Diagnóstico e tratamento da acromegalia no Brasil

Abstract

RESUMOAcromegalia é uma doença debilitante e desfigurante que, se não controlada adequadamente, reduz a expectativa de vida do paciente.Complicações cardiovasculares e respiratórias representam as principais causas de morte nos acromegálicos. Atualmente, o diagnóstico é realizado de acordo com as diretrizes do consenso de 2000: ausência de supressão do GH para um valor <1ng/mL e IGF-1 elevado. Avanços em todas as modalidades terapêuticas têm ocorrido, propiciando o controle bioquímico da doença em um número cada vez maior de pacientes. Estudos prévios mostraram que a obtenção de níveis seguros de GH (GH médio <2,5ng/mL) e de IGF-1 normal reduz a taxa de mortalidade para o normal. Em 2002, foram publicadas diretrizes para o manejo da acromegalia, o qual envolve, muitas vezes, uma abordagem multidisciplinar. Neste artigo, fazemos uma avaliação crítica do que dispomos no Brasil para seguirmos as diretrizes estabelecidas nos consensos sobre diagnóstico e tratamento da acromegalia. ABSTRACT Diagnosis and Treatment of Acromegaly in Brazil.Acromegaly is a disabling and disfiguring illness, which, if not adequately controlled, decreases life expectancy. Cardiovascular and respiratory complications represent the main causes of death in acromegalic patients. Nowadays, the diagnosis is made following the guidelines reported in the 2000 consensus: Failure of GH to suppress to less than 1ng/mL and an increased IGF-1. Progress in all therapeutic modalities has been made, allowing biochemical disease control in more patients. Previous studies demonstrated that achieving safe GH levels (mean GH <2.5ng/mL) and normal IGF-1 decreases mortality rate to normal. In 2002, the guidelines for management of acromegaly were published which encompass, many times, a multidisciplinary approach. In this article, we critically evaluate what is available in Brazil that allows us to follow the guidelines established in the diagnosis and treatment consensus.

Avaliação do metabolismo da glicose em pacientes acromegálicos antes e após tratamento com octreotide LAR

“…Isto é concordante com outras séries nacionais e internacionais, cuja prevalência varia entre 23% a 69% (8,18,(27)(28)(29).…”

Cost-effectiveness analysis of somatostatin analogues in the treatment of acromegaly in Brazil

“…The annual incidence of this disease is 3-4 cases per million with a prevalence of 40-70 cases per million (2)(3). The disease presents the same frequency for men and women and its mean age of onset is estimated to be 30-50 years (2)(3)(4). Due to its slowly progressive nature, formal diagnosis often occurs 10 years after the fi rst symptoms and signs appear (4).…”

“…The disease presents the same frequency for men and women and its mean age of onset is estimated to be 30-50 years (2)(3)(4). Due to its slowly progressive nature, formal diagnosis often occurs 10 years after the fi rst symptoms and signs appear (4). Complications associated to acromegaly are cardiovascular, respiratory and neoplasic diseases, that contribute to the increased mortality rate related to this disease, which is 2-4 times higher than that of an age and sex matched population (4)(5).…”

“…Due to its slowly progressive nature, formal diagnosis often occurs 10 years after the fi rst symptoms and signs appear (4). Complications associated to acromegaly are cardiovascular, respiratory and neoplasic diseases, that contribute to the increased mortality rate related to this disease, which is 2-4 times higher than that of an age and sex matched population (4)(5). Adequate treatment, as well as early diagnosis, may revert the increased mortality risk in acromegalic patients.…”

“…Adequate treatment, as well as early diagnosis, may revert the increased mortality risk in acromegalic patients. There are no epidemiological studies of the Brazilian population on acromegalic patients (4).…”