BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease pe...BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.展开更多
BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hi...BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.展开更多
Acromegaly,characterized by persistent hypersecretion of growth hormone(GH),is most often caused by a pituitary neuroendocrine tumor(PitNET),though,less often,ectopic GH or GH-releasing hormone secretion from various ...Acromegaly,characterized by persistent hypersecretion of growth hormone(GH),is most often caused by a pituitary neuroendocrine tumor(PitNET),though,less often,ectopic GH or GH-releasing hormone secretion from various neoplasms outside the pituitary gland could cause it.Nearly 70%of somatotroph PitNETs are macroadenomas at diagnosis.Transsphenoidal surgery,the most effective treatment modality for acromegaly,could achieve remission in 73%.However,the remission rates could reach 87%if surgery is followed by medical therapy.Due to variable therapeutic responses to surgical and medical therapy,pre-treatment awareness regarding the best therapeutic modality based on clinical,biochemical,radiological,histopathological and genetic parameters would help in accurate pretreatment decision-making.Earlier studies have identified poor prognosis markers like tumor size,tumor invasion,T2-weighted hyperintensity,granulation,and pretreatment GH and/or insulin-like growth factor 1 levels.In a recent study,published by Alvarez et al identified that preoperative PitNET volume is a good predictor of control of acromegaly following surgical treatment and the likelihood of requiring more aggressive additional therapies after surgery.They found that PitNET volume exceeding 3697 mm³was associated with poorer disease control in patients with somatotroph PitNETs.展开更多
AIM: To examine the risk of colorectal neoplasm in acromegalic patients by meta-analyzing all relevant controlled studies. METHODS: Extensive English language medical literature searches for human studies, up to Decem...AIM: To examine the risk of colorectal neoplasm in acromegalic patients by meta-analyzing all relevant controlled studies. METHODS: Extensive English language medical literature searches for human studies, up to December 2007, were performed using suitable keywords. Pooled estimates [odds ratio (OR) with 95% confidence intervals (CI)] were obtained using either the fixed or random-effects model as appropriate. Heterogeneity between studies was evaluated with the Cochran Q test whereas the likelihood of publication bias was assessed by constructing funnel plots. Their symmetry was estimated by the adjusted rank correlation test. RESULTS: For hyperplastic polyps the pooled ORs with 95% CI were 3.557 (2.587-4.891) by fixed effects model and 3.703 (2.565-5.347) by random effects model. The Z test values for overall effect were 7.81 and 6.984, respectively (P < 0.0001). For colon adenomas the pooled ORs with 95% CI were 2.486 (1.908-3.238) (fixed effects model) and 2.537 (1.914-3.364) (random effects model). The Z test values were 6.747 and 6.472, respectively (P < 0.0001). For colon cancer the pooled OR with 95% CI was identical for both fixed and random effects model (OR, 4.351; 95% CI, 1.533-12.354; Z = 2.762, P = 0.006]. There was no significant heterogeneity and no publication bias in all the above meta-analyses. CONCLUSION: Acromegaly is associated with an increased risk of colorectal neoplasm.展开更多
Introduction:Acromegaly is chronic progressive disease with multisystem involvement characterised by an excess secretion of growth hormone and increased circulating insulin like growth factor 1 concentration.Aims and ...Introduction:Acromegaly is chronic progressive disease with multisystem involvement characterised by an excess secretion of growth hormone and increased circulating insulin like growth factor 1 concentration.Aims and Objectives:To assess surgical outcome of acromegaly patients at tertiary care institute using SF 36 quality of life questionnaire.SF-36 scores comprise 3 components:the physical component summary(PCS),the mental component summary(MCS)and role-social component summary(RCS).30 acromegaly patients admitted in Guwahati medical college were enrolled in study and followed up post operatively for surgical remission.All participants completed the SF-36 preoperatively,1 year and 2 years postoperatively.Material and Method:Out of 30 patients 6 patients had surgical remission post operatively on the basis of postoperative glucose suppressed GH Level done after 12 weeks.Preoperatively subscale scores(physical functioning,role physical,general health)which were below the set standards for the normal population show significant postoperative improvements along with mental health(MH)scores.Similarly,PCS,MCS and RCS scores changed significantly after surgery.We also compared the QOL of 6 patients whose peak GH level was<0.4μg/L during postoperative oral glucose tolerance testing with those patients whose nadir GH level was≥0.4μg/L.There was significant difference between partial and complete remission group in subscale score role physical,social function and mental health.Similarly,PCS and RCS score significantly different in partial and complete remission group than MCS score.Conclusions:QOL is considerably reduced in patients with acromegaly compared to general population which improves significantly after surgical treatment.Patients achieving the new remission criteria had significant improvement in physical and social components than those who did not.展开更多
Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspe...Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspecific gastrointestinal complaints. Ultrasonography and subsequent endosonography diagnosed a large （4.5 cm）, hyperechoic, sessile polyp with numerous pedicles. An open cholecystectomy was performed and revealed a villous adenoma with several foci of carcinoma in situ. Detailed investigations showed no other tumors of the gastrointestinal tract. After five years of follo up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.展开更多
Acromegaly is an insidious endocrine disease character- ized by chronic elevation of growth hormone （GH） and insulin-like growth factor-1 （IGF-1）.Ell Persistent excess se- cretion of GH and IGF-1 damages both card...Acromegaly is an insidious endocrine disease character- ized by chronic elevation of growth hormone （GH） and insulin-like growth factor-1 （IGF-1）.Ell Persistent excess se- cretion of GH and IGF-1 damages both cardiac structure and function, leading to acromegalic cardiomyopathy, which is one of the most common causes of increased mortality in acromegaly and can result in an average of 10-year reduction in life expectancy.I2＇31 In patients with acromegaly, approximately 3% have been reported having a unique cardiomyopathy characterized by biventricular hypertrophy, myocardial necrosis, lymphocytic infiltration, interstitialfibrosis.展开更多
Background: Somatostatin analogues have shown to be effective in controlling the levels of growth hormone and are recommended for the treatment of acromegaly. These treatments have high costs of acquisition and their ...Background: Somatostatin analogues have shown to be effective in controlling the levels of growth hormone and are recommended for the treatment of acromegaly. These treatments have high costs of acquisition and their use might be restricted in limited resource settings. Objective: To evaluate the cost-effectiveness of somatostatin analogues for acromegaly in Colombia. Setting/Subjects/Intervention: A decision model was developed using a hypothetical cohort of patients with Acromegaly. Patients were treated according to the clinical practice of the country. Response to treatment and transition probabilities were derived from published literature. Costs and resource utilization were extracted from public and private sources in Colombia. Main Outcome Measure(s): Cost-effectiveness ratio, measured in Colombian pesos in a 2 year time-horizon. Results: The total medical treatment costs for the octreotide group were (Colombian Pesos) COP$ 53,807,616, compared to the total costs for the lanreotide group of COP$ 83,126,567. In the octreotide arm 65.30% of the patients and in the lanreotide arm 59.50% of the patients were successfully controlled. The number of deaths was 295 (13.1%) and 302 (13.4%) for octreotide and lanreotide, respectively. Because the costs are lower and the effectiveness is higher for octreotide in comparison with lanreotide, octreotide is more cost-effective than lanreotide. Probabilistic sensitivity analyses were consistent showing octreotide as the most cost-effective option. Conclusions: Costs and effects of octreotide compare favorably to those of lanreotide in the treatment of acromegaly in Colombia. Sensitivity analysis showed that despite the uncertainty in cost-effectiveness ratio this result is robust.展开更多
BACKGROUND Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone,which leads to excess secretion of Insulin like growth factor 1 from the liver,causi...BACKGROUND Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone,which leads to excess secretion of Insulin like growth factor 1 from the liver,causing abnormal soft tissue growth.There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms.Data was collected from patients with a confirmed diagnosis of acromegaly to evaluate the intensity,variety and impact of abdominal symptoms in comparison with a control group who were healthy participants recruited from the local fracture clinic.AIM To evaluate the frequency type and burden of abdominal symptoms in acromegaly in comparison with a control group.METHODS Medical documentation of patients with a diagnosis of acromegaly treated in one tertiary medical centre between 2010 and 2017 has been analysed.Data was collected from patients with confirmed acromegaly,using the Short Form Health Survey(SF36)and Rome IV Diagnostic questionnaire for Functional Gastrointestinal Disorders in Adults(R4DQ)and compared to a sex-and agematched control group,to assess the burden of abdominal symptoms.Microsoft Excel and IBM SPSS v 25 were used for data analysis.RESULTS Fifty patients with acromegaly(24 male and 26 females;age range 23-64 years,mean 43)and 200 controls(96 male and 104 females;age range 18-84,mean 42.4)were recruited.92%(46 out of 50)of patients with acromegaly reported abdominal symptoms and 78%(39 out of 50)had at least one functional gastrointestinal disorder according to the Rome IV diagnostic criteria,compared to 16%of controls(OR>1,P<0.0001).The most commonly reported symptom was constipation(69%acromegaly vs 21%of controls OR>1,P<0.0001,95%CI:4.4–15.8).34 out of 50(68%)respondents met the criteria for functional constipation according to Rome IV.Upper gastrointestinal disorders were also more prevalent in the acromegaly group.There was no statistically significant difference in the prevalence of biliary and anorectal symptoms between the two groups.Patients in acromegaly group scored lower on the mean scores of the eight parameters of SF36 Quality of Life questionnaire(mean scores 60.04 vs 71.23,95%CI:-13.6829 to-8.6971,OR>1,P<0.001)as compared to the control group.CONCLUSION Upper and lower functional gastrointestinal tract disorders(defined by Rome IV diagnostic criteria)are significantly more prevalent in patients with acromegaly compared with healthy age and sex matched controls in our study.Functional constipation is the most commonly reported problem.Poorer quality of life may in part be attributable to the increased prevalence of abdominal symptoms.展开更多
Introduction: The Carney complex (CC) is an autosomal dominant syndrome, characterized by multiple endocrine neoplasms, pigmented skin lesions, endocrine hyper-activity and myxomas. Case study: C. E., 71 years old, wa...Introduction: The Carney complex (CC) is an autosomal dominant syndrome, characterized by multiple endocrine neoplasms, pigmented skin lesions, endocrine hyper-activity and myxomas. Case study: C. E., 71 years old, was addressed to our center in August 1994, following the finding of a sellar enlargement in a skull radiography performed after an accident. A pituitary tomography showed the presence of a lesion extended up to the optic chiasm, a macroadenoma that was treated with transsphenoidal endoscopic surgery. A histological diagnosis of a “GH secreting macroadenoma” was performed. An echocardiographic study highlighted an atrial isolated myxoma that was subsequently removed. A contrast-enhanced abdominal magnetic resonance imaging (MRI) excluded adrenal lesions. In 2001, in relation to relapse of Acromegaly, the patient started therapy with somatostatin analogues which was replaced, in 2008, by Pegvisomant to obtain biochemical control of the disease. Conclusions: At the time of initial screening, it is important not to underestimate the possibility that certain clinical features fall within the context of more complex syndromes. The knowledge of how Acromegaly presents itself in relation to CC and its associated characteristics such as cardiac myxoma or typical skin lesions, will help clinicians to timely diagnose this rare disease and treat it appropriately.展开更多
Acromegaly is a progressive disease caused by an increased in the levels of growth hormone(GH),followed by an increased in the levels of insulin-like growth factor-1(IGF-1).Most cases are caused by GH-secreting pituit...Acromegaly is a progressive disease caused by an increased in the levels of growth hormone(GH),followed by an increased in the levels of insulin-like growth factor-1(IGF-1).Most cases are caused by GH-secreting pituitary adenomas.Long-term exposure to excessive GH would affect all systems of the body,of which the cardiovascular system has the highest incidence rate and mortality rate.This review discusses the influence of acromegaly on cardiovascular diseases and its treatment.展开更多
Objective To analyze clinical characteristics of acromegaly patients who have discordant growth hormone(GH)or insulin-like growth factor-1(IGF-1)levels and evaluate impact of different GH cut-offs on discordance rate....Objective To analyze clinical characteristics of acromegaly patients who have discordant growth hormone(GH)or insulin-like growth factor-1(IGF-1)levels and evaluate impact of different GH cut-offs on discordance rate.Methods A retrospective analysis was conducted on data from 66 acromegaly patients treated at Nanjing Drum Tower Hospital from November 2017 to March 2023.Patients were categorized based on the nadir GH(GHn)and ICF-1 levels at the last follow-up into four groups:controlled,high GH,high IGF-1,and active.Clinical and metabolic parameters were compared across these groups,and impact of different CHn and fasting growth hormone(GHf)cut-offs on discordance rate vwas evaluated.Results No statistically significant differences were observed among groups in age,duration of followup,imaging characteristics(all P>0.05).High IGF-1 group had higher fasting insulin and homeostasis model assessment forβcell function compared to controlled and high GH group(all P<0.05),while these parameters did not differ between high GH and controlled group.High ICF-1 group had higher carboxy-terminal crosslinked telopeptide of type 1 collagen,osteocalcin and procollagen type 1 N-terminal propeptide compared to controlled and high GH group,but differences were not statistically significant(all P>0.05).These parameters also did not differ between high CH and controlled group.Discordance rate was not significantly different when CHn cut-offs were 1.0μg/L or 0.4μg/L(30.3%vs 21.3%,P=0.146).Compared to 2.5μg/L,discordance rate was lower when CHf cut-off was 1.0μg/L(39.4%us 24.3%,P=0.041).Conclusion The discordance rate in treated acromegaly patients during follow-up is approximately 30%.Different CH measurement timings and cut-offs significantly impact discordance rate.Patients with normal GH and elevated IGF-1 levels are at potential risk of active disease,and require closer followup.This study provides a valuable reference for treatment of patients with discordant GH and IGF-1 levels.展开更多
Background Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone （GH） adenoma is gigantism and/or acromegaly...Background Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone （GH） adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma. Methods Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed. Results In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 （IGF-1） were normal or higher, but nadir GH levels were all still 〉1 μg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission. Conclusions When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.展开更多
A 12-year-old cat, weighting 7.4 kg, suffering from fatigue, exercise intolerance, polyphagia, polyuria and polydipsia was presented. Obesity, a massive head, inferior prognathia and widened inter-dental spaces were n...A 12-year-old cat, weighting 7.4 kg, suffering from fatigue, exercise intolerance, polyphagia, polyuria and polydipsia was presented. Obesity, a massive head, inferior prognathia and widened inter-dental spaces were noted on examination. Radiographic surveys showed organs enlargement. Labaratory results revealed hyperglycemia and glycosuria. Based on fasting hyperglycemia, concurrent hyperglycemia and glycosuria, diagnosis of diabetes mellitus was made. However, according to the poor diabetic regulation, clinical signs and the absence of other diseases, a tentative diagnosis of acromegaly was confirmed by increased plasma levels of growth hormone. Managing diabetes mellitus with increasing doses of insulin was the only possible therapeutic strategy.展开更多
Growth hormone-secreting pituitary adenomas(GHPAs)cause acromegaly,a condition characterized by persistent excess of growth hormone(GH)and its target hormone,insulin-like growth factor 1(IGF-1).This hormonal imbalance...Growth hormone-secreting pituitary adenomas(GHPAs)cause acromegaly,a condition characterized by persistent excess of growth hormone(GH)and its target hormone,insulin-like growth factor 1(IGF-1).This hormonal imbalance gives rise to diverse comorbidities,ultimately resulting in a shortened lifespan compared to the general population(Piccard et al.,2012).Extensive research has demonstrated that tumors exert a pivotal promoting effects on inflammation,and conversely,inflammatory responses exert reciprocal influence on various biological processes of tumors(Fridlender et al.,2009;Piccard et al.,2012).The microbiome profoundly impacts brain function,behavior,and neuroendocrine responses to stress.Through the hypothalamic-pituitary-adrenal(HPA)axis,the neuroendocrine system modulates the composition and permeability of the gastrointestinal tract,indicating a bidirectional network between gut microbiome and neuroendocrine system(Farzi et al.,2018).In the present study,we explored the microbiome profile in patients with GH adenomas and its potential role in inflammation,utilizing Mendelian randomization(MR)to reveal the casual relationship between microbiome and inflammation markers.展开更多
Growth hormone(GH)excess is associated with several systemic complications,one of which is the increased risk of neoplastic processes particularly of the gastrointestinal(GI)tract.Among the GI neoplasms,the most repor...Growth hormone(GH)excess is associated with several systemic complications,one of which is the increased risk of neoplastic processes particularly of the gastrointestinal(GI)tract.Among the GI neoplasms,the most reported association is with benign and malignant neoplasms of the colon.In the majority of published literature,an increased incidence of GI neoplasms,both colonic adenomas as well as colorectal carcinoma is reported.However,the studies on colon cancer-specific mortality rate are conflicting with recent studies reporting similar cancer-specific mortality rates in comparison to controls.Many studies have reported an association of colorectal neoplasms with GH levels.Pathogenic mechanisms put forward to explain this association of GH excess and GI neoplasms primarily involve the increased GH-insulin-like growth factor 1(IGF-1)signaling.Both GH and IGF-1 have proliferative,anti-apoptotic,and angiogenic effects on the systemic tissues leading to cellular proliferation.Other contributing factors to the increased risk of GI neoplasms include slow intestinal transit with a redundant large bowel,altered bile acids,deranged local immune response,shared genetic susceptibility factors and hyperinsulinemia.In view of the increased risk association,most guidelines for the care of acromegaly patients recommend an initial screening colonoscopy.Recommendations for further follow-up colonoscopy differ but broadly,the guidelines agree that it depends on the findings at first colonoscopy and state of remission of GH excess.Regarding the concern about the risk of colorectal cancers in patients receiving recombinant GH therapy,most cohort studies do not show an increased risk.展开更多
Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation ...Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation and patient’s clinical and hormonal parameters. Methods: We enrolled 22 acromegalic patients with apnea hypopnea index (AHI) ≥ 5 if symptomatic, or ≥15 in the absence of sleep related symptoms. Patients underwent the following evaluations: GH and IGF-1 serum levels, arterial blood gas test, spirometry, carbon monoxide diffusing capacity (DLCO), home-based cardiorespiratory sleep and pulmonary function test. Results: The prevalence of OSAS was 66.6%. Patients with a severe form of OSAS appeared to be affected from acromegaly for more years than those with a lower severity of disease and those with acromegaly duration > 10 years had significantly higher levels of glycated hemoglobin. We observed a positive correlation between GH level at diagnosis and DLCO value, showing that acromegalic patients have an increase in static and dynamic respiratory volumes and alveolar-capillary exchange surface compared to the general population. We also observed a positive correlation between baseline serum IGF-1 level and DLCO/VA and between years of disease and DLCO/VA, showing the association of increased lung volume and increase of the exchange surface. Conclusions: The results of this study add new information on lung volume and alveolar gas exchange in acromegaly. Our findings highlight the role of SSA as therapy with positive impact on complication and comorbidities of acromegaly.展开更多
Introduction: Ectopic secretion of GHRH is a rare cause of acromegaly. However, its recognition is clinically important because different therapeutic approaches are required. Case Presentation: We present a challengin...Introduction: Ectopic secretion of GHRH is a rare cause of acromegaly. However, its recognition is clinically important because different therapeutic approaches are required. Case Presentation: We present a challenging case of acromegaly secondary to ectopic GHRH secretion from pancreatic neuroendocrine tumor in a 52-year-old female. The patient is treated with different modalities which include pegvisomant in an attempt to control the stimulated GH-axis considering the limited data about its use in treatment of ectopic acromegaly. Conclusion: GHRH-secreting tumor is a rare cause of acromegaly. Surgical resection of the tumor is the therapy of choice whenever possible. However, further studies are warranted for unresectable tumor or resistant cases.展开更多
Pegvisomant is a recent treatment modality of acromegaly, which is most effective in regulating IGF-1 levels. Tumor growth has been reported in 5% of the acromegaly cases treated with pegvisomant. Herein we report a c...Pegvisomant is a recent treatment modality of acromegaly, which is most effective in regulating IGF-1 levels. Tumor growth has been reported in 5% of the acromegaly cases treated with pegvisomant. Herein we report a case of acromegaly resistant to surgical treatment, radiotherapy and medical therapy with a somatostatin analogue and cabergolin. Due to presence of pituitary tumor with cavernous sinus invasion and unremitting disease activity pegvisomant therapy was initiated. She developed left abducens nerve palsy after pegvisomant treatment. The objective of this report is to emphasize the value of close follow-up of the acromely cases under pegvisomant therapy, especially if they have cavernous sinus infiltrating tumor. A 44-year-old woman with acromegaly presented with visual defect and diplopia on left lateral gaze. Her complaint developed 3 years after initiation of pegvisomant therapy. Her neurologic examination was consistent with mild abducens nerve palsy on left side. Other causes for abducens nerve palsy were excluded. Pegvisomant was discontinued upon patient request. Although sella MRI did not reveal a tumor growth, even minimal growth within cavernous sinus can cause cranial nerve involvement. Therefore close and careful follow-up of cavernous sinus infiltrating tumors after pegvisomant therapy is crucial to early recognition of complications.展开更多
Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions....Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions. In view of advances in the management of these multisecreting pituitary neuroendocrine tumors and the lack of published data in Africa, and in Senegal particularly, this survey was carried out with the aim of describing the epidemiological, clinical and therapeutic aspects of multisecreting PitNETs. Patients and Method: It was a multicenter, retrospective, descriptive and analytical study carried out on files collected from 1st January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals in Dakar and the endocrinology department of the Abass Ndao hospital in Dakar. Results: Of the 242 patients treated for PitNET, 09 presented (the mean age of our patients was 41.7 ± 11 years) with bihormonal PitNET, i.e. a proportion of 3.71%. Two types of association were found: 08 tumors with GH (Growth Hormon) + PRL (prolactin) secretion and 01 PitNET with ACTH (Adreno Corticotropic Homon) + prolactin secretion. Clinically, gonadotropic insufficiency was found in all patients (100%). Dysmorphic syndrome was found in 6 patients (66.7%) and tumor syndrome in 7 patients (77.8%). Ophthalmological evaluation revealed a decrease in visual acuity in 66.6% of patients. All had macroadenomas, with extension noted in 02 patients. All patients underwent transsphenoidal surgery with complications such as transient diabetes insipidus (3 patients, 33.3%), followed by cerebrospinal fluid leaks (1 patient, 11.1%). Remission was noted in all 5 patients tested. A comparison between the different secretory forms did not reveal any significant difference in the frequency of postoperative complications. Conclusion: Despite the lack of immunohistochemistry, two types of association were found: ACTH-PRL and GH-PRL. All were macroadenomas, the majority with an associated tumor syndrome. The latter was significantly less frequent in bisecreting PitNETs compared with monosecreting and non-functional forms. However, there was no significant difference in the occurrence of post-operative complications between the three secretory forms of PitNETs.展开更多
文摘BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.
文摘BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.
文摘Acromegaly,characterized by persistent hypersecretion of growth hormone(GH),is most often caused by a pituitary neuroendocrine tumor(PitNET),though,less often,ectopic GH or GH-releasing hormone secretion from various neoplasms outside the pituitary gland could cause it.Nearly 70%of somatotroph PitNETs are macroadenomas at diagnosis.Transsphenoidal surgery,the most effective treatment modality for acromegaly,could achieve remission in 73%.However,the remission rates could reach 87%if surgery is followed by medical therapy.Due to variable therapeutic responses to surgical and medical therapy,pre-treatment awareness regarding the best therapeutic modality based on clinical,biochemical,radiological,histopathological and genetic parameters would help in accurate pretreatment decision-making.Earlier studies have identified poor prognosis markers like tumor size,tumor invasion,T2-weighted hyperintensity,granulation,and pretreatment GH and/or insulin-like growth factor 1 levels.In a recent study,published by Alvarez et al identified that preoperative PitNET volume is a good predictor of control of acromegaly following surgical treatment and the likelihood of requiring more aggressive additional therapies after surgery.They found that PitNET volume exceeding 3697 mm³was associated with poorer disease control in patients with somatotroph PitNETs.
文摘AIM: To examine the risk of colorectal neoplasm in acromegalic patients by meta-analyzing all relevant controlled studies. METHODS: Extensive English language medical literature searches for human studies, up to December 2007, were performed using suitable keywords. Pooled estimates [odds ratio (OR) with 95% confidence intervals (CI)] were obtained using either the fixed or random-effects model as appropriate. Heterogeneity between studies was evaluated with the Cochran Q test whereas the likelihood of publication bias was assessed by constructing funnel plots. Their symmetry was estimated by the adjusted rank correlation test. RESULTS: For hyperplastic polyps the pooled ORs with 95% CI were 3.557 (2.587-4.891) by fixed effects model and 3.703 (2.565-5.347) by random effects model. The Z test values for overall effect were 7.81 and 6.984, respectively (P < 0.0001). For colon adenomas the pooled ORs with 95% CI were 2.486 (1.908-3.238) (fixed effects model) and 2.537 (1.914-3.364) (random effects model). The Z test values were 6.747 and 6.472, respectively (P < 0.0001). For colon cancer the pooled OR with 95% CI was identical for both fixed and random effects model (OR, 4.351; 95% CI, 1.533-12.354; Z = 2.762, P = 0.006]. There was no significant heterogeneity and no publication bias in all the above meta-analyses. CONCLUSION: Acromegaly is associated with an increased risk of colorectal neoplasm.
文摘Introduction:Acromegaly is chronic progressive disease with multisystem involvement characterised by an excess secretion of growth hormone and increased circulating insulin like growth factor 1 concentration.Aims and Objectives:To assess surgical outcome of acromegaly patients at tertiary care institute using SF 36 quality of life questionnaire.SF-36 scores comprise 3 components:the physical component summary(PCS),the mental component summary(MCS)and role-social component summary(RCS).30 acromegaly patients admitted in Guwahati medical college were enrolled in study and followed up post operatively for surgical remission.All participants completed the SF-36 preoperatively,1 year and 2 years postoperatively.Material and Method:Out of 30 patients 6 patients had surgical remission post operatively on the basis of postoperative glucose suppressed GH Level done after 12 weeks.Preoperatively subscale scores(physical functioning,role physical,general health)which were below the set standards for the normal population show significant postoperative improvements along with mental health(MH)scores.Similarly,PCS,MCS and RCS scores changed significantly after surgery.We also compared the QOL of 6 patients whose peak GH level was<0.4μg/L during postoperative oral glucose tolerance testing with those patients whose nadir GH level was≥0.4μg/L.There was significant difference between partial and complete remission group in subscale score role physical,social function and mental health.Similarly,PCS and RCS score significantly different in partial and complete remission group than MCS score.Conclusions:QOL is considerably reduced in patients with acromegaly compared to general population which improves significantly after surgical treatment.Patients achieving the new remission criteria had significant improvement in physical and social components than those who did not.
文摘Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspecific gastrointestinal complaints. Ultrasonography and subsequent endosonography diagnosed a large （4.5 cm）, hyperechoic, sessile polyp with numerous pedicles. An open cholecystectomy was performed and revealed a villous adenoma with several foci of carcinoma in situ. Detailed investigations showed no other tumors of the gastrointestinal tract. After five years of follo up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.
文摘Acromegaly is an insidious endocrine disease character- ized by chronic elevation of growth hormone （GH） and insulin-like growth factor-1 （IGF-1）.Ell Persistent excess se- cretion of GH and IGF-1 damages both cardiac structure and function, leading to acromegalic cardiomyopathy, which is one of the most common causes of increased mortality in acromegaly and can result in an average of 10-year reduction in life expectancy.I2＇31 In patients with acromegaly, approximately 3% have been reported having a unique cardiomyopathy characterized by biventricular hypertrophy, myocardial necrosis, lymphocytic infiltration, interstitialfibrosis.
文摘Background: Somatostatin analogues have shown to be effective in controlling the levels of growth hormone and are recommended for the treatment of acromegaly. These treatments have high costs of acquisition and their use might be restricted in limited resource settings. Objective: To evaluate the cost-effectiveness of somatostatin analogues for acromegaly in Colombia. Setting/Subjects/Intervention: A decision model was developed using a hypothetical cohort of patients with Acromegaly. Patients were treated according to the clinical practice of the country. Response to treatment and transition probabilities were derived from published literature. Costs and resource utilization were extracted from public and private sources in Colombia. Main Outcome Measure(s): Cost-effectiveness ratio, measured in Colombian pesos in a 2 year time-horizon. Results: The total medical treatment costs for the octreotide group were (Colombian Pesos) COP$ 53,807,616, compared to the total costs for the lanreotide group of COP$ 83,126,567. In the octreotide arm 65.30% of the patients and in the lanreotide arm 59.50% of the patients were successfully controlled. The number of deaths was 295 (13.1%) and 302 (13.4%) for octreotide and lanreotide, respectively. Because the costs are lower and the effectiveness is higher for octreotide in comparison with lanreotide, octreotide is more cost-effective than lanreotide. Probabilistic sensitivity analyses were consistent showing octreotide as the most cost-effective option. Conclusions: Costs and effects of octreotide compare favorably to those of lanreotide in the treatment of acromegaly in Colombia. Sensitivity analysis showed that despite the uncertainty in cost-effectiveness ratio this result is robust.
文摘BACKGROUND Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone,which leads to excess secretion of Insulin like growth factor 1 from the liver,causing abnormal soft tissue growth.There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms.Data was collected from patients with a confirmed diagnosis of acromegaly to evaluate the intensity,variety and impact of abdominal symptoms in comparison with a control group who were healthy participants recruited from the local fracture clinic.AIM To evaluate the frequency type and burden of abdominal symptoms in acromegaly in comparison with a control group.METHODS Medical documentation of patients with a diagnosis of acromegaly treated in one tertiary medical centre between 2010 and 2017 has been analysed.Data was collected from patients with confirmed acromegaly,using the Short Form Health Survey(SF36)and Rome IV Diagnostic questionnaire for Functional Gastrointestinal Disorders in Adults(R4DQ)and compared to a sex-and agematched control group,to assess the burden of abdominal symptoms.Microsoft Excel and IBM SPSS v 25 were used for data analysis.RESULTS Fifty patients with acromegaly(24 male and 26 females;age range 23-64 years,mean 43)and 200 controls(96 male and 104 females;age range 18-84,mean 42.4)were recruited.92%(46 out of 50)of patients with acromegaly reported abdominal symptoms and 78%(39 out of 50)had at least one functional gastrointestinal disorder according to the Rome IV diagnostic criteria,compared to 16%of controls(OR>1,P<0.0001).The most commonly reported symptom was constipation(69%acromegaly vs 21%of controls OR>1,P<0.0001,95%CI:4.4–15.8).34 out of 50(68%)respondents met the criteria for functional constipation according to Rome IV.Upper gastrointestinal disorders were also more prevalent in the acromegaly group.There was no statistically significant difference in the prevalence of biliary and anorectal symptoms between the two groups.Patients in acromegaly group scored lower on the mean scores of the eight parameters of SF36 Quality of Life questionnaire(mean scores 60.04 vs 71.23,95%CI:-13.6829 to-8.6971,OR>1,P<0.001)as compared to the control group.CONCLUSION Upper and lower functional gastrointestinal tract disorders(defined by Rome IV diagnostic criteria)are significantly more prevalent in patients with acromegaly compared with healthy age and sex matched controls in our study.Functional constipation is the most commonly reported problem.Poorer quality of life may in part be attributable to the increased prevalence of abdominal symptoms.
文摘Introduction: The Carney complex (CC) is an autosomal dominant syndrome, characterized by multiple endocrine neoplasms, pigmented skin lesions, endocrine hyper-activity and myxomas. Case study: C. E., 71 years old, was addressed to our center in August 1994, following the finding of a sellar enlargement in a skull radiography performed after an accident. A pituitary tomography showed the presence of a lesion extended up to the optic chiasm, a macroadenoma that was treated with transsphenoidal endoscopic surgery. A histological diagnosis of a “GH secreting macroadenoma” was performed. An echocardiographic study highlighted an atrial isolated myxoma that was subsequently removed. A contrast-enhanced abdominal magnetic resonance imaging (MRI) excluded adrenal lesions. In 2001, in relation to relapse of Acromegaly, the patient started therapy with somatostatin analogues which was replaced, in 2008, by Pegvisomant to obtain biochemical control of the disease. Conclusions: At the time of initial screening, it is important not to underestimate the possibility that certain clinical features fall within the context of more complex syndromes. The knowledge of how Acromegaly presents itself in relation to CC and its associated characteristics such as cardiac myxoma or typical skin lesions, will help clinicians to timely diagnose this rare disease and treat it appropriately.
文摘Acromegaly is a progressive disease caused by an increased in the levels of growth hormone(GH),followed by an increased in the levels of insulin-like growth factor-1(IGF-1).Most cases are caused by GH-secreting pituitary adenomas.Long-term exposure to excessive GH would affect all systems of the body,of which the cardiovascular system has the highest incidence rate and mortality rate.This review discusses the influence of acromegaly on cardiovascular diseases and its treatment.
文摘Objective To analyze clinical characteristics of acromegaly patients who have discordant growth hormone(GH)or insulin-like growth factor-1(IGF-1)levels and evaluate impact of different GH cut-offs on discordance rate.Methods A retrospective analysis was conducted on data from 66 acromegaly patients treated at Nanjing Drum Tower Hospital from November 2017 to March 2023.Patients were categorized based on the nadir GH(GHn)and ICF-1 levels at the last follow-up into four groups:controlled,high GH,high IGF-1,and active.Clinical and metabolic parameters were compared across these groups,and impact of different CHn and fasting growth hormone(GHf)cut-offs on discordance rate vwas evaluated.Results No statistically significant differences were observed among groups in age,duration of followup,imaging characteristics(all P>0.05).High IGF-1 group had higher fasting insulin and homeostasis model assessment forβcell function compared to controlled and high GH group(all P<0.05),while these parameters did not differ between high GH and controlled group.High ICF-1 group had higher carboxy-terminal crosslinked telopeptide of type 1 collagen,osteocalcin and procollagen type 1 N-terminal propeptide compared to controlled and high GH group,but differences were not statistically significant(all P>0.05).These parameters also did not differ between high CH and controlled group.Discordance rate was not significantly different when CHn cut-offs were 1.0μg/L or 0.4μg/L(30.3%vs 21.3%,P=0.146).Compared to 2.5μg/L,discordance rate was lower when CHf cut-off was 1.0μg/L(39.4%us 24.3%,P=0.041).Conclusion The discordance rate in treated acromegaly patients during follow-up is approximately 30%.Different CH measurement timings and cut-offs significantly impact discordance rate.Patients with normal GH and elevated IGF-1 levels are at potential risk of active disease,and require closer followup.This study provides a valuable reference for treatment of patients with discordant GH and IGF-1 levels.
文摘Background Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone （GH） adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma. Methods Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed. Results In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 （IGF-1） were normal or higher, but nadir GH levels were all still 〉1 μg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission. Conclusions When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.
文摘A 12-year-old cat, weighting 7.4 kg, suffering from fatigue, exercise intolerance, polyphagia, polyuria and polydipsia was presented. Obesity, a massive head, inferior prognathia and widened inter-dental spaces were noted on examination. Radiographic surveys showed organs enlargement. Labaratory results revealed hyperglycemia and glycosuria. Based on fasting hyperglycemia, concurrent hyperglycemia and glycosuria, diagnosis of diabetes mellitus was made. However, according to the poor diabetic regulation, clinical signs and the absence of other diseases, a tentative diagnosis of acromegaly was confirmed by increased plasma levels of growth hormone. Managing diabetes mellitus with increasing doses of insulin was the only possible therapeutic strategy.
基金supported by the National Natural Science Foundation of China(82372624 to X.J.)Guangdong Basic and Applied Basic Research Foundation(2024A1515013102 and 2022A1515012430 to X.J.)The funders had no role in study design,data collection and interpretation,or the decision to submit the work for publication.
文摘Growth hormone-secreting pituitary adenomas(GHPAs)cause acromegaly,a condition characterized by persistent excess of growth hormone(GH)and its target hormone,insulin-like growth factor 1(IGF-1).This hormonal imbalance gives rise to diverse comorbidities,ultimately resulting in a shortened lifespan compared to the general population(Piccard et al.,2012).Extensive research has demonstrated that tumors exert a pivotal promoting effects on inflammation,and conversely,inflammatory responses exert reciprocal influence on various biological processes of tumors(Fridlender et al.,2009;Piccard et al.,2012).The microbiome profoundly impacts brain function,behavior,and neuroendocrine responses to stress.Through the hypothalamic-pituitary-adrenal(HPA)axis,the neuroendocrine system modulates the composition and permeability of the gastrointestinal tract,indicating a bidirectional network between gut microbiome and neuroendocrine system(Farzi et al.,2018).In the present study,we explored the microbiome profile in patients with GH adenomas and its potential role in inflammation,utilizing Mendelian randomization(MR)to reveal the casual relationship between microbiome and inflammation markers.
文摘Growth hormone(GH)excess is associated with several systemic complications,one of which is the increased risk of neoplastic processes particularly of the gastrointestinal(GI)tract.Among the GI neoplasms,the most reported association is with benign and malignant neoplasms of the colon.In the majority of published literature,an increased incidence of GI neoplasms,both colonic adenomas as well as colorectal carcinoma is reported.However,the studies on colon cancer-specific mortality rate are conflicting with recent studies reporting similar cancer-specific mortality rates in comparison to controls.Many studies have reported an association of colorectal neoplasms with GH levels.Pathogenic mechanisms put forward to explain this association of GH excess and GI neoplasms primarily involve the increased GH-insulin-like growth factor 1(IGF-1)signaling.Both GH and IGF-1 have proliferative,anti-apoptotic,and angiogenic effects on the systemic tissues leading to cellular proliferation.Other contributing factors to the increased risk of GI neoplasms include slow intestinal transit with a redundant large bowel,altered bile acids,deranged local immune response,shared genetic susceptibility factors and hyperinsulinemia.In view of the increased risk association,most guidelines for the care of acromegaly patients recommend an initial screening colonoscopy.Recommendations for further follow-up colonoscopy differ but broadly,the guidelines agree that it depends on the findings at first colonoscopy and state of remission of GH excess.Regarding the concern about the risk of colorectal cancers in patients receiving recombinant GH therapy,most cohort studies do not show an increased risk.
文摘Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation and patient’s clinical and hormonal parameters. Methods: We enrolled 22 acromegalic patients with apnea hypopnea index (AHI) ≥ 5 if symptomatic, or ≥15 in the absence of sleep related symptoms. Patients underwent the following evaluations: GH and IGF-1 serum levels, arterial blood gas test, spirometry, carbon monoxide diffusing capacity (DLCO), home-based cardiorespiratory sleep and pulmonary function test. Results: The prevalence of OSAS was 66.6%. Patients with a severe form of OSAS appeared to be affected from acromegaly for more years than those with a lower severity of disease and those with acromegaly duration > 10 years had significantly higher levels of glycated hemoglobin. We observed a positive correlation between GH level at diagnosis and DLCO value, showing that acromegalic patients have an increase in static and dynamic respiratory volumes and alveolar-capillary exchange surface compared to the general population. We also observed a positive correlation between baseline serum IGF-1 level and DLCO/VA and between years of disease and DLCO/VA, showing the association of increased lung volume and increase of the exchange surface. Conclusions: The results of this study add new information on lung volume and alveolar gas exchange in acromegaly. Our findings highlight the role of SSA as therapy with positive impact on complication and comorbidities of acromegaly.
文摘Introduction: Ectopic secretion of GHRH is a rare cause of acromegaly. However, its recognition is clinically important because different therapeutic approaches are required. Case Presentation: We present a challenging case of acromegaly secondary to ectopic GHRH secretion from pancreatic neuroendocrine tumor in a 52-year-old female. The patient is treated with different modalities which include pegvisomant in an attempt to control the stimulated GH-axis considering the limited data about its use in treatment of ectopic acromegaly. Conclusion: GHRH-secreting tumor is a rare cause of acromegaly. Surgical resection of the tumor is the therapy of choice whenever possible. However, further studies are warranted for unresectable tumor or resistant cases.
文摘Pegvisomant is a recent treatment modality of acromegaly, which is most effective in regulating IGF-1 levels. Tumor growth has been reported in 5% of the acromegaly cases treated with pegvisomant. Herein we report a case of acromegaly resistant to surgical treatment, radiotherapy and medical therapy with a somatostatin analogue and cabergolin. Due to presence of pituitary tumor with cavernous sinus invasion and unremitting disease activity pegvisomant therapy was initiated. She developed left abducens nerve palsy after pegvisomant treatment. The objective of this report is to emphasize the value of close follow-up of the acromely cases under pegvisomant therapy, especially if they have cavernous sinus infiltrating tumor. A 44-year-old woman with acromegaly presented with visual defect and diplopia on left lateral gaze. Her complaint developed 3 years after initiation of pegvisomant therapy. Her neurologic examination was consistent with mild abducens nerve palsy on left side. Other causes for abducens nerve palsy were excluded. Pegvisomant was discontinued upon patient request. Although sella MRI did not reveal a tumor growth, even minimal growth within cavernous sinus can cause cranial nerve involvement. Therefore close and careful follow-up of cavernous sinus infiltrating tumors after pegvisomant therapy is crucial to early recognition of complications.
文摘Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions. In view of advances in the management of these multisecreting pituitary neuroendocrine tumors and the lack of published data in Africa, and in Senegal particularly, this survey was carried out with the aim of describing the epidemiological, clinical and therapeutic aspects of multisecreting PitNETs. Patients and Method: It was a multicenter, retrospective, descriptive and analytical study carried out on files collected from 1st January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals in Dakar and the endocrinology department of the Abass Ndao hospital in Dakar. Results: Of the 242 patients treated for PitNET, 09 presented (the mean age of our patients was 41.7 ± 11 years) with bihormonal PitNET, i.e. a proportion of 3.71%. Two types of association were found: 08 tumors with GH (Growth Hormon) + PRL (prolactin) secretion and 01 PitNET with ACTH (Adreno Corticotropic Homon) + prolactin secretion. Clinically, gonadotropic insufficiency was found in all patients (100%). Dysmorphic syndrome was found in 6 patients (66.7%) and tumor syndrome in 7 patients (77.8%). Ophthalmological evaluation revealed a decrease in visual acuity in 66.6% of patients. All had macroadenomas, with extension noted in 02 patients. All patients underwent transsphenoidal surgery with complications such as transient diabetes insipidus (3 patients, 33.3%), followed by cerebrospinal fluid leaks (1 patient, 11.1%). Remission was noted in all 5 patients tested. A comparison between the different secretory forms did not reveal any significant difference in the frequency of postoperative complications. Conclusion: Despite the lack of immunohistochemistry, two types of association were found: ACTH-PRL and GH-PRL. All were macroadenomas, the majority with an associated tumor syndrome. The latter was significantly less frequent in bisecreting PitNETs compared with monosecreting and non-functional forms. However, there was no significant difference in the occurrence of post-operative complications between the three secretory forms of PitNETs.
