TRATAMIENTO COMBINADO CON DROGAS DOPAMINERGICAS Y SOMATOSTATINERGICAS EN PACIENTES CON ACROMEGALIA
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En los pacientes con acromegalia, la normalización de los niveles de hormona de crecimiento y de factor de crecimiento tipo I similar a la insulina está asociada con el retorno hacia niveles normales de expectativa y calidad de vida. Estos resultados pueden ser obtenidos en dos tercios de los pacientes mediante la administración de análogos de la somatostatina. El agregado de cabergolina, un agonista dopaminérgico potente, económico y bien tolerado, puede mejorar aun más los resultados terapéuticos. |
participó en la investigación
Roberto Attanasio*
MD, Ospedali Riuniti, Bergamo, Italia*
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Recepción del artículo: 2 de Octubre, 2006
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Aprobación: 7 de Noviembre, 2006
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Resumen
La neurocirugía aun es considerada la primera opción terapéutica para los pacientes con acromegalia. No obstante, tanto la habilidad del neurocirujano como el grado de hipersecreción de hormona de crecimiento (GH) y el tamaño del tumor son los principales factores limitantes de los resultados de la cirugía. En general, los efectos de la radioterapia son escasos y diferidos y se encuentran condicionados por la presencia de hipopituitarismo y aumento de la mortalidad por causa cerebrovascular. Luego del desarrollo de los análogos de la somatostatina (AS) efectivos y adecuadamente tolerados, el papel del tratamiento médico aumentó en forma progresiva. No obstante, aun con la administración de dosis elevadas de AS de depósito durante un período prolongado, el 30% al 40% de los pacientes no logra la normalización de los niveles de GH/factor de crecimiento tipo I similar a la insulina (IGF-I). Recientemente se publicaron datos convincentes acerca de la asociación entre los agonistas dopaminérgicos potentes de acción prolongada, como la cabergolina, y los AS de depósito. El agregado de cabergolina resultó exitoso para la obtención de niveles de IGF-I adecuados para la edad en alrededor de la mitad de los pacientes parcialmente sensibles a los AS. El papel de la secreción simultánea de prolactina aun es objeto de debate. La tolerabilidad fue adecuada. En conclusión, nosotros sugerimos que la administración combinada de cabergolina y AS de depósito a los pacientes acromegálicos parcialmente sensibles a los AS constituye una opción de segunda línea dentro del algoritmo del tratamiento médico de la acromegalia.
Palabras clave
acromegalia, GH, IGF-1, agonistas de la dopamina, análogos de la somatostatina
Clasificación en siicsalud
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Especialidades
Principal: Endocrinología y Metabolismo
Relacionadas: Farmacología, Medicina Farmacéutica, Medicina Interna
Enviar correspondencia a:
Renato Cozzi, Division of Endocrinology, Ospedale Niguarda Ca'Granda, I-20149, Milán, Italia
Artículo completo
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Combined Treatment with Dopamine Agonist and Somatostatin Analogs: Its Role in the Algorithm of Medical Therapy of Acromegaly
Abstract
Neurosurgery is still regarded as the first therapeutic option in acromegaly. However, neurosurgeon's skill as well as the degree of GH hypersecretion and the tumour size are the main limiting factors to surgical outcome. The effects of radiotherapy are often poor and they are delayed, burdened by hypopituitarism and increased cerebro-vascular mortality. After the development of widely effective and well-tolerated somatostatin analogues (SA), medical treatment has progressively increased its role. However, even prolonged treatment with high doses of depot SA does not achieve GH/IGF-I normalisation in 30-40% of patients. Recently convincing evidence has been reported about the association of powerful and long-acting dopamine agonist drugs such as cabergoline to depot SA. The addition of cabergoline was successful in obtaining normal age-matched IGF-I levels in about half of patients partially sensitive to SA. The role of PRL co-secretion is still debated. Tolerability was good. In conclusion, we suggest the combination of cabergoline to depot SA in acromegalic patients partially sensitive to SA as second-line treatment in the algorithm of medical therapy for acromegaly.
Key words
acromegaly, GH, IGF-I, dopamine agonists, somatostatin analogues
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Bibliografía del artículo
1. Colao A, Lombardi G. Growth hormone and prolactin excess. Lancet 1998; 352:1455-1461.
2. Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly. Q J Med 1970; 39:1-16.
3. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis and management. Endocr Rev 2004; 25:102-152.
4. Bates AS, Van't Hoff W, Jones JM, Clayton RN. An audit of outcome of treatment in acromegaly. Q J Med 1993; 86:293-299.
5. Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol 1994; 41:95-102.
6. Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 2004; 89:667-674.
7. Giustina A, Barkan A, Casanueva FF, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000; 85:526-529.
8. Melmed S, Casanueva FF, Cavagnini F, et al. Guidelines for acromegaly management. J Clin Endocrinol Metab 2002; 87:4054-4058.
9. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol 2005; 152:379-387.
10. Biermasz NR, Pereira AM, Neelis KJ, Roelfsema F, Romijn JA. Role of radiotherapy in the management of acromegaly. Exp Rev Endocrinol Metab 2006; 1:449-460.
11. Landolt AM, Haller D, Lomax N, et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: Comparison with fractionated radiotherapy. J Neurosurg 1998; 88:1002-1008.
12. Attanasio R, Epaminonda P, Motti E, et al. Gamma-knife radiosurgery in acromegaly: a 4-year-follow-up study. J Clin Endocrinol Metab 2003; 88:3105-3112.
13. Liuzzi A, Chiodini PG, Botalla L, Cremascoli G, Muller EE, Silvestrini F. Decreased plasma growth hormone (GH) levels in acromegalics following CB 154 (2-Br-alpha-ergocryptine) administration. J Clin Endocrinol Metab 1974; 38:910-914.
14. Chiodini PG, Liuzzi A, Botalla L, Oppizzi G, Muller EE, Silvestrini F. Stable reduction of plasma growth hormone (hGH) during the chronic administration of 2-Br-alpha-ergocryptine (CB-154) in acromegalic patients. J Clin Endocrinol Metab 1975; 40:705-708.
15. Jaffe CA, Barkan AL. Treatment of acromegaly with dopamine agonists. Endocrinol Metab Clin NA 1992; 21:713-735.
16. Kleinberg DL, Boyd AE, Wardlaw S, et al. Pergolide for the treatment of pituitary tumors secreting prolactin or growth hormone. N Engl J Med 1983; 309:704-709.
17. Chiodini PG, Attanasio R, Cozzi R, et al. CV 205-502 in acromegaly. Acta Endocrinol (Kbh) 1993; 128:389-393.
18. Lombardi G, Colao A, Ferone D, et al. CV 205-502 treatment in therapy-resistant acromegalic patients. Eur J Endocrinol 1995 ; 132:559-564.
19. Abs R, Verhelst J, Maiter D, et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab 1998; 83:374-378.
20. Cozzi R, Attanasio R, Barausse M, et al. Cabergoline in acromegaly: a renewed role for dopamine agonist treatment? Eur J Endocrinol 1998; 139:516-521.
21. Freda PU, Katznelson L, van der Lely AJ, Reyes CM, Zhao S, Rabinowitz D. Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 2005; 90:4465-4473.
22. Vance ML, Harris AG 1991 Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide. Results of the International Multicenter Acromegaly Study Group. Arch Int Med 151:1573-1588.
23. Cozzi R, Attanasio R, Montini M, et al. Four-year treatment with octreotide-LAR in 110 acromegalic patients: the predictive value of short-term results. J Clin Endocrinol Metab 2003; 88:3090-3098.
24. Attanasio R, Baldelli R, Pivonello R, et al. Lanreotide 60 mg, a new long-acting formulation: effectiveness in the chronic treatment of acromegaly. J Clin Endocrinol Metab 2003; 88:5258-5265.
25. Cozzi R, Montini M, Attanasio R, et al. Primary treatment of acromegaly with octreotide LAR: a long-term (up to 9 years) prospective study on its efficacy in the control of disease activity and on tumor shrinkage. J Clin Endocrinol Metab 2006; 91:1397-1403.
26. Trainer PJ, Drake WM, Katznelson L, et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med 2000; 342:1171-1177.
27. Lamberts SW, Zweens M, Verschoor L, del Pozo E. A comparison among the growth hormone-lowering effects in acromegaly of the somatostatin analog SMS 201-995, bromocriptine and the combination of both drugs. J Clin Endocrinol Metab 1986; 63:16-19.
28. Chiodini PG, Cozzi R, Dallabonzana D, et al. Medical treatment of acromegaly with SMS 201-995, a somatostatin analog: a comparison with bromocriptine. J Clin Endocrinol Metab 1987; 64:447-453.
29. Fredstorp L, Kutz K, Werner S. Treatment with octreotide and bromocriptine in patients with acromegaly: an open pharmacodynamic interaction study. Clin Endocrinol 1994; 41:103-108.
30. Flogstad AK, Halse J, Grass P, et al. A comparison of octreotide, bromocriptine, or a combination of both drugs in acromegaly. J Clin Endocrinol Metab 1994; 79:461-465.
31. Marzullo P, Ferone D, Di Somma C, et al. Efficacy of combined treatment with lanreotide and cabergoline in selected therapy-resistant acromegalic patients. Pituitary 1999; 1:115-120.
32. Selvarajah D, Webster J, Ross R, Newell-Price J. Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly. Eur J Endocrinol 2005; 152:569-574.
33. Gatta B, Hau DH, Catargi B, Roger P, Tabarin A. Re-evaluation of the efficacy of the association of cabergoline to somatostatin analogues in acromegalic patients. Clin Endocrinol 2005; 63:477-481.
34. Cozzi R, Attanasio R, Lodrini S, Lasio G. Cabergoline addition to depot somatostatin analogs in resistant acromegalic patients: efficacy and lack of predictive value of prolactin status. Clin Endocrinol 2004; 61:209-215.
35. Verhelst J, Abs R, Maiter D, et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 1999; 84:2518-2522.
36. Lamberts SW, Liuzzi A, Chiodini PG, Verde G, Klijn JG, Birkenhager JC. The value of plasma prolactin levels in the prediction of the responsiveness of growth hormone secretion to bromocriptine and TRH in acromegaly. Eur J Clin Invest 1982; 12:151-155.
37. Saveanu A, Lavaque E, Gunz G, et al. Demonstration of enhanced potency of a chimeric somatostatin-dopamine molecule, BIM-23A387, in suppressing growth hormone and prolactin secretion from human pituitary somatotroph adenoma cells. J Clin Endocrinol Metab 2002; 87:5545-5552.
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