tratamiento médico
radiación
Cómo citar
Resumen
Contexto: la acromegalia es una enfermedad rara caracterizada por el crecimiento excesivo de los huesos y tejidos blandos debido a una hipersecreción de hormona de crecimiento (GH), generalmente asociada con tumores hipofisarios. Su diagnóstico y tratamiento oportunos son fundamentales para reducir las complicaciones crónicas.
Objetivo: determinar si existen diferencias clínicas y en la respuesta al tratamiento según la edad y el género en pacientes con acromegalia en Colombia.
Métodos: estudio observacional, analítico, multicéntrico, de cohorte retrospectiva, basado en un registro nacional de pacientes con acromegalia en Colombia.
Resultados: se incluyeron un total de 201 pacientes (de los cuales 60 % eran mujeres y 75 % eran menores de 60 años). El peso promedio fue de 75.1 kg ± 12.9 y la estatura fue de 1.63 m ± 0.08, siendo mayor en hombres y en menores de 60 años. El tiempo promedio de evolución de la enfermedad hasta el diagnóstico fue de 6.9 ± 4.4 años, sin embargo, los adultos mayores tuvieron un tiempo mayor de 8.6 ± 5.7 años, sin diferencias con respecto al género. El tipo de tumor más común fue el macroadenoma en el 78 % de los casos. Además de los síntomas clásicos de la enfermedad, la disminución del libido fue más frecuente en hombres, mientras que la depresión predominó en los mayores de 60 años. La hipertensión arterial así como la patología colónica y hepatobiliar, fueron más comunes en mujeres. La cardiomiopatía, la hipertensión y la patología ósea (osteoporosis y osteopenia) fueron más frecuentes entre las personas mayores de 60 años. El enfoque de tratamiento preferido fue la intervención quirúrgica y la orientación médica para individuos de entre 18 y 60 años. La combinación de manejo médico e intervención quirúrgica fue la opción asociada con un mayor control clínico.
Conclusión: el tratamiento combinado de cirugía y manejo médico se asoció con un mayor control clínico de la acromegalia, sin diferencias significativas en el control de la enfermedad según género o grupo etario.
Citas
de Herder WW. The History of Acromegaly. Neuroendocrinol. 2016;103(1):7–17. https://doi.org/10.1159/000371808
Kasuki L, Antunes X, Lamback EB, Gadelha MR. Acromegaly: Update on Management and Long-Term Morbidities. Endocrinol Metab Clin North Am. 2020;49(3):475–86. https://doi.org/10.1016/j.ecl.2020.05.007
Broder, M. S., Chang, E., Cherepanov, D., Neary, M. P., & Ludlam, W. H. (2016). INCIDENCE AND PREVALENCE OF ACROMEGALY IN THE UNITED STATES: A CLAIMS-BASED ANALYSIS. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 22(11), 1327-1335. https://doi.org/10.4158/EP161397.OR
Chin SO. Epidemiology of Functioning Pituitary Adenomas. Endocrinol Metab. 2020;35(2):237–42. https://doi.org/10.3803/EnM.2020.35.2.237
Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006;91(12):4769–75. https://doi.org/10.1210/jc.2006-1668
Castellanos-Bueno R, Abreu-Lomba A, Buitrago-Gómez N, Patiño-Arboleda M, Pantoja-Guerrero D, Valenzuela-Rincón A, et al. Clinical and epidemiological characteristics, morbidity and treatment based on the registry of acromegalic patients in Colombia: RAPACO. Growth Horm IGF Res. 2021;60–61:101425. https://doi.org/10.1016/j.ghir.2021.101425
Knappe UJ, Petroff D, Quinkler M, Schmid SM, Schöfl C, Schopohl J, et al. Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry. Eur J Endocrinol. 2020;182(3):275–84. https://doi.org/10.1530/EJE-19-0784
Sesmilo G, Gaztambide S, Venegas E, Picó A, Del Pozo C, Blanco C, et al. Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA). Pituitary. 2013;16:115–21. https://doi.org/10.1007/s11102-012-0384-x
Maione L, Chanson P. National acromegaly registries. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101264. https://doi.org/10.1016/j.beem.2019.02.001
Portocarrero-Ortiz LA, Vergara-Lopez A, Vidrio-Velazquez M, Uribe-Diaz AM, García-Dominguez A, Reza-Albarrán AA, et al. The Mexican Acromegaly Registry: Clinical and Biochemical Characteristics at Diagnosis and Therapeutic Outcomes. J Clin Endocrinol Metab. 2016;101(11):3997–4004. https://doi.org/10.1210/jc.2016-1937
Dal J, Feldt-Rasmussen U, Andersen M, Kristensen LØ, Laurberg P, Pedersen L, et al. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. Eur J Endocrinol. 2016;175(3):181–90. https://doi.org/10.1530/EJE-16-0117
Araujo-Castro M, Biagetti B, Menéndez Torre E, Novoa-Testa I, Cordido F, Pascual Corrales E, et al. Differences Between GH-and PRL-Cosecreting and GH-Secreting Pituitary Adenomas: a Series of 604 Cases. J Clin Endocrinol Metab . 2024:109(12); e2178–e2187. https://doi.org/10.1210/clinem/dgae126
Fekete C, Lechan RM. Central regulation of hypothalamic-pituitary-thyroid axis under physiological and pathophysiological conditions. Endocr Rev. 2014;35(2):159–94. https://doi.org/10.1210/er.2013-1087
Cuevas-Ramos D, Carmichael JD, Cooper O, Bonert VS, Gertych A, Mamelak AN, et al. A structural and functional acromegaly classification. J Clin Endocrinol Metab. 2015;100(1):122–31. https://doi.org/10.1210/jc.2014-2468
Biagetti B, Iglesias P, Villar-Taibo R, Moure MD, Paja M, Araujo-Castro M, et al. Mortality in Acromegaly Diagnosed in Older Individuals in Spain Is Higher in Women Compared to the General Spanish Population. J Clin Endocrinol Metab. 2023:108(9), 2193–2202. https://doi.org/10.1210/clinem/dgad141
Vilar L, Vilar CF, Lyra R, Lyra R, Naves LA. Acromegaly: clinical features at diagnosis. Pituitary. 2017;20:22–32. https://doi.org/10.1007/s11102-016-0772-8
Colao A, Grasso LFS, Giustina A, Melmed S, Chanson P, Pereira AM, et al. Acromegaly. Nat Rev Dis Primer. 2019;5:20. https://doi.org/10.1038/s41572-019-0071- 6
Cortés HT, García WR, Giraldo CMG, Lomba AA, Tovar AP, Moreno LVS, et al. Consensus on the definition of diagnostic, therapeutic and follow-up criteria for acromegaly in Colombian patients. Rev Colomb Endocrinol Diabetes Metab. 2022;9(4):590-605. https://doi.org/10.53853/encr.9.4.780
Potorac I, Petrossians P, Daly AF, Schillo F, Slama CB, Nagi S, et al. Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr Relat Cancer. 2015;22(2):169–77. https://doi.org/10.1530/ERC-14-0305
Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014;99(11):3933–51. https://doi.org/10.1210/jc.2014-2700
Gheorghiu ML, Negreanu F, Fleseriu M. Updates in the Medical Treatment of Pituitary Adenomas. Horm Metab Res. 2020;52(01):8–24. https://doi.org/10.1055/a-1066-4592
Reincke M, Petersenn S, Buchfelder M, Gerbert B, Skrobek-Engel G, Franz H, et al. The German Acromegaly Registry: description of the database and initial results. Exp Clin Endocrinol Diabetes. 2006;114(9):498–505. https://doi.org/10.1055/s-2006-948313
Tschöp M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50(4):707–9. https://doi.org/10.2337/diabetes.50.4.707
Bredella MA, Schorr M, Dichtel LE, Gerweck AV, Young BJ, Woodmansee WW, et al. Body Composition and Ectopic Lipid Changes With Biochemical Control of Acromegaly. J Clin Endocrinol Metab. 2017;102(11):4218–25. https://doi.org/10.1210/jc.2017-01210
Conaglen HM, de Jong D, Crawford V, Elston MS, Conaglen JV. Body Image Disturbance in Acromegaly Patients Compared to Nonfunctioning Pituitary Adenoma Patients and Controls. Int J Endocrinol. 2015;2015(1):624872. https://doi.org/10.1155/2015/624872
Leães CGS, Fernandes MV, Alves L, Araújo B, Rech CGSL, Ferreira NP, et al. Assessment of Anthropometric and Physical Health Indicators before and after Pituitary Surgery in Patients with Nonfunctioning Pituitary Adenomas, Acromegaly, and Cushing Disease. Indian J Endocrinol Metab. 2019;23(4):473–9. https://doi.org/10.4103/ijem.IJEM_301_19
Dupuy O, Petrossians P, Brue T, Morange I, Bordier L, Mayaudon H, et al. L’acromégalie du sujet âgé. Ann Endocrinol. 2009;70(4):225–9. https://doi.org/10.1016/j.ando.2009.05.002
Colao A, Amato G, Pedroncelli AM, Baldelli R, Grottoli S, Gasco V, et al. Gender- and age-related differences in the endocrine parameters of acromegaly. J Endocrinol Invest. 2002;25:532–8. https://doi.org/10.1007/BF03345496
Carvalho P, Lau E, Carvalho D. Surgery induced hypopituitarism in acromegalic patients: a systematic review and meta-analysis of the results. Pituitary. 2015;18:844–60. https://doi.org/10.1007/s11102-015-0661-6
Rick J, Jahangiri A, Flanigan PM, Chandra A, Kunwar S, Blevins L, et al. Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes. J Neurosurg. 2018;131(1):147–53. https://doi.org/10.3171/2018.4.JNS18230
Alibas H, Uluc K, Kahraman-Koytak P, Uygur MM, Tuncer N, Tanridag T, et al. Evaluation of depressive mood and cognitive functions in patients with acromegaly under somatostatin analogue therapy. J Endocrinol Invest. 2017;40:1365–72. https://doi.org/10.1007/s40618-017-0722-y
Sievers C, Sämann PG, Pfister H, Dimopoulou C, Czisch M, Roemmler J, et al. Cognitive function in acromegaly: description and brain volumetric correlates. Pituitary 2012;15:350–7. https://doi.org/10.1007/s11102-011-0326-z
Isik K, Ba?o?ul C, Yildirim H. The relationship between perceived loneliness and depression in the elderly and influencing factors. Perspect Psychiatr Care. 2021;57(1):351–7. https://doi.org/10.1111/ppc.12572
Puglisi S, Terzolo M. Hypertension and Acromegaly. Endocrinol Metab Clin North Am. 2019;48(4):779–93. https://doi.org/10.1016/j.ecl.2019.08.008
Schutte AE, Volpe M, Tocci G, Conti E. Revisiting the relationship between blood pressure and insulin-like growth factor-1. Hypertens. 2014;63(5):1070–7. https://doi.org/10.1161/HYPERTENSIONAHA.113.03057
Ferraù F, Albani A, Ciresi A, Giordano C, Cannavò S. Diabetes Secondary to Acromegaly: Physiopathology, Clinical Features and Effects of Treatment. Front Endocrinol. 2018;9:358. https://doi.org/10.3389/fendo.2018.00358
Wennberg A, Lorusso R, Dassie F, Benavides-Varela S, Parolin M, De Carlo E, et al. Sleep disorders and cognitive dysfunction in acromegaly. Endocrine. 2019;66:634–41. https://doi.org/10.1007/s12020-019-02061-1
Kužma M, Killinger Z, Jackuliak P, Va?uga P, Hans D, Binkley N, et al. Pathophysiology of growth hormone secretion disorders and their impact on bone microstructure as measured by trabecular bone score. Physiol Res. 2019;68(2):S121–9. https://doi.org/10.33549/physiolres.934303
Terzolo M, Puglisi S, Reimondo G, Dimopoulou C, Stalla GK. Thyroid and colorectal cancer screening in acromegaly patients: should it be different from that in the general population? Eur J Endocrinol. 2020;183(4):D1–13. https://doi.org/10.1530/EJE-19-1009
Lenders NF, McCormack AI, Ho KKY. Management of endocrine disease: Does gender matter in the management of acromegaly? Eur J Endocrinol. 2020;182(5):R67–82. https://doi.org/10.1530/EJE-19-1023
Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020;105(4):e937-e946. https://doi.org/10.1210/clinem/dgz096
Uzi?b?o-?yczkowska B, Jurek A, Witek P, Zieli?ski G, Gielerak G, Krzesi?ski P. Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods. Front Endocrinol. 2020;11:418. https://doi.org/10.3389/fendo.2020.00418
Wassenaar MJE, Biermasz NR, Hamdy NAT, Zillikens MC, van Meurs JBJ, Rivadeneira F, et al. High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly. Eur J Endocrinol. 2011;164(4):475–83. https://doi.org/10.1530/EJE-10-1005
Fleseriu M, Biller BMK, Freda PU, Gadelha MR, Giustina A, Katznelson L, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021;24:1–13. https://doi.org/10.1007/s11102-020-01091-7
Bollerslev J, Heck A, Olarescu NC. MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly. Eur J Endocrinol. 2019;181(2):R57–71. https://doi.org/10.1530/EJE-19-0124
Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Eur J Endocrinol. 2018;178(5):459–69. https://doi.org/10.1530/EJE-18-0015
Giustina A, Barkhoudarian G, Beckers A, Ben-Shlomo A, Biermasz N, Biller B, et al. Multidisciplinary management of acromegaly: A consensus. Rev Endocr Metab Disord. 2020;21:667–78. https://doi.org/10.1007/s11154-020-09588-z
Alimohamadi M, Ownagh V, Mahouzi L, Ostovar A, Abbassioun K, Amirjmshidi A. The impact of immunohistochemical markers of Ki-67 and p53 on the long-term outcome of growth hormone-secreting pituitary adenomas: A cohort study. Asian J Neurosurg. 2014;9(03):130–6. https://doi.org/10.4103/1793-5482.142732
Bernabeu I, Aller J, Álvarez-Escolá C, Fajardo-Montañana C, Gálvez-Moreno Á, Guillín-Amarelle C, et al. Criteria for diagnosis and postoperative control of acromegaly, and screening and management of its comorbidities: Expert consensus. Endocrinol Diabetes Nutr. 2018;65(5):297–305. https://doi.org/10.1016/j.endinu.2018.01.008
Tovar H, Rojas W. Experiencia en acromegalia en el Hospital de San José: Acta Médica Colomb. 2010;35(2):48–52. https://doi.org/10.36104/amc.2010.1568
Dal J, Skov BG, Andersen M, Feldt-Rasmussen U, Feltoft CL, Karmisholt J, et al. Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta-analysis of the literature. Clin Endocrinol (Oxf). 2020;94(4):625–35. https://doi.org/10.1111/cen.14392
Tanimoto K, Hizuka N, Fukuda I, Takano K, Hanafusa T. The influence of age on the GH-IGF1 axis in patients with acromegaly. Eur J Endocrinol. 2008;159(4):375–9. https://doi.org/10.1530/EJE-08-0243
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