Ayhan KARAKOÇ, Göksun AYVAZ, Hüseyin DEMİRCİ, Gülhan DAYSAL, Erdal KAN, Füsun Törüner BALOŞ, Nur ÇAKIR, Nejdet ÇEVİKER, İlhan YETKİN, Metin ARSLAN

Akromegalide deneyimler

Amaç: Merkezimizde yedi yıllık dönemde izlenen 28 akromegali hastasını retrospektif olarak inceledik ve vakaların klinik, laboratuar bulgularını ve tedavi sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Akromegali tanısı, klinik yakınma ve bulgular ile birlikte, bazal büyüme hormonu, IGF-1 ve OGTT’de glukoz-büyüme hormonu cevabı ile konulmuştu. Kür kriteri olarak, postoperatif üçüncü ayda serum büyüme hormonu seviyesinin, bazal veya OGTT’de 1 ng/mL’nin altına inmesi kullanıldı. Bulgular: Yirmi sekiz hastanın 18’i primer vaka, 10’u farklı dış merkezlerde opere edilen nüks-rezidü vakaydı. %32’sinde mikroadenom, %68’inde makroadenom vardı. Hastaların başlıca şikayeti el-ayak büyümesi (%64.2) idi. İlk operasyonla total kür oranı %18.2 olarak saptandı. Mikroadenomda kür oranı %20, makroadenomda ise %16.7 idi. İkinci operasyon ile %66.7 kür sağlandığı görüldü. Reoperasyon sonrası kalıcı hipopituitarizm oranı %50 idi. Gamma-knife + somatostatin analoğu alan hastalardan bir tanesinin (%20) tedavinin ikinci yılında bazal ve OGTT sırasında büyüme hormonu düzeyi 1 ng/mL’nin altında iken; iki yıllık yalnız oktreotid tedavisi ile altı hastanın (%60) bazal ve OGTT sırasında büyüme hormonu düzeyleri 1 ng/mL’nin altındaydı. Sonuç: Cerrahi tedavinin başarısında cerrahın tecrübesi kadar, vakaların özellikleri ve kür kriteri olarak alınan büyüme hormonu değeri de belirleyici olmaktadır. Cerrahi sonrası kür elde edilemeyen akromegali hastalarında, adjuvan somatostatin analoğu tedavisinin reoperasyon kadar başarılı olduğu ve ciddi yan etkileri olmaması nedeniyle tercih sebebi olabileceğini düşünmekteyiz.

Experiences in acromegaly

Purpose: We examined retrospectively 28 acromegalic patients who were seen over the previous seven-year period and aimed to evaluate their laboratory clinical findings and post-treatment results. Methods: Acromegaly is diagnosed by specific clinical findings and laboratory tests such as increased serum levels of GH, IGF-1, and glucose-GH suppression level in OGTT. Serum GH level measuring less then 1 ng/mL three months after the operation was the criterion of cure in our study. Results: The total cure rate was 18.2% after the first operation. The cure rate was 20% in microadenoma while it was 16.7% in macroadenoma. After the second operation the cure rate was 66.7%. Permanent hypopituitarism risk after reoperation was 50%. There was only one patient (20%) whose GH level was below 1 ng/mL among the patients who received both gammaknife and somatostatin analogue treatment, whereas there were six patients (60%) in the group receiving octreotide treatment for two years. Conclusion: The success rate of surgery is determined by the experience of the surgeon as well as properties of the patient and initial GH level. In acromegaly patients in whom a complete cure could not be achieved after the first operation, adjuvant octreotide therapy is as successful as reoperation and can be the treatment of choice because of its less serious side effects compared to surgery.

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