Nikolaiev R. Optimization of early diagnosis of pituitary tumors taking into account hormonal and metabolic disorders and genetic component.

The thesis is dedicated to the topical issue of endocrinology, namely, the deepening of modern scientific understanding of early diagnosis of hormone-active pituitary tumors and establishment of prognostic significant criteria of early development of acromegaly, which is the basis for optimization of treatment of this patients and prevention of organ and metabolic complications. The analysis of family accumulation of diseases and hereditary predisposition to acromegaly and determination of the contribution of genetic and environmental factors made it possible to establish the peculiarities of acromegaly inheritance among the inhabitants of the Eastern region of Ukraine. It revealed that the frequency of hormonally active pituitary tumors was 0,15 % per 1000 patients, which indicates the effectiveness of the proposed screening technique and the feasibility of its implementation in health care system. It was registered that the intensity of the tumor process in patients with acromegaly, associated with the age of onset of the disease, as evidenced by a decrease in the proliferative and secretory activity of Growth hormone secreting (GH-secreting) pituitary adenoma in elderly patients. The clinical course of acromegaly in men is characterized by early manifestation of the disease, long pre-nosological period and duration of active phase. It is proved that genetic analysis is advisable for pediatric and young patients or in those in whom GH-secreting macro/giant pituitary adenoma has been diagnosed at a young age (up to 35 years), regardless of family burden of pituitary adenoma. In patients with aggravated heredity, genetic analysis should be performed in any case to identify familial isolated pituitary adenoma (FIPA) and predict the further course of the disease and the effectiveness of long-term suppressive therapy. It is proved that designed questionnaire can be used by physicians of primary and secondary health care facilities for opportunistic screening in selected risk groups for acromegaly. It revealed that рatients with acromegaly in combination with gigantism with established genetic determinism for the development of GH-secreting pituitary adenoma require combination suppressive therapy with a somatostatin analogue and an antagonist of GH-receptors – pegvisomant. Statistics models are constructed that allow estimating the risk of developing acromegaly in high-risk groups based on the levels of the above indicators.