Aspectos epidemiológicos da acromegalia causada por secreção ectópica de hormônio liberador de hormônio do crescimento: revisão sistemática.

Abstract

Introduction. Acromegaly is a hormonal change due to the release of excess growth hormone (GH) by the pituitary gland (pituitary), during adulthood, making hands, feet and other body parts to increase in size due to the overgrowth of parts mol. Among the various etiologies, tumor of ectopic location, in other words, outside their usual place (hypothalamic-pituitary axis), which produces releasing hormone growth hormone (GHRH) is 0.5 to 5.0 percent of cases acromegaly. Objectives. Develop a systematic review on the epidemiological profile of patients with acromegaly caused by ectopic tumors of GHRH; identify the main surgical correlations and triggering mechanisms of ectopic tumors of GHRH; Identify possible risk factors of patients with ectopic tumors of GHRH; investigate suspicious signals for diagnosis of patients with acromegaly by ectopic tumors GHRH. Methodology. Systematic Review of cases reports and serial cases studies using the keywords "Acromegaly", "Tumor" and "Growth hormone releasing hormone", in virtual libraries MEDLINE / PubMed (Medical Literature Analysis and Retrieval System Online), Web of Science, Scopus, OneFile (Gale) and Medknow Publications from January 2005 to December 2015. Results. There is no correlation between gender and acromegaly by secreting ectopic tumors of GHRH, 1 woman to 1.3 man. The age at diagnosis averaged 40.7 years, with 83.3% of patients between 20 and 60 years. MEN-1 (Multiple Endocrine Neoplasia type 1) was diagnosed in 33.3% of patients. Histopathological type most prevalent tumor was well differentiated neuroendocrine carcinoma (CEBD), 10 patients. The CEBD had a 63.6% rate of metastasis. The sites of greatest prevalence are pancreatic and lung cancers, 14 and 11 patients, respectively. Tumor resection was performed in 21 patients. Cranial magnetic resonance imaging was performed in 90% patients to rule out the central cause of acromegaly. CT scans of the abdomen and chest had high completion rates for the location of the primary tumor. In the past 20 years, we can see the growth in the number of cases diagnosed with the use of octreotide scan, used in 18 of these the total of 20 cases of the period. Conclusion. The most affected age group was between 21 and 59, there is no statistically significant difference was found with regard to the sex. There is an association of the disease with the presence of NEM-1, especially in pancreatic tumors. As to the secreting types of ectopic GHRH tumors found it demonstrated a predominance of lung carcinoids, being followed by the pancreas. For the diagnose, the most imaging used is computed tomography (TCAR), but magnetic resonance imaging (RNM) was used at an initial stage to identify whether or not pituitary adenomas. The octreotide scan was the best innovation in the last 20 years, resulting in a large increase in the number of diagnosed cases.