medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-178medsovet-9111Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYНовые возможности лечения акромегалии и поражения опорно-двигательного аппарата при акромегалии: акцент на антагонисты соматотропного гормонаAddressing acromegaly and its musculoskeletal complications through new treatment strategies: Focus on growth hormone antagonistshttps://orcid.org/0000-0002-9574-105XВорохобинаН. В.VorokhobinaN. V.

Ворохобина Наталья Владимировна, д.м.н., профессор, заведующая кафедрой эндокринологии имени академика В.Г. Баранова

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 

Natalia V. Vorokhobina, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology named after Academician V.G. Baranov

41, Kirochnaya St., St Petersburg, 191015, Russia

natvorokh@mail.ruhttps://orcid.org/0000-0001-8734-2449ФогтС. Н.FogtS. N.

Фогт Сергей Николаевич, к.м.н., доцент кафедры эндокринологии имени академика В.Г. Баранова

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 

Sergei N. Fogt, Cand. Sci. (Med.), Associate Professor of the Department of Endocrinology named after Academician V.G. Baranov

41, Kirochnaya St., St Petersburg, 191015, Russia

s_fogt@mail.ruhttps://orcid.org/0000-0003-4990-5946КузнецоваА. В.KuznetsovaA. V.

Кузнецова Алла Васильевна, к.м.н., доцент, доцент кафедры эндокринологии имени академика В.Г. Баранова

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 

Alla V. Kuznetsova, Cand. Sci. (Med.), Associate Professor of the Department of Endocrinology named after Academician V.G. Baranov

41, Kirochnaya St., St Petersburg, 191015, Russia

all-kuznetsova@yandex.ruhttps://orcid.org/0000-0002-1977-8299БаландинаК. А.BalandinaK. A.

Баландина Ксения Александровна, к.м.н., доцент кафедры эндокринологии имени академика В.Г. Баранова

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 

Kseniya A. Balandina, Cand. Sci. (Med.), Associate Professor of the Department of Endocrinology named after Academician V.G. Baranov

41, Kirochnaya St., St Petersburg, 191015, Russia

ksenya_sautina@mail.ruhttps://orcid.org/0000-0003-3599-3199ГалаховаР. К.GalakhovaR. K.

Галахова Равиля Камильевна, к.м.н., доцент кафедры эндокринологии имени академика В.Г. Баранова

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 

Ravilya K. Galakhova, Cand. Sci. (Med.), Associate Professor of the Department of Endocrinology named after Academician V.G. Baranov

41, Kirochnaya St., St Petersburg, 191015, Russia

rgalakhova@gmail.comСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation20252405202506117123Copyright © Ворохобина Н.В., Фогт С.Н., Кузнецова А.В., Баландина К.А., Галахова Р.К., 20252025Ворохобина Н.В., Фогт С.Н., Кузнецова А.В., Баландина К.А., Галахова Р.К.Vorokhobina N.V., Fogt S.N., Kuznetsova A.V., Balandina K.A., Galakhova R.K.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/9111

Акромегалия является редким, но тяжелым полиорганным заболеванием, негативно влияющим на качество и продолжительность жизни пациентов. Этому способствует формирование патологического комплекса прогрессирующих гормональных, метаболических и системных нарушений, каждое из которых является независимым фактором риска ранней инвалидизации и преждевременной смерти. При акромегалии развивается поражение опорно-двигательного аппарата вследствие гиперпродукции соматотропного гормона и инсулиноподобного фактора роста-1, увеличивается регенерация костной ткани с изменением кортикальных и трабекулярных структур костей. Активность остеокластов превышает активность остеобластов, что приводит к специфическим микроархитектурным изменениям губчатой кости и потере костной массы. Характерными нарушениями опорно-двигательного аппарата у пациентов с акромегалией являются гипертрофические артропатии периферического и осевого скелета, заболевания височно-нижнечелюстного сустава, синдром запястного канала, что снижает качество жизни пациентов даже после нормализации секреции гормонов. Вопрос выбора терапии у пациентов с акромегалией при остеоартропатии изучен недостаточно. Медикаментозная терапия акромегалии является важным этапом как для предоперационной подготовки пациентов, так и для последующего лечения. В случае частичной или полной резистентности к монотерапии аналогами соматостатина или их непереносимости в качестве рекомендуемой терапии целесообразно использование группы антагонистов рецепторов соматотропного гормона – пэгвисоманта. Препарат блокирует действие избытка гормона роста, приводит к снижению концентрации инсулиноподобного фактора роста-1 в сыворотке крови, а также сывороточных белков, чувствительных к гормону роста, включая свободный инсулиноподобный фактор роста-1; модулирует пролиферацию, дифференцировку и минерализацию клеток остеобластов; обладает высокой селективностью в отношении рецепторов гормона роста и не взаимодействует с рецепторами других гормонов, включая пролактин. Данный вид терапии обладает высокой эффективностью, позволяет нивелировать неблагоприятное влияние аналогов соматостатина на углеводный обмен, стабилизировать рост опухоли гипофиза. Особенностью действия пэгвисоманта является возможность влияния на пролиферацию, дифференцировку и минерализацию клеток остеобластов, что снижает частоту переломов позвоночника у пациентов с акромегалией.

Acromegaly is a rare but severe multi-organ disease that negatively affects the quality and duration of patients’ lives. This is exacerbated by the formation of a pathological complex of progressive hormonal, metabolic, and systemic disorders, each of which is an independent risk factor for early disability and premature death. In acromegaly, damage to the musculoskeletal system occurs due to the hyperproduction of growth hormone and insulin-like growth factor-1, leading to increased regeneration of bone tissue with changes in the cortical and trabecular structures of the bones. The activity of osteoclasts exceeds that of osteoblasts, resulting in specific microarchitectural changes in trabecular bone and loss of bone mass. Characteristic musculoskeletal disorders in patients with acromegaly include hypertrophic arthropathies of the peripheral and axial skeleton, temporomandibular joint diseases, and carpal tunnel syndrome, which diminish the quality of life for patients even after normalization of hormone secretion. The issue of therapy selection for patients with acromegaly and osteoarthropathy has been insufficiently studied. Medical therapy for acromegaly is an important stage both for the preoperative preparation of patients and for subsequent treatment. In cases of partial or complete resistance to monotherapy with somatostatin analogs or their intolerance, the use of a growth hormone receptor antagonist, specifically pegvisomant, is advisable as a recommended therapy. This drug suppresses the action of excess growth hormone, reduces the concentration of insulin-like growth factor-1 in the serum, as well as serum proteins sensitive to growth hormone, including free insulin-like growth factor-1; it modulates the proliferation, differentiation, and mineralization of osteoblast cells; it exhibits high selectivity for growth hormone receptors and does not interact with the receptors of other hormones, including prolactin. This type of therapy is highly effective, neutralizes the adverse effects of somatostatin analogs on carbohydrate metabolism, and stabilizes tumor growth. A distinctive feature of pegvisomant’s action is its ability to influence the proliferation, differentiation, and mineralization of osteoblast cells, which reduces the frequency of spinal fractures in patients with acromegaly.

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