Acromegalia y gigantismo diagnóstico y tratamiento. Revisión Sistemática

Abstract

Background: Acromegaly and gigantism are complex disorders that present significant diagnostic challenges, with an annual incidence of three to four new cases per million inhabitants. Objective: To describe the various diagnostic and therapeutic approaches for the treatment of patients with acromegaly and gigantism. Methods: A systematic review of studies published between 2019 and 2023 was conducted using databases such as PubMed, Scopus, Elsevier, Clinical Endocrinology, and SciELO. Results: Seventeen articles in Spanish and English met the inclusion criteria. Clinical suspicion contributed to the initial diagnosis in 60% to 98.5% of cases. Serum growth hormone (GH) levels and insulin-like growth factor I (IGF-I) were identified as initial biochemical tests, with usage rates between 71.3% and 86%. Regarding treatment, cabergoline showed low efficacy in acromegaly management (37%) compared to somatostatin analogs such as octreotide (81.6%) and lanreotide (82%) (p = 0.001). Pegvisomant (PEGV) achieved an effectiveness of 62.9% (p < 0.001). Surgical intervention demonstrated a 70% success rate in acromegaly caused by microadenomas and 64.9% in macroadenomas, with complete remission reaching 76% when postoperative adjuvant therapy ―such as radiotherapy― was employed (p = 0.02). Conclusion: Acromegaly and gigantism are rare and often underdiagnosed conditions, primarily due to a lack of awareness in clinical practice. Diagnosis begins with clinical evaluation, hormonal laboratory tests, and imaging studies. Currently, a wide range of pharmacological and surgical treatment options are available, aimed at improving patient prognosis. Keywords: acromegaly, gigantism, growth hormone (GH), endocrinology, adenoma