Maria Florencia Battistone1, Karina Miragaya2, Amelia Rogozinski3, Monica Agüero4, Analia Alfieri5, Maria Carolina Ballarino6, Laura Boero7, Karina Danilowicz7, Sabrina Diez8, Marina Donoso5, Patricia Fainstein-Day9, Alejandra Furioso3, Natalia Garcia-Basavilbaso10, Mariela Glerean9, Debora Katz11, Monica Loto12, Susana Mallea-Gil6, Marcela Martinez13, Maria Isabel Sabate14, Marisa Servidio15, Patricia Slavinsky11, Graciela Stalldecker8, Soledad Sosa7, Grabriela Szuman16, Julieta Tkatch17, Ignacio Caldo18, Daniela Lubieniecki18, Mirtha Guitelman17. 1. División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina. florencia_batti@hotmail.com. 2. Servicio de Endocrinología, Sanatorio Güemes, Buenos Aires, Argentina. 3. División Endocrinología, Hospital Ramos Mejía, Buenos Aires, Argentina. 4. Grupo de trabajo Endocrinología, Hospital Tornú, Buenos Aires, Argentina. 5. Servicio de Endocrinología, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina. 6. Servicio de Endocrinología, Hospital Militar Central, Buenos Aires, Argentina. 7. División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina. 8. Servicio de Endocrinología, Hospital General de Agudos Dr. Ignacio Pirovano,, Buenos Aires, Argentina. 9. Servicio de Endocrinología, Hospital Italiano, Buenos Aires, Argentina. 10. Servicio de Endocrinología, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina. 11. Sección Neuroendocrinología, FLENI, Buenos Aires, Argentina. 12. Servicio de Endocrinología, Hospital Británico, Buenos Aires, Argentina. 13. Servicio de Endocrinología, Hospital C. Milstein, Buenos Aires, Argentina. 14. Servicio de Endocrinología, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina. 15. Unidad de Endocrinología, Hospital Teodoro Alvarez, Buenos Aires, Argentina. 16. Servicio de Endocrinología, Sanatorio Municipal Dr. J. Mendez, Buenos Aires, Argentina. 17. División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina. 18. Unidad de Gastroenterología, Hospital Carlos G. Durand, Buenos Aires, Argentina.
Abstract
PURPOSE: Current international guidelines recommend colonoscopy in patients with acromegaly at the time of diagnosis, even though the risk of developing colorectal neoplasm is still controversial. The main objective of this Argentine multicenter study was to analyze through screening colonoscopy the presence of advanced neoplastic lesions considered as precancerous, in patients with acromegaly compared to a control group. METHODS: This is a case-control retrospective study. Full length colonoscopy of 70 acromegalic patients and 128 control subjects were studied. Polyps were classified into non pre-cancerous lesions and advance neoplastic lesions which included advanced adenomas (preneoplastic) and colorectal carcinomas. RESULTS: Thirty three out of 70 acromegalic patients and 32 out of 128 subjects controls presented polyps in the colonoscopy [47.1% vs 25%, p = 0.002, OR 2.68]. Non precancerous polyps were found in 11 (15.7%) and 23 (17.9%) (p = 0.690), while advanced neoplastic lesions were found in 22 (31.4%) and 9 (7.0%) (p = 0,0001 - OR: 6.06) patients and controls respectively. Advanced adenomas and colorectal carcinomas were found in 18 (27.3%) and 9 (7.0%) (p = 0,0006-OR: 4,57), and 4 (5.7%) and 0 (0.0%) p = 0.0063) of patients and controls respectively. The presence of insulin resistance was the only statistically significant associated factor among acromegalic patients with and without colonic polyps. CONCLUSIONS: Our findings show an increased risk of preneoplastic colonic lesions and colorectal carcinoma in patients with chronic and sustained GH excess compared to a control group. This supports the recommendation to perform screening colonoscopy at diagnosis of acromegaly.
PURPOSE: Current international guidelines recommend colonoscopy in patients with acromegaly at the time of diagnosis, even though the risk of developing colorectal neoplasm is still controversial. The main objective of this Argentine multicenter study was to analyze through screening colonoscopy the presence of advanced neoplastic lesions considered as precancerous, in patients with acromegaly compared to a control group. METHODS: This is a case-control retrospective study. Full length colonoscopy of 70 acromegalicpatients and 128 control subjects were studied. Polyps were classified into non pre-cancerous lesions and advance neoplastic lesions which included advanced adenomas (preneoplastic) and colorectal carcinomas. RESULTS: Thirty three out of 70 acromegalicpatients and 32 out of 128 subjects controls presented polyps in the colonoscopy [47.1% vs 25%, p = 0.002, OR 2.68]. Non precancerous polyps were found in 11 (15.7%) and 23 (17.9%) (p = 0.690), while advanced neoplastic lesions were found in 22 (31.4%) and 9 (7.0%) (p = 0,0001 - OR: 6.06) patients and controls respectively. Advanced adenomas and colorectal carcinomas were found in 18 (27.3%) and 9 (7.0%) (p = 0,0006-OR: 4,57), and 4 (5.7%) and 0 (0.0%) p = 0.0063) of patients and controls respectively. The presence of insulin resistance was the only statistically significant associated factor among acromegalicpatients with and without colonic polyps. CONCLUSIONS: Our findings show an increased risk of preneoplastic colonic lesions and colorectal carcinoma in patients with chronic and sustained GH excess compared to a control group. This supports the recommendation to perform screening colonoscopy at diagnosis of acromegaly.
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