PDF(Pubmed)
Abstract：
Acromegaly is an endocrine disorder characterized by dysregulated hypersecretion of growth hormone (GH), leading to an overproduction of insulin-like growth factor 1 (IGF-1). The etiology is usually a GH-secreting pituitary adenoma with the resultant presentation of coarse facial features, frontal bossing, arthritis, prognathism (protrusion of the mandible), and impaired glucose tolerance, among others. Most pituitary adenomas arise due to sporadic mutations that lead to unregulated cellular division, subsequent tumor formation, and resultant GH hypersecretion. Major scientific organizations and authorities in endocrinology release regularly updated guidelines for diagnosing and managing acromegaly. We have holistically evaluated four data-driven and evidentiary approaches in the management of acromegaly to compare and contrast these guidelines and show their salient differences. These guidelines have been reviewed because they are major authorities in acromegaly management. In this comprehensive article, differences in the diagnosis and treatment recommendations of the discussed guidelines have been highlighted. Our findings showed that diagnosing modalities were similar among the four approaches; however, some guidelines were more specific about additional supporting investigations to confirm a diagnosis of acromegaly. For management options, each guideline had suggestions about ideal therapeutic outcomes. Treatment options were identical but salient differences were noticed, such as the addition of combination therapy and alternative therapy in the setting of failure to respond to first and second-line treatments. Reviewing clinical guidelines for various pathologies encourages sharing ideas among medical practitioners and ensures that global best practices are adopted. Therefore, a constant review of these clinical practice guidelines is necessary to keep clinicians up to date with the latest trends in patient management.
摘要：
肢端肥大症是一种内分泌疾病，其特征是生长激素（GH）分泌异常，导致胰岛素样生长因子1（IGF-1）的过量产生。病因通常是分泌GH的垂体腺瘤，结果表现为粗糙的面部特征，额前带，关节炎,前突（下颌骨突出），糖耐量受损，在其他人中。大多数垂体腺瘤是由于偶发性突变导致细胞分裂不受调节，随后的肿瘤形成，并导致GH分泌过多。内分泌学的主要科学组织和主管部门定期发布更新的诊断和管理肢端肥大症的指南。我们已经全面评估了肢端肥大症管理中的四种数据驱动和证据方法，以比较和对比这些指南并显示它们的显着差异。这些指南已经过审查，因为它们是肢端肥大症管理的主要权威。在这篇全面的文章中，我们强调了所讨论的指南在诊断和治疗建议方面的差异.我们的研究结果表明，四种方法的诊断方式相似；然而，一些指南更具体地说明了额外的辅助研究,以确认肢端肥大症的诊断.对于管理选项，每个指南都有关于理想治疗结局的建议.治疗方案相同，但有显著差异，例如，在一线和二线治疗无效的情况下，增加联合治疗和替代疗法。审查各种病理的临床指南鼓励医生之间分享想法，并确保采用全球最佳实践。因此,必须不断审查这些临床实践指南,以使临床医生了解患者管理的最新趋势.
