problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl12699problendo-12699Research ArticleКлиническая эндокринологияClinical endocrinologyСелективный скрининг пациентов с ассоциированными соматическими заболеваниями как метод раннего выявления акромегалииSelective screening of patients with associated somatic diseases as a method of early detection of acromegalyhttps://orcid.org/0000-0002-9944-2997АнциферовМ. Б.AntsiferovM. B.

Анциферов Михаил Борисович, доктор медицинских наук, профессор

Москва

eLibrary SPIN: 1035-4773

Mikhail B. Antsiferov, MD, Professor

Moscow

eLibrary SPIN: 1035-4773

ed@zdrav.mos.ruhttps://orcid.org/0000-0001-5045-798XПронинВ. С.ProninV. S.

Пронин Вячеслав Сергеевич, доктор медицинских наук, профессор  кафедры эндокринологии 

125284, Москва, 2-й Боткинский проезд, д. 7

eLibrary SPIN: 6720-4948

Vyacheslav S. Pronin, MD, Professor of endocrinology

125284, Москва, 2-й Боткинский проезд, д. 7

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vspronin@yandex.ruhttps://orcid.org/0000-0003-0066-845XАлексееваТ. М.AlekseevaT. M.

Алексеева Татьяна Марковна 

Москва

eLibrary SPIN: 2644-4484

Tatyana M. Alekseeva

Moscow

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mamamarka@yandex.ruhttps://orcid.org/0000-0001-5073-035XИоноваО. А.IonovaO. A.

Ионова Ольга Анатольевна 

Москва

eLibrary SPIN: 7858-8508

Olga A. Ionova

Moscow

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olgamkl8@gmail.comhttps://orcid.org/0000-0002-0681-4772МартыноваЕ. Ю.MartynovaE. Y.

Мартынова Евгения Юрьевна 

Москва

eLibrary SPIN: 4992-0837

Evgeniya Y. Martynova

Moscow

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doctor.martynova@gmail.comhttps://orcid.org/0000-0001-9963-756XПотешкинЮ. Е.PoteshkinYu. E.

Потешкин Юрий Евгеньевич, кандидат медицинских наук

Москва

SPIN: 3287-6744

Yuriy E. Poteshkin, PhD

Moscow

SPIN: 3287-6744

dr.yep@ya.ruhttps://orcid.org/0000-0002-0297-2810ЧуброваН. А.ChubrovaN. A.

Чуброва Наталья Александровна 

Москва

eLibrary SPIN: 2710-3292

Natalya A. Chubrova

Moscow

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arion-n@mail.ruhttps://orcid.org/0000-0003-0292-5907ЖеребчиковаК. Ю.ZherebchikovaK. Y.

Жеребчикова Кристина Юрьевна 

Москва

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Kristina Y. Zherebchikova

Moscow

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K.y.zherebchikova@gmail.comЭндокринологический диспансер Департамента здравоохранения города МосквыРоссияEndocrinological dispensary of Moscow Healthcare DepartmentRussian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian medical Academy of continuing professional educationRussian FederationООО «Актуальная медицина»РоссияLLC «Relevant medicine»Russian FederationРоссийский национальный исследовательский медицинский университет им. Н.И ПироговаРоссияPirogov Russian National Research Medical University (Pirogov Medical University)Russian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияMoscow state medical University named after I.M. Sechenov (Sechenov University)Russian Federation2021080120216712030Copyright © Анциферов М.Б., Пронин В.С., Алексеева Т.М., Ионова О.А., Мартынова Е.Ю., Потешкин Ю.Е., Чуброва Н.А., Жеребчикова К.Ю., 20212021Анциферов М.Б., Пронин В.С., Алексеева Т.М., Ионова О.А., Мартынова Е.Ю., Потешкин Ю.Е., Чуброва Н.А., Жеребчикова К.Ю.Antsiferov M.B., Pronin V.S., Alekseeva T.M., Ionova O.A., Martynova E.Y., Poteshkin Y.E., Chubrova N.A., Zherebchikova K.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/12699Обоснование

Обоснование. Акромегалия является полиорганным инвалидизирующим заболеванием, эффективность лечения которого напрямую зависит от своевременной диагностики. Скрытое течение и запоздалый диагноз повышают экспозицию патологической гиперсекреции гормона роста и инсулиноподобного ростового фактора-1, способствуя развитию в организме необратимых системных и метаболических изменений, негативно влияющих на выживаемость.

Цель

Цель. Клиническая оценка диагностического комплексного подхода с использованием селективного скрининга для выявления случаев акромегалии у пациентов с сочетанными соматическими заболеваниями.

Методы

Методы. Алгоритм диагностического поиска включал двухэтапное анкетирование, экспертную оценку клинического статуса, проведение лабораторного и инструментального обследований. Стационарное обследование включало использование дополнительных лабораторно-инструментальных методов и экспертную оценку полученных результатов с заполнением анкеты врача. При наборе более 18 баллов проводили более специфическое обследование: двукратное определение уровня инсулиноподобного ростового фактора-1, оральный глюкозотолерантный тест с определением величины надира гормона роста, магнитно-резонансную томографию (МРТ) головного мозга с контрастным усилением. Диагноз «акромегалия» ставили на основании анкетных данных, экспертной оценки клинического статуса, результатов лабораторного и инструментального обследований.

Результаты

Результаты. Проведенное по балльной системе анкетирование 1249 больных, имевших сочетанные системные и обменные нарушения, позволило заподозрить акромегалию у 367 пациентов (29,4%). Им было предложено дальнейшее обследование. Большинство из них ранее наблюдались у специалистов по поводу сахарного диабета (79,3%) или патологии щитовидной железы (10%). В результате стационарного обследования 329 пациентов у 35 (10,6%) больных было отмечено повышение в крови уровня инсулиноподобного ростового фактора-1. У 19 больных стойкое повышение его уровня сочеталось с отсутствием подавления гормона роста менее 0,4 нг/мл на фоне нагрузки глюкозой. При проведении МРТ у 9 больных была выявлена аденома гипофиза (у 2 — микроаденома и у 7 — макроаденома).

Заключение

Заключение. В результате проведенного исследования 1249 пациентов (средний возраст 58±13 лет) с наличием сопутствующих заболеваний обнаружено 9 впервые выявленных больных акромегалией, которым было назначено адекватное лечение. Внедрение технологии селективного скрининга в практику работы эндокринолога позволит повысить эффективность диагностического поиска больных акромегалией, оценить распространенность заболевания в России и потребность в специализированной медицинской помощи.

Backgraund

Backgraund: Acromegaly is a multi-organ disabling disease, the effectiveness of treatment of which directly depends on timely diagnosis. Latent course and delayed diagnosis increase the exposure of pathological hypersecretion of growth hormone and insulin-like growth factor-1, contributing to the development of irreversible systemic and metabolic changes in the body that negatively affect survival.

Aims

Aims: The aim of the study was to clinically test a comprehensive diagnostic approach using selective screening to detect cases of acromegaly in patients with combined somatic diseases.

Materials and methods

Materials and methods: The diagnostic search algorithm included a 2-stage questionnaire, expert assessment of the clinical status, laboratory and instrumental examination. The inpatient examination included the use of additional laboratory and instrumental methods and expert evaluation of the results obtained by filling out a doctor’s questionnaire. When the score was higher than 18 points, a more specific examination was performed: double determination of the insulin-like growth factor-1 level, oral glucose tolerance test with determination of the nadir of growth hormone value, and MRI of the brain with contrast enhancement. The diagnosis of acromegaly was made on the basis of personal data, expert assessment of the clinical status, results of laboratory and instrumental examinations.

Results

Results: A survey of 1249 patients with combined systemic and metabolic disorders conducted using the point system allowed us to suspect acromegaly in 367 patients (29.4%), who were offered further examination. The majority of patients were previously seen by specialists for diabetes mellitus (79.3%) or thyroid pathology (10%). In the result of inpatient ­examination of 329 patients, 35 (10.6%) patients showed an increase in the blood level of IGF-I. In 19 patients, a persistent increase in the level of IGF-I was combined with the absence of GH suppression of less than 0.4 ng/ml against the background of glucose load. During MRI in 9 patients, pituitary adenoma was detected (in 2 — microadenoma and 7 — ­macroadenoma).

Conclusions

Conclusions: As a result of the study, among the group of 1249 patients (mean age 58±13 years) with the presence of concomitant diseases, 9 newly identified patients with acromegaly were found who were prescribed adequate treatment. The introduction of selective screening technology into the practice of an endocrinologist will improve the effectiveness of diagnostic search for patients with acromegaly, more accurately assess the prevalence of the disease in Russia and the need for specialized medical care.

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The authors declare that there are no conflicts of interest present.