| Acromegaly is an endocrine and metabolic disease caused by over secretion of growth hormone.Acromegaly patients over secrete GH for a long time,and the levels of GH and IGF-1 in the body of patients maintain a high level for a long time,which act on the bones,viscera and soft tissues of the whole body,causing corresponding damage to multiple systems of the body,such as acromegaly osteoarthropathy,acromegaly diabetes,acromegaly hypertension,coronary heart disease.The prognosis of this disease is poor,the incidence rate of male and female is similar.The incidence rate of patients aged 31-50 years is obviously higher than other age levels.The number of patients per million population is about 3-5 per year,and the population of each million people is about 35-120.A study specifically studying the serum IGF-1 level shows that the incidence rate of acromegaly in normal population is about 1000 per million people per year.This study shows that acromegaly patients are likely to be misdiagnosed or missed in clinical practice.Acromegaly is a systemic disease that can cause multiple systems.It is of great clinical significance to discuss its treatment.Methods: Methods: the clinical data of 31 patients with acromegaly admitted to the gamma knife center of Tianjin Huanhu hospital from May 2017 to June 2019 were analyzed retrospectively.All the patients in the group received gamma knife radiosurgery,and received 20 mg octreotide microspheres for injection one month after gamma knife operation,once every 4 weeks.The first octreotide microspheres treatment lasted for 3 months.All the patients were treated with gamma knife radiosurgery and octreotide 20 mg microspheres for injection 1 month after gamma knife operation,once every 4 weeks.The first course of octreotide microspheres treatment lasted for 3 months.Tumor reduction: tumor disappearance or tumor volume reduction ≥ 10%;tumor resting state: tumor volume unchanged or changed < 10%;tumor volume increased: tumor volume increased ≥ 10% compared with preoperative.Tumor reduction and tumor resting state are defined as effective tumor control,while tumor volume increase is defined as ineffective tumor control.The definition of endocrine level cure after treatment is: three months after gamma knife treatment,the serum GH level is less than 2.5 μ g / L at random or the trough level of serum GH is less than 1 μ g / L after OGTT,meanwhile,the serum IGF-1 reaches the normal level matching with age and gender.To evaluate the therapeutic effect of gamma knife radiosurgery combined with octreotide microsphere for injection in the treatment of acromegaly.Results: there were 31 patients with acromegaly in this group,12 males and 19 females.The average age of the patients was 46.77 ± 12.39 years old,and the average volume of tumor was 1.72 ± 1.05 cm3.After 6 months of gamma knife treatment,the enhanced MRI scan of pituitary showed that the tumor volume of 2 patients increased by more than 10% compared with that before operation,and the tumor volume of the other 29 patients did not increase significantly.The serum GH level of 31 patients before operation was measured.10 patients whose serum GH level was less than 30 μ g / L reached the endocrine healing level after treatment.The healing rate was 71.43%.In the 30-50 μ g / l group,the endocrine healing rate was 40%.However,only one patient whose serum GH level was more than 50 μ g / L recovered to normal after operation,the healing rate was 14.29%.There was significant statistical difference in the endocrine healing rate among the three groups(P=0.038).After reexamination of OGTT,the mean value of serum GH in the cured group was 0.67 ± 0.19 μ g / L,and that in the untreated group was 3.69 ± 2.18 μ g / L.the difference was statistically significant.Conclusion: the tumor control rate is related to the preoperative tumor volume,and the postoperative GH level is closely related to the preoperative serum GH level.Gamma knife stereotactic radiosurgery combined with octreotide microsphere injection can effectively control the volume of pituitary growth hormone adenoma,greatly reduce the level of serum GH and IGF-1,and improve the symptoms of acromegaly,which can be used as an important option for patients with acromegaly who cannot receive surgical treatment. |
