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Feokhromotsitoma: klinicheskie rekomendatsii I mezhdunarodnogo Simpoziuma (ISP)

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Abstract


В рамках I Международного симпозиума по феохромоцитоме (ISP), проведенного в октябре 2005, была обсуждена концепция в отношении катехоламин-продуцирующих опухолей. Были выработаны рекомендации по биохимической и топической диагностике, генетическому обследованию и лечению. В качестве главного диагностического теста и самого точного метода скрининга было рекомендовано определение плазменных или мочевых фракций метанефринов; доверительные интервалы значений метанефринов продемонстрировали наибольшую чувствительность и специфичность. Выбор методов топической диагностики должен основываться на принципе клинической целесообразности. Предоперационная фармакологическая блокада при феохромоцитоме признана обязательной. Генетическое тестирование больных является необходимым в связи с тем, что приблизительно четверть наблюдений феохромоцитом являются результатом герминальных мутаций в пяти вероятных генах; тем не менее этот метод должен применяться по клиническим показаниям, т.к. в настоящее время проверка каждого гена у каждого пациента экономически неэффективна. Показания к конкретному варианту генетического исследования формируются на основании оценки опухолевой локализации, множественности опухолевого поражения, наличию метастазов и типу преобладающей гормональной секреции. Важными проблемами, требующими дальнейшего решения, являются отсутствие адекватных методов дифференциального диагноза злокачественных и доброкачественных опухолей и неудовлетворительные результаты лечения злокачественных опухолей.

D G Bel'tsevich

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