简垂体瘤术后激素替代.ppt

*Thisstudyconsistedofthefollow-upof85GH-deficientadults?whocompletedtheNottinghamHealthProfile(NHP)andthePsychological?GeneralWell-BeingSchedule(PGWB)self-ratingquestionnairesin1992,as?partofa12-monthdouble-blindrandomizedstudyofGHreplacement.In?2001weattemptedtocontactall85patientsandaskedthemtocomplete?thetwoquestionnairesagain.Follow-updatawereobtainedin61patients.?BoththeNHPandthePGWBgiveatotalscoreand?subsectionscoresforsixspecificareasofQoL.Ahighscorecorrelates?withincreasedmorbidityintheNHP,andwithreducedmorbidityinthe?PGWB.***仅用于严重GH缺乏或明显骨质疏松?起始：小剂量(0.15-0.3mgiH.HS)(老年人0.1mg/d)?剂量调节：个体化（根据临床反应和IGF-1）（年龄轻/IGF-1低/雌激素激素替代可能增加GH剂量；年龄老/IGF-1高/停雌激素激素/用雄激素/血糖升高/副作用时减少GH剂量）?4-6月调整1次剂量，终剂量很少超过1mgQd（以最小维持量维持）(1mg=3iu*AdaptedfromCooketal.JClinEndocrinolMetab1999;84:3956–60GH-deficientwomentreatedwithGHandreceivingoraloestrogenrequiretwiceasmuchGHtomaintainserumIGF-Ilevelsintheupperpartofthenormalrangeaswomenreceivingtransdermaloestrogen.ThisfigureshowsthetimecourseofGHdose(μg/kg/day)andIGF-Ilevels(ng/ml)inapatientwhowasswitchedfromoraltotransdermaloestrogenduringhercourseoftreatment.Within2weeksofchangingtherouteofadministration,thepatientcomplainedofadverseeffectsduetoGHexcess(muscleandjointaching)andhadanelevatedIGF-Ilevel.AfterreductionoftheGHdosetohalfofthatpreviouslyusedwhenonoraloestrogen,symptomsofGHexcesswererelievedandIGF-Iwasnormalized.Thus,ifoestrogenisreplacedtransdermallyinwomen,GHrequirementsaremuchlessthanwhenreceivingoraloestrogentherapy.TheeffectoforaloestrogenonliverIGF-Iproductionisprobablyduetothehigherconcentrationsofoestrogenasitpassesthroughtheliver.ThisobservationhasimplicationsintermsofthecostofGH.Thecostcanbesignificantlyreducedifwomenn