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Klin Monbl Augenheilkd 2024; 241(01): 48-68
DOI: 10.1055/a-2186-5548
DOI: 10.1055/a-2186-5548
Übersicht
Aktuelle Therapieansätze der endokrinen Orbitopathie – sind die zielgerichteten Therapien die Zukunft?
Article in several languages: deutsch | English
Zusammenfassung
Die endokrine Orbitopathie (EO) ist eine Autoimmunerkrankung der Augenhöhle, die am allerhäufigsten im Zusammenhang mit einer Schilddrüsenautoimmunerkrankung vom Typ Basedow auftritt. Für die Diagnose spezifisch und für die Pathogenese von zentraler Bedeutung ist das Auftreten von gegen den TSH-Rezeptor gerichteten Autoantikörpern (TRAK). Diese Autoantikörper, zumeist mit stimulierender Wirkung, induzieren eine unkontrollierte Schilddrüsenüberfunktion und in der Augenhöhle einen Gewebeumbau und eine mehr oder weniger ausgeprägte Entzündung. In Folge kommt es zu einer periokulären, entzündlichen Schwellung in variablem Ausmaß, Exophthalmus und Fibrose der Augenmuskeln und dadurch zu einer Störung der symmetrischen Augenbeweglichkeit mit Doppelbildwahrnehmung. In den letzten Jahrzehnten umfassten die therapeutischen Anstrengungen für die entzündliche Orbitopathie allgemein immunsuppressive Maßnahmen und für die Schilddrüsenüberfunktion die symptomatische Therapie durch Hemmung der Schilddrüsenhormonproduktion. Mit dem Bekanntwerden, dass durch die TRAK auch ein wichtiger Wachstumsfaktorrezeptor aktiviert wird, der IGF1R (Insulin-like-Growth-Factor-1-Rezeptor), wurden Biologika entwickelt, die diesen blockieren. Teprotumumab ist bereits in den USA zugelassen, und die Therapieeffekte sind v. a. hinsichtlich der Exophthalmusreduktion enorm. Nebenwirkungen, v. a. Hyperglykämie und Hörstörungen, sind zu beachten. Inwieweit die Autoimmunreaktionen (Produktion der TRAK/Anlocken von immunkompetenten Zellen) durch diese Therapien auch beeinflusst werden, ist noch nicht ausreichend geklärt. Rezidive nach der Therapie zeigen, dass die Hemmung der Autoimmunreaktion im Therapiekonzept insbesondere bei schwerem Verlauf mit enthalten sein muss.
Schlüsselwörter
endokrine Orbitopathie - Pathogenese - Risikofaktoren - Klassifikation - Leitlinien - zielgerichtete TherapienPublication History
Received: 08 July 2023
Accepted: 05 October 2023
Accepted Manuscript online:
05 October 2023
Article published online:
19 January 2024
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