problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl12791problendo-12791Research ArticleКлиническая эндокринологияClinical endocrinologyДискордантные показатели инсулиноподобного фактора роста 1 (ИФР-1) и соматотропина (СТГ) в диагностике и мониторинге акромегалииDiscordant parameters of insulin-like growth factor 1 and growth hormone in the diagnosis and monitoring of acromegalyhttps://orcid.org/0000-0002-7102-5323СахноваЕ. Е.SakhnovaE. E.

Сахнова Екатерина Евгеньевна, ординатор, отделение нейроэндокринологии и остеопатий

SPIN-код: 4777-7937

117292, Москва, ул. Дм. Ульянова, д. 11 

Ekaterina E. Sakhnova, MD

11 Dm. Ulyanova street, 117292 Moscow

katerisaa_29@mail.ruhttps://orcid.org/0000-0001-9119-2447ПржиялковскаяЕ. Г.PrzhiyalkovskayaE. G.

Пржиялковская Елена Георгиевна, кандидат медицинских наук

SPIN-код: 9309-3256

Москва

Elena G. Przhiyalkovskaya, MD, PhD

Moscow

przhiyalkovskaya.elena@gmail.comhttps://orcid.org/0000-0002-6674-6441БелаяЖ. Е.BelayaZh. E.

Белая Жанна Евгеньевна, доктор медицинских наук, профессор

SPIN-код: 4746-7173

Москва

Zhanna E. Belaya, MD, PhD, Professor

Moscow

jannabelaya@gmail.comhttps://orcid.org/0000-0002-5634-7877МельниченкоГ. А.MelnichenkoG. A.

Мельниченко Галина Афанасьевна, доктор медицинских наук, профессор, академик РАН 

SPIN-код: 8615-0038

Москва

Galina A. Melnichenko, MD, PhD, acad.

Moscow

teofrast2000@mail.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation2022171220216814048Copyright © Сахнова Е.Е., Пржиялковская Е.Г., Белая Ж.Е., Мельниченко Г.А., 20222022Сахнова Е.Е., Пржиялковская Е.Г., Белая Ж.Е., Мельниченко Г.А.Sakhnova E.E., Przhiyalkovskaya E.G., Belaya Z.E., Melnichenko G.A.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/12791

Акромегалия — это редкое эндокринное заболевание, ассоциированное с множественными осложнениями и повышенной смертностью. Своевременная диагностика и адекватное лечение позволяют приблизить продолжительность жизни пациентов с акромегалией к общепопуляционному уровню. При скрининге, верификации диагноза и оценке эффективности различных методов лечения акромегалии используются следующие показатели: уровень гормона роста (соматотропного гормона, СТГ) в крови, как базальный, так и в ходе орального глюкозотолерантного теста (СТГ в ходе ОГТТ), и концентрация инсулиноподобного фактора роста-1 (ИФР-1). Вместе с тем в клинической практике до 39% пациентов с акромегалией имеют дискордантные результаты этих анализов. Ошибочная интерпретация не соответствующих друг другу лабораторных данных может приводить к гипердиагностике акромегалии или, наоборот, — несвоевременному выявлению заболевания, а также к избыточному назначению ненужных методов лечения или, в обратном случае, — длительному отсутствию адекватной терапии. В данном обзоре обсуждаются распространенность дискордантных результатов СТГ и ИФР-1 у пациентов с акромегалией; факторы, обуславливающие это расхождение, а также влияние несоответствия гормональных показателей на исходы лечения. Однозначного объяснения дискордантности уровней СТГ и ИФР-1 и руководства к ведению пациентов с акромегалией, имеющих такие результаты, к сожалению, в настоящее время не найдено. Специалисту крайне важно применять комплексный подход и учитывать все возможные факторы при интерпретации этих лабораторных показателей.

Acromegaly is a rare endocrine disorder associated with multiple complications and increased mortality. Timely diagnosis and adequate treatment can bring the life expectancy of patients with acromegaly closer to the general population level. The tests for the diagnosis of acromegaly are measurement of both serum GH, and GH after oral glucose administration; serum insulin-like growth factor-1 (IGF-1). However, in clinical practice, up to 39% of patients with discordant results are found. The patients with discordant GH and IGF-1levels, are the most difficult to manage. This review discusses the prevalence of discordant GH and IGF-1 outcomes in patients with acromegaly; factors causing this discrepancy; the impact of hormone levels on treatment outcomes. Although endocrinologists are used to dealing with this discrepancy in clinical practice for many years, discordant patients’outcome remains uncertain and undefined The optimal treatment should be individually tailored for each patient, taking into account all clinical parameters.

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