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Colegio de Medicina Interna de México.

2009, Número 6

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Med Int Mex 2009; 25 (6)


Acromegalia

Ruiz BR, Durán PEG, Arellano MSA, Sánchez PV, Moreno LÓT, Mendoza HFC

Idioma: Español
Referencias bibliográficas: 71
Paginas: 468-480
Archivo PDF: 292.29 Kb.


RESUMEN

La acromegalia es una enfermedad crónica multisistémica causada por hipersecreción de hormona de crecimiento. La causa en más de 95% de los casos es adenoma hipofisario, con algunos casos raros de producción neoplásica ectópica de hormona del crecimiento u hormona liberadora de hormona del crecimiento (GHRH). Es un padecimiento raro, con prevalencia de 53-69 casos por millón e incidencia de tres a cuatro nuevos casos por millón por año. La mortalidad es aproximadamente dos veces mayor que en la población general; se relaciona con reducción en la esperanza de vida de diez años. Las causas de muerte son predominantemente por enfermedad cardiovascular, cerebrovascular y respiratorias. Algunos síntomas y signos son graduales e inespecíficos, que retrasan el diagnóstico aproximadamente de ocho a diez años. Este retraso se refleja en el tamaño del tumor al momento del diagnóstico, casi todos son macroadenomas (70%). El diagnóstico se realiza con cuantificación elevada del factor de crecimiento similar a la insulina tipo 1 (IGF-1) según la edad y género y se corrobora con un nadir de hormona del crecimiento mayor de 1 ng/mL a las dos horas de la ingestión de 75 g de glucosa. Se prefiere el tratamiento quirúrgico para la mayoría de los pacientes. Las concentraciones séricas de hormona del crecimiento se controlan una hora después de haber resecado completamente el adenoma, la cirugía transesfenoidal es la preferida y en manos expertas cura a la mayoría de los pacientes con microadenomas circunscritos (80%) y concentraciones de hormona del crecimiento menores de 40 ng/mL. El seguimiento es continuo con determinación de factor de crecimiento similar a la insulina tipo 1, hormona del crecimiento suprimida y resonancia magnética.


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