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Медикаментозная терапия инциденталом гипофиза

Анализ литературы показал, что несмотря на наличие теоретической основы для использования медикаментозной терапии инциденталом –присутствие активных рецепторов в опухолевой ткани, лекарственные препараты не нашли широкого применения. У пациентов с инциденталомами и сопутствующим умеренным повышением уровняпролактина, гиперпролактинемия может быть скорректирована назначением агонистов дофамина (58). В отличие от пролактином,указанные препараты не предназначены для уменьшения размеров инциденталомы, которые редко подвергаются обратному развитию. Критерием эффективности медикаментозной терапии считается уменьшение размеров опухолевой ткани более чем на 25-30% (63). В ряде работ рассматривалась возможность назначения агонистов дофамина пациентам с инциденталомами гипофиза с целью уменьшения размера образования. На фоне приема агонистов дофамина – каберголина или бромокриптин, уменьшение объемов образования наблюдалось в течение 1 года наблюдалось в 10-21,2 % случаев(42-44).Противоречивые результаты могут быть обусловлены применением различных препаратов и доз агонистов дофамина, а также наличием или отсутствием дофаминовых рецепторов в ткани опухоли.

Изучалась возможность применения аналогов соматостатина в лечении инциденталом гипофиза, учитывая что рецепторы соматостатина присутствуют во многих инциденталомах гипофиза (преимущественно 2 типа). При назначении препарата в течение 1 года уменьшение размеров наблюдалось в 5-25%, увеличение в 12%, стабилизация в 83% (45-48). Предпринимались попытки назначения комбинированной терапии агонистами дофамина и аналогами соматостатина. При применении сочетанной терапии октреотидоми каберголиному 60% пациентов наблюдалось уменьшение размеров опухоли на 10%. В другом исследовании, в которое было включено 10 пациентов, перенесших нейрохирургическоелечение без положительного эффекта, использовались пролонгированные формы октреотида и каберголин по 0,5 мг через в день в течение 6 месяцев. Отмечалось значимое уменьшение размеров образования (более 30%), сопровождавшееся улучшением зрительной функции (72).

Эксперты рабочей группы убеждены, что оказание медицинской помощи согласно Федеральным клиническим рекомендациям может существенно повысить ее эффективность. Однако данные рекомендации требуют персонифицированного подхода - тщательной оценки индивидуальных особенностей пациента, результатов лабораторно-инструментального обследования, на основании чего лечащий врач самостоятельно должен выработать оптимальную тактику ведения пациента.

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