Abstract

CHIH HAO, Chen-Ku. Guías para el diagnóstico y tratamiento de acromegalia, prolactinomas y enfermedad de Cushing. Acta méd. costarric [online]. 2004, vol.46, suppl.1, pp.25-36. ISSN 0001-6002.

The most frequent functioning pituitary adenomas are those who that produce prolactin (prolactinomas), growth hormone (acromegaly) and ACTH (Cushing’s disease). There are different opinions about the diagnosis and treatment of these diseases. We present here the guidelines for diagnosis and treatment of these tumors made by the Costa Rican Association of Endocrinology, Diabetes and Nutrition. The main cause of acromegaly is a pituitary tumor that produces growth hormone. The diagnosis is usually made several years after the disease has started because the physical changes occur very slowly. The initial treatment should be surgery and when it fails, medical therapy with octreotide is the main choice. Radiotherapy can be used although it is limited by the long time it takes to start its effect. If there is hyperprolactinemia, other causes of prolactin elevation should be ruled out. If a prolactinoma is identified, the treatment almost always will be with dopamine agonists. Surgery should be performed only in macroprolactinomas with visual field changes that do not shrink with medical treatment. The first choice for medical treatment will be bromocriptine although there are other agents like cabergoline and quinagolide. In Cushing´s disease, there are different tests for screening for hypercortisolism, after which a confirmatory test should be performed. Initial treatment should be surgery followed by radiotherapy. In these cases, medical treatment is less effective than in other pituitary tumors.

Keywords : acromegalia; prolactinoma; enfermedad de Cushing; guías de tratamiento.