Sven Berkmann1, Joël Brun2, Philipp Schuetz3, Emanuel Christ4, Luigi Mariani5, Beat Mueller3. 1. Department of Neurosurgery, Kantonsspital Aarau, 5001, Aarau, Switzerland. sven.berkmann@ksa.ch. 2. Department of Neurosurgery, Kantonsspital Aarau, 5001, Aarau, Switzerland. 3. Division of Endocrinology, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland. 4. Division of Endocrinology, Diabteology and Metabolism, University Department of Medicine, Universitaetsspital Basel, Basel, Switzerland. 5. Department of Neurosurgery, Universitaetsspital Basel, Basel, Switzerland.
Abstract
BACKGROUND: Acromegaly is associated with various comorbidities, such as arterial hypertension (aHT), type 2 diabetes mellitus (DM2), obstructive sleep apnoea syndrome (OSAS), carpal tunnel syndrome (CTS) and polyposis coli. For therapeutic decisions, it is essential to know if, and to what extent, these associated morbidities are reversible or preventable. The aim of this study is to assess the prevalence and course of aHT, obesity, OSAS, CTS, DM2 and polyposis coli in acromegalic patients. METHODS: The following criteria for inclusion in this database study were used: treatment for acromegaly at the authors' institutions; full endocrinological and radiological work- and follow-up; screening for aHT, DM2, CTS, OSAS, obesity and polyposis coli. All patients were followed-up for > 3 months, and treatments were indicated with the intent of biochemical remission (normal IGF-1 and random growth hormone level). RESULTS: Sixty-three patients were included. Twelve (19%), 45 (71%) and 6 (10%) patients harboured micro-, macro- and giant adenomas, respectively. Nineteen tumours (30%) invaded the cavernous sinus. Mean tumour volume was 5.4 cm3. Mean follow-up time was 42 months. Sixty-one (97%) patients had transsphenoidal surgery; two patients only had drug therapy. Surgery led to remission in 31 (51%) patients. Intracavernous growth and larger tumour volume were negative predictors for cure. Drug therapy lead to remission in 22 (73%) patients within a mean follow-up of 54 months. The pretherapeutic prevalence of associated morbidities was as follows: aHT, 56%; DM2, 25%; OSAS, 29%; CTS, 29%; polyposis coli, 5%. There were neither age nor gender preferences for the respective prevalences. Surgery leads to remission of aHT and DM2 in 6% and 25%, respectively. Additional drug therapy resulted in remission of aHT, DM2 and CTS in 17%, 14% and 14%, respectively. Other associated morbidities persisted regardless of therapeutic efforts. Even if criteria for remission were not met, no new comorbidities of acromegaly developed during follow-up. CONCLUSIONS: Treating acromegaly may relieve threatening associated morbidities such as aHT and DM2; nevertheless, only few comorbidities are reversible, which highlights the importance of treating acromegaly as early as possible.
BACKGROUND: Acromegaly is associated with various comorbidities, such as arterial hypertension (aHT), type 2 diabetes mellitus (DM2), obstructive sleep apnoea syndrome (OSAS), carpal tunnel syndrome (CTS) and polyposis coli. For therapeutic decisions, it is essential to know if, and to what extent, these associated morbidities are reversible or preventable. The aim of this study is to assess the prevalence and course of aHT, obesity, OSAS, CTS, DM2 and polyposis coli in acromegalic patients. METHODS: The following criteria for inclusion in this database study were used: treatment for acromegaly at the authors' institutions; full endocrinological and radiological work- and follow-up; screening for aHT, DM2, CTS, OSAS, obesity and polyposis coli. All patients were followed-up for > 3 months, and treatments were indicated with the intent of biochemical remission (normal IGF-1 and random growth hormone level). RESULTS: Sixty-three patients were included. Twelve (19%), 45 (71%) and 6 (10%) patients harboured micro-, macro- and giant adenomas, respectively. Nineteen tumours (30%) invaded the cavernous sinus. Mean tumour volume was 5.4 cm3. Mean follow-up time was 42 months. Sixty-one (97%) patients had transsphenoidal surgery; two patients only had drug therapy. Surgery led to remission in 31 (51%) patients. Intracavernous growth and larger tumour volume were negative predictors for cure. Drug therapy lead to remission in 22 (73%) patients within a mean follow-up of 54 months. The pretherapeutic prevalence of associated morbidities was as follows: aHT, 56%; DM2, 25%; OSAS, 29%; CTS, 29%; polyposis coli, 5%. There were neither age nor gender preferences for the respective prevalences. Surgery leads to remission of aHT and DM2 in 6% and 25%, respectively. Additional drug therapy resulted in remission of aHT, DM2 and CTS in 17%, 14% and 14%, respectively. Other associated morbidities persisted regardless of therapeutic efforts. Even if criteria for remission were not met, no new comorbidities of acromegaly developed during follow-up. CONCLUSIONS: Treating acromegaly may relieve threatening associated morbidities such as aHT and DM2; nevertheless, only few comorbidities are reversible, which highlights the importance of treating acromegaly as early as possible.
Authors: Abd Moain Abu Dabrh; Khaled Mohammed; Noor Asi; Wigdan H Farah; Zhen Wang; Magdoleen H Farah; Larry J Prokop; Laurence Katznelson; Mohammad Hassan Murad Journal: J Clin Endocrinol Metab Date: 2014-10-30 Impact factor: 5.958
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Authors: Alin Abreu; Alejandro Pinzón Tovar; Rafael Castellanos; Alex Valenzuela; Claudia Milena Gómez Giraldo; Alejandro Castellanos Pinedo; Doly Pantoja Guerrero; Carlos Alfonso Builes Barrera; Humberto Ignacio Franco; Antônio Ribeiro-Oliveira; Lucio Vilar; Raquel S Jallad; Felipe Gaia Duarte; Mônica Gadelha; Cesar Luiz Boguszewski; Julio Abucham; Luciana A Naves; Nina Rosa C Musolino; Maria Estela Justamante de Faria; Ciliana Rossato; Marcello D Bronstein Journal: Pituitary Date: 2016-08 Impact factor: 4.107