BEZERRA, G. B. V. N.; MIRANDA JUNIOR, M. G.; http://lattes.cnpq.br/0869295979421238; http://lattes.cnpq.br/0769845116573347; BEZERRA, Giorgi Bella Varga Nobre.; MIRANDA JUNIOR, Marcos Guedes.
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.