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ISSN 0016-3813 (Impreso)

2010, Número 6

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Gac Med Mex 2010; 146 (6)


Abordaje endonasal endoscópico transesfenoidal en adenomas hipofisiarios productores de hormona de crecimiento. Resultados preliminares

Rangel MCR, Santos-Franco JA, Sandoval-Balanzario MA, Saavedra-Andrade R, Velázquez-Chávez F, Dávila-Romero JC

Idioma: Español
Referencias bibliográficas: 48
Paginas: 367-375
Archivo PDF: 183.98 Kb.


RESUMEN

Introducción: Ha sido reportado que el abordaje endonasal endoscópico transesfenoidal (AEET) ofrece menor trauma y menor estancia hospitalaria en el manejo general de los adenomas de hipófisis (AH). Hasta ahora no hay series de AEET enfocadas en el manejo específico de la acromegalia. Objetivo: Evaluar la seguridad y la efectividad del AEET en acromegalia. Pacientes y métodos: Serie prospectiva de casos de pacientes con AH productores de hormona de crecimiento (GH) tratados mediante AEET, con seguimiento de un año. Resultados: De noviembre de 2006 a diciembre de 2007 se operaron 19 pacientes: 11 mujeres y 8 hombres acromegálicos. Se realizó resección total en 16 casos (84%) y subtotal en tres (16%). Un caso se complicó con fístula de líquido cefalorraquídeo (LCR) que cedió mediante drenaje espinal. La estancia hospitalaria media fue de 2.5 días. En total, 16 pacientes (84%) mejoraron clínicamente y en tres (16%) no hubo cambios. Dos pacientes tuvieron tumor residual (11%). Los valores postoperatorios de GH fueron ‹ 2.0 ng/dl (radioimmunoassay [RIA]) en 17 casos (89%) y › 2.0 ng/dl en dos (11%). Los niveles del factor de crecimiento insulínico tipo 1 (IGF-1) se normalizaron en 16 casos (84%) y continuaron elevados en tres (16%). Uno de los pacientes cursó con elevación de solamente IGF-1. Los pacientes con tumor residual y valores altos de GH e IGF-1 fueron enviados a radiocirugía. Conclusiones: El abordaje endonasal endoscópico transesfenoidal parece ser útil en pacientes con acromegalia, con índice alto de curación entre otros beneficios.


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