medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-147medsovet-8273Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYПредикторы морфофункциональных особенностей соматотрофных опухолей и эффективности лечения аналогами соматостатина 1-й генерацииPredictors of morphofunctional features of somatotrophic tumors and of the effectiveness of treatment with first-generation somatostatin receptor ligandshttps://orcid.org/0000-0001-6094-3623ПронинЕ. В.ProninE. V.

Пронин Евгений Вячеславович, врач-эндокринолог высшей категории эндокринологического отделения для взрослых

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Evgeny V. Pronin, Endocrinologist of the Highest Category of the Endocrinological Department for Adults

37, Bldg. 1, Prechistenka St., Moscow, 119034

r-wp@mail.ruhttps://orcid.org/0000-0001-5045-798XПронинВ. С.ProninV. S.

Пронин Вячеслав Сергеевич, д.м.н., профессор кафедры эндокринологии, Российская медицинская академия непрерывного профессионального образования

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Vyacheslav S. Pronin, Dr. Sci. (Med.), Professor of the Endocrinology Department

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

spronin@yandex.ruhttps://orcid.org/0000-0002-9944-2997АнциферовМ. Б.AntsiferovM. B.

Анциферов Михаил Борисович, д.м.н., профессор, главный внештатный специалист Департамента здравоохранения города Москвы по эндокринологии, президент, Эндокринологический диспансер

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Mikhail B. Antsiferov, Dr. Sci. (Med.), Professor, Chief Freelance Specialist of the Moscow Department of Health in Endocrinology, President, Endocrinological Dispensary

37, Bldg. 1, Prechistenka St., Moscow, 119034

antsiferov@rambler.ruhttps://orcid.org/0000-0003-1694-4682ПетряйкинА. В.PetryaykinA. V.

Петряйкин Алексей Владимирович, д.м.н., врач-рентгенолог, ведущий научный сотрудник

127051, Москва, ул. Петровка, д. 24, стр. 1

Alexey V. Petraikin, Dr. Sci. (Med.), Radiologist, Leading Researcher

24, Bldg. 1, Petrovka St., Moscow, 127051

alexeypetraikin@gmail.comhttps://orcid.org/0000-0003-0066-845XАлексееваТ. М.AlexeevaT. M.

Алексеева Татьяна Марковна, врач-эндокринолог высшей категории, заведующая эндокринологическим отделением для взрослых

119034, Москва, ул. Пречистенка, д. 37, стр. 1

Tatiana M. Alexeeva, Endocrinologist of the Highest Category of the Endocrinological Department for Adults

37, Bldg. 1, Prechitenka St., Moscow, 119034

mamamarka@yandex.ruhttps://orcid.org/0000-0003-4353-6705ЛапшинаА. М.LapshinaA. M.

Лапшина Анастасия Михайловна, к.м.н., врач-патологоанатом

115478, Москва, ул. Дмитрия Ульянова, д. 11

Anastasia M. Lapshina, Cand. Sci. (Med.), Pathologist

11, Dmitry Ulyanov St., Moscow, 115478

https://orcid.org/0000-0001-6891-0009УрусоваЛ. С.UrusovaL. S.

Урусова Лилия Сергеевна, к.м.н., руководитель референс-центра патоморфологических и иммуногистохимических методов исследований

115478, Москва, ул. Дмитрия Ульянова, д. 11

Liliya S. Urusova, Cand. Sci. (Med.), Head of the Reference Center for Pathomorphological and Immunohistochemical Research Methods

11, Dmitry Ulyanov St., Moscow, 115478

https://orcid.org/0000-0003-4857-5404ХоружаяА. Н.KhoruzhayaA. N.

Хоружая Анна Николаевна, врач-рентгенолог, младший научный сотрудник

127051, Москва, ул. Петровка, д. 24, стр. 1

Anna N. Khoruzhaya, Radiologist, Junior Researcher

24, Bldg. 1, Petrovka St., Moscow, 127051

a.khoruzhaya@npcmr.ruhttps://orcid.org/0009-0006-4140-0942ТамаеваС. М.TamaevaS. M.

Тамаева Сафи Мухтаровна, студент

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Safi M. Tamaeva, Student

8, Bldg. 2, Trubetskaya St., Moscow, 119991

safitamaeva@yandex.ruЭндокринологический диспансерРоссияEndocrinological DispensaryRussian FederationЭндокринологический диспансер; Российская медицинская академия непрерывного профессионального образованияРоссияEndocrinological Dispensary; Russian Medical Academy of Continuous Professional EducationRussian FederationНаучно-практический клинический центр диагностики и телемедицинских технологийРоссияScientific and Practical Clinical Center for Diagnostics and Telemedicine TechnologieRussian FederationНациональный медицинский исследовательский центр эндокринологииРоссияNational Medical Research Center of EndocrinologyRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2024190520240698111Copyright © Пронин Е.В., Пронин В.С., Анциферов М.Б., Петряйкин А.В., Алексеева Т.М., Лапшина А.М., Урусова Л.С., Хоружая А.Н., Тамаева С.М., 20242024Пронин Е.В., Пронин В.С., Анциферов М.Б., Петряйкин А.В., Алексеева Т.М., Лапшина А.М., Урусова Л.С., Хоружая А.Н., Тамаева С.М.Pronin E.V., Pronin V.S., Antsiferov M.B., Petryaykin A.V., Alexeeva T.M., Lapshina A.M., Urusova L.S., Khoruzhaya A.N., Tamaeva S.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8273Введение

Введение. Своевременная дифференциальная диагностика плотнои редкогранулированных соматотрофных опухолей позволяет предсказать наиболее вероятный сценарий течения акромегалии, рецепторный фенотип и пролиферативный потенциал опухолевых клеток, риск продолженного послеоперационного роста, а также результативность планируемой медикаментозной терапии аналогами соматостатина 1-й генерации.

Цель

Цель. Проанализировать цитологические, радиологические и терапевтические предикторы, позволяющие оценивать морфофункциональный состав соматотрофных опухолей и прогнозировать чувствительность к аналогам соматостатина 1-й генерации.

Материалы и методы

Материалы и методы. Обследованы 525 больных акромегалией (153 мужчины) в возрасте 60,2 ± 14,0 года, получающих медикаментозную терапию аналогами соматостатина 1-й генерации в течение 72,0 ± 51,9 мес.

Результаты

Результаты. Эффективность лечения оценивалась по итоговому уровню инсулиноподобного фактора роста-1 индекса (≤1) и сопоставлялась с данными патоморфологического (97 пациентов) и повторного радиологического (53 пациента) обследования. Исследовано влияние клеточного состава плотнои редкогранулированных соматотрофных опухолей на иммуногистохимические и радиологические характеристики с обозначением ведущих предикторов морфологической идентификации соматотрофных опухолей. Предложены дополнительные радиомаркеры по количественной оценке относительной интенсивности опухолевого сигнала на Т2-, Т1и (Т2-Т1)-взвешенных магнитно-резонансных изображениях для неинвазивной дифференциальной диагностики плотнои редкогранулированных соматотрофных опухолей и определения оптимальной тактики лечения. Обоснована целесообразность использования фармакотерапевтического тестирования с кратковременным (3–6 мес.) лечением аналогами соматостатина 1-й генерации для оценки интактности рецепторных и пострецепторных механизмов и выбора оптимальной медикаментозной терапии.

Заключение

Заключение. Прецизионный подход на основе комплексных клинических, радиологических, патоморфологических и функциональных характеристик позволяет стратифицировать пациентов с акромегалией для оптимизации лечебного пособия. Достижение контроля акромегалии при медикаментозной терапии аналогами соматостатина 1-й генерации зависит от объема и гормональной активности опухоли, абсолютной и относительной экспрессии 2-го подтипа соматостатиновых рецепторов, выраженности деструктивных изменений и особенностей клеточного состава. При рефрактерности к аналогам соматостатина 1-й генерации целесообразным является решение вопроса о лечении пэгвисомантом.

Introduction

Introduction. Timely differential diagnosis between densely and sparsely granulated somatotrophic tumors allows predicting the most probable scenario of acromegaly course, receptor phenotype and proliferative potential of tumor cells, risk of continued postoperative growth, as well as the efficacy of planned drug therapy with first-generation somatostatin receptor ligands.

Aim

Aim. To validate cytological, radiological and therapeutic predictors allowing to evaluate the morphofunctional composition of somatotrophic tumors and to predict sensitivity to first-generation somatostatin receptor ligands.

Materials and methods

Materials and methods. 525 patients (153 men) aged 60.2 ± 14.0 years receiving drug therapy with first-generation somatostatin receptor ligands for 72.0 ± 51.9 months were examined.

Results

Results. Treatment efficacy was evaluated according to the final level of IGF-1 index (≤1) and compared with the data of pathomorphologic (97 patients) and repeated radiologic (53 patients) examination. The influence of cellular composition of densely and sparsely granulated somatotrophic tumors on immunohistochemical and radiologic characteristics with the designation of leading predictors of morphologic identification of somatotrophic tumors was investigated. Additional radio markers for quantitative assessment of relative intensity of tumor signal on T2-, T1and (T2-T1)-weighted MRI for non-invasive differential diagnostics of densely and sparsely granulated somatotrophic tumors and determination of optimal treatment tactics were proposed. The expediency of using pharmacotherapeutic testing with short-term (3–6 months) first-generation somatostatin receptor ligands administration to assess the intactness of receptor and postreceptor mechanisms and to choose optimal drug therapy was substantiated.

Conclusion

Conclusion. The precision approach based on comprehensive clinical, radiological, pathomorphological and functional characteristics allows stratification of patients with acromegaly to optimize treatment benefit. Achievement of acromegaly control in drug therapy with first-generation somatostatin receptor ligands depends on tumor volume and its hormonal activity, absolute and relative expression of the 2nd subtype of somatostatin receptors, severity of destructive changes and features of cellular composition. In case of refractoriness to first-generation somatostatin receptor ligands, the use of pegvisomant is expedient.

акромегалиясоматотрофные опухолипрецизионная медицина2-й подтип соматостатиновых рецепторовфиброзные тельцаТ2-взвешенные изображенияТ1-взвешенные изображения(Т2-Т1)-взвешенные изображениямедикаментозная терапияаналоги соматостатина 1-го поколенияпэгвисомантacromegalysomatotrophic tumorsprecision medicineT2-weighted MRIT1-weighted MRI(T2-T1)-weighted MRIdrug therapyfirst-generation somatostatin receptor ligandspegvisomantReferencesAsa SL, Kucharczyk W, Ezzat S. Pituitary acromegaly: not one disease. Endocr Relat Cancer. 2017;24(3):C1–C4. https://doi.org/10.1530/erc-16-0496.Asa SL, Kucharczyk W, Ezzat S. Pituitary acromegaly: not one disease. Endocr Relat Cancer. 2017;24(3):C1–C4. https://doi.org/10.1530/erc-16-0496.Lenders NF, Earls PE, Inder WJ, McCormack AI. The evolution in pituitary tumour classification: a clinical perspective. Endocr Oncol. 2023;3(1):e220079. https://doi.org/10.1530/EO-22-0079.Lenders NF, Earls PE, Inder WJ, McCormack AI. 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The authors declare that there are no conflicts of interest present.