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10 Streszczenia Warszawa.P65 II Zjazd Polskiego Towarzystwa Neuroendokrynologicznego Streszczenia prac przedstawionych na II Zjeździe Polskiego Towarzystwa Neuroendokrynologicznego SESJA I — Neuropeptydy i ich analogi gastryna. Przedoperacyjne zastosowanie LRS u większości chorych S1.03. Kliniczne zastosowanie analogów somatosatyny doprowadziło do zahamowania czynności wydzielniczej nowotwo- ru. Towarzyszyła temu poprawa kliniczna umożliwiająca bezpiecz- Wojciech Zgliczyński ne przeprowadzenie zabiegu operacyjnego. U chorych z ektopo- Klinika Endokrynologii CMKP, Warszawa wym wydzielaniem ACTH i uogólnionym procesem nowotworo- wym przewlekłe leczenia LRS lub zastosowanie znakowanych izo- Gruczolaki przysadki (głównie wydzielające GH i TSH), wyspiaki topem analogów somatostatyny — 90Y-DOTA-TOC spowodowało trzustki (gastrinoma, glukagonoma, rzadziej insulinoma), guzy rdze- remisję objawów hiperkortyzolemii. nia nadnerczy (pheochromocytoma), nowotwory z komórek około- W guzach neuroendokrynnych przewodu pokarmowego (GEP), pęcherzykowych tarczycy (rak rdzeniasty) oraz rakowiaki — głów- z których około 80% wykazuje ekspresję receptora somatostatyny nie przewodu pokarmowego, ale również płuc, grasicy, jajników typ 2, scyntygrafia tych receptorów przy użyciu oktreotydu zna- — posiadają receptory dla somatostatyny. Zsyntetyzowanie ana- kowanego 111In lub 99mTc wydaje się być najlepszą metodą ich obra- logów somatostatyny — ligandów receptora somatostatynowego zowania. Metoda ta jest szczególnie skuteczna w lokalizacji guzów (LRS): oktreotydu, lanreotydu i vapreotydu stworzyło nowe perspek- typu gastrinoma, glukagonoma, nieczynnych guzów trzustki i rako- tywy dla endokrynologii klinicznej. Ligandy receptora somatosta- wiaków oraz ich przerzutów. Analogi somatostatyny znalazły też tynowego znalazły zastosowanie w scyntygraficznych badaniach zastosowanie w leczeniu objawowym guzów neuroendokrynnych, lokalizacyjnych, leczeniu farmakologicznym i radioizotopowym przede wszystkim w zespole rakowiaka, glukagonoma i VIP-oma. nowotworów gruczołów dokrewnych wykazujących ekspresję re- U większości chorych z GEP zastosowanie LRS daje wyraźną po- ceptorów somatostatyny. prawę kliniczną i zmniejszenie lub całkowite ustąpienie dolegliwo- W somatotropowych gruczolakach przysadki przebiegających ści. W sposób istotny poprawia to komfort życia i wpływa korzyst- z objawami akromegalii w badaniach scyntygraficznych z zastoso- nie na rokowanie. Stabilizacja wielkości guza zdarza się w połowie 111 waniem oktreotydu znakowanego indem ( In-octreoscan), wyka- przypadków, natomiast zmniejszenie wielkości guza znacznie rza- zano obecność receptorów dla somatostatyny. Nie wykazano jed- dziej. U chorych z guzami GEP w okresie uogólnionego procesu nak przewagi tej metody w lokalizacji guzów nad ich obrazowa- nowotworowego jako leczenie paliatywne stosowana jest terapia niem za pomocą MR. Na podstawie wyniku octreoscanu trudno LRS sprzężonymi z radioizotopami. również przewidzieć skuteczność leczenia LRS, która w akromegalii Podsumowanie: Wprowadzenie LRS stało się przełomem w roz- dotyczy około 50% przypadków. Alternatywą dla chorych nieodpo- poznawaniu i leczeniu nowotworów gruczołów dokrewnych. Li- wiadających na to leczenie może być zastosowanie nowo zsyntetyzo- gandy receptora somatostatynowego znalazły zastosowanie zarów- wanych LRS o powinowactwie do większości z wszystkich 5 podty- no w diagnostyce lokalizacyjnej guzów neuroendokrynnych (octre- pów receptora somatostatyny, jak na przykład SOM 230. Skuteczność oscan), jak i w leczeniu gruczolaków przysadki wydzielających GH tego nowego LRS ostatnio wykazano również w gruczolakach korty- i TSH. Zastosowanie LRS jest postępowaniem z wyboru w lecze- kotropowych, przebiegających z objawami choroby Cushinga. niu zespołu rakowiaka, VIP-oma, glukagonoma. Obiecującym też Wykazaliśmy, że przedoperacyjne zastosowanie LRS, takich jak lan- jest zastosowanie LRS w celowanej terapii radioizotopowej u cho- reotyd i oktreotyd o przedłużonym działaniu nie tylko prowadzi rych z GEP w okresie uogólnienia procesu nowotworowego. MATERIAŁY ZJAZDOWE do poprawy klinicznej, ale istotnie zwiększa skuteczność opera- cyjnego leczenia akromegalii. W tyreotropinoma z objawami nadczynności tarczycy przedopera- Clinical applicability of somatostatin analogs cyjne zastosowanie LRS doprowadziło do szybkiego ustąpienia nadczynności tyreotoksykozy. Umożliwiło to skuteczne usunięcie Wojciech Zgliczyński guza przysadki i definitywne wyleczenie 9 spośród 10 leczonych Department of Endocrinology, Medical Center for Postgraduate Education, tym sposobem. Natomiast u żadnego z 8 pacjentów operowanych Warsaw bez przygotowania LRS nie uzyskano wyleczenia. W przypadkach nowotworów przebiegających z objawami ekto- Somatostatin receptors are present in hypophysial adenomas (se- powego wydzielania ACTH badanie z zastosowaniem LRS znako- creting mainly GH and TSH), insuloma (gastrinoma, glucagono- wanych 111In lub 99mTc przyczyniło się do lokalizacji ognisk — głów- ma, more seldom insulinoma), tumors of adrenal medulla (phe- nie rakowiaka płuc i grasicy z nadmiernym wydzielaniem korty- ochromocytoma), parafollicular cells neoplasms of thyroid gland kotropiny oraz amin i peptydów jak serotonina, chromogranina, (medullary carcinoma) as well as carcinoids — mainly of alimenta- 672 Endokrynologia Polska/Polish Journal of Endocrinology 2006; 6 (57) ry tract, but also of lungs, thymus and ovaries. Somatostatin recep- granin, serotonin and gastrin. In the majority of patients preopera- tor ligands (SRL): ocreotide, lanreotide and vapreotide — created tive treatment with SRL caused suppresion of tumors secretory ac- neoplasia new perspective for clinical endocrinology. SRL have fo- tivity. Clinical improvement was achieved, which enabled a safe und application in scintiscanner localizing examinations as well as surgery. Patients with ectopic secretion of ACTH and generalized in pharmacological and radioisotope treatment of endocrine neo- neoplasmatic disease who were undergoing a prolonged treatment plasia with expression of somatostatin receptors. with SRL or with isotope labeled somatostatin analogs — 90Y-DOTA- In somatotropic hypophysial adenomas with the symptoms of acro- TOC experienced reduction of hypercortisolemia. megaly presence of somatostatin receptors were shown in scinti- In patients with neuroendocrine tumors of alimentary tract (GEP/NET) scanner examination with ocreotide labeled marked Indium (111In). 80% of whom show expression of somatostatin type 2 receptor, the However, the superiority of this method over MR imaging in locali- best method of imaging seems to be scintiscanning of the receptors zing tumors was not shown. It is also difficult to forecast predict the with the use of Indium or Technetium labeled octreotide. This me- efficacy of SRL treatment, which in acromegaly is about 50% of cases. thod is especially efficient in localization of tumors of the gastrinoma For not responding patients the alternative may be treatment with and glucagonoma type, inactive pancreatic tumors and carcinoids, as newly synthesized SRL with affinity to all 5 sub-types of somato- well as their metastases. Somatostatin analogs found use also in symp- statin receptor — for example SOM 230. The efficacy of this new tomatic treatment of neuroendocrine tumors, first and foremost in car- SRL was recently shown for corticotropic adenomas with the symp- cinoid syndrom, glucagonoma and VIP-oma. Most patients with GEP toms of Cushing’s disease. experience clear improvement in clinical status and lessening or total We have shown that preoperative treatment with SRL such as pro- ceasing of discomfort. The quality of life is essentially improved which longed activity lanreotide and octreotide gives not only clinical has positive effect on prognosis. In half of cases a stabilization of tu- improvement but substantially increases the efficacy of surgical tre- mors’ dimension occurs, however diminishing of the tumor occurs atment of acromegaly. much more seldom. In patients with GEP-type tumors in the period Preoperative treatment with SRL in cases of tyreotropinoma with of generalized neoplasmatic disease, SRL therapy conjugated with ra- symptoms of hyperthyreosis have led to fast normalizing of the dioisotopes is used as a palliative treatment. thyroid gland function. Successful removal of pituitary gland tu- Summary: Introduction of SRL was a step forward in diagnosis mor was thus enabled and definite cure of 9 out of 10 patients fol- and treatment of endocrine glands’ cancers. SRL found use both in lowed. In contrast the cure was not obtained in any of the 8 pa- localizing diagnostic of neuroendocrine tumors (octreoscan) and tients who underwent surgery without prior treatment with SRL. in treatment of hypophysial adenomas secreting GH and TSH. SRL In cancers with symptoms of ectopic secretion of ACTH examina- is a treatment of choice for carcinoid syndrom, glucagonoma and tion with Indium 111 or Technetium 99m labeled SRL was useful VIP-oma. Application of SRL is also promising in targeted radio- in localization of carcinoids’ foci, mainly of lungs and thymus, with isotope therapy in patients with GEP-type tumors in the period of excessive secretion of corticothropin and peptides such as chromo- generalized neoplasmatic disease. SESJA II — Choroby podwzgórza i przysadki cz. I Wyniki: Stwierdzono następującą częstość występowania podty- S2.01. Receptory somatostatynowe w „klinicznie pów r-sst w badanych guzach: nieczynnych hormonalnie” gruczolakach przysadki sst5 > sst1 > sst2A = sst2B > sst3
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