Stefano Frara1, Meliha Melin Uygur2, Luigi di Filippo1, Mauro Doga1, Marco Losa3, Simona Santoro1, Pietro Mortini3, Andrea Giustina1. 1. Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy. 2. Marmara University Pendik Training and Research Hospital, Department of Endocrinology and Metabolism Disease, 34800 Istanbul, Turkey. 3. Department of Neurosurgery, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
Abstract
CONTEXT: Osteopathy and morphometric vertebral fractures (VFs) are emerging complications in acromegaly. However, the prediction of VFs in this clinical setting is still a matter of uncertainty, and it is debated whether they are an early event in the natural history of the disease. OBJECTIVE: We aimed to evaluate the prevalence and determinants of morphometric VFs in patients with recently diagnosed acromegaly. METHODS: We enrolled 92 patients (43 men/49 women) on admission to the neurosurgery unit before transsphenoidal surgery, and compared them with control individuals without secondary forms of osteoporosis and pituitary disorders. We performed a VF assessment on preoperative chest x-ray images and collected biochemical, demographic, and clinical data. RESULTS: We detected a significantly higher prevalence of VFs (33.7%) in patients with acromegaly than in controls (P = .001). Among the patients with acromegaly and VFs, 12 (38.7%) showed multiple VFs, and 5 (16.1%) showed moderate/severe VFs. Patients with VFs had higher random serum growth hormone (GH) levels than those with no VFs (P = .03), but there was no difference in insulin-like growth factor-1 (IGF-1) (P = .07) and IGF-1/Upper Normal Limit ratio (P = .08). Free 3,5,3'-triiodothyronine was slightly lower in patients with acromegaly and VFs than in those without VFs (P = .05). In multiple logistic analysis, GH was independently associated with risk for VFs (P = .003). The preoperative serum GH cutoff value that predicted VFs was 12 ng/mL. CONCLUSION: For the first time, high prevalence of radiological VFs is reported in patients with recent diagnosis of acromegaly. Therefore, we can hypothesize that VFs are an early phenomenon of acromegaly and related to GH levels. VF assessment should be included in the workup at the diagnosis of acromegaly.
CONTEXT: Osteopathy and morphometric vertebral fractures (VFs) are emerging complications in acromegaly. However, the prediction of VFs in this clinical setting is still a matter of uncertainty, and it is debated whether they are an early event in the natural history of the disease. OBJECTIVE: We aimed to evaluate the prevalence and determinants of morphometric VFs in patients with recently diagnosed acromegaly. METHODS: We enrolled 92 patients (43 men/49 women) on admission to the neurosurgery unit before transsphenoidal surgery, and compared them with control individuals without secondary forms of osteoporosis and pituitary disorders. We performed a VF assessment on preoperative chest x-ray images and collected biochemical, demographic, and clinical data. RESULTS: We detected a significantly higher prevalence of VFs (33.7%) in patients with acromegaly than in controls (P = .001). Among the patients with acromegaly and VFs, 12 (38.7%) showed multiple VFs, and 5 (16.1%) showed moderate/severe VFs. Patients with VFs had higher random serum growth hormone (GH) levels than those with no VFs (P = .03), but there was no difference in insulin-like growth factor-1 (IGF-1) (P = .07) and IGF-1/Upper Normal Limit ratio (P = .08). Free 3,5,3'-triiodothyronine was slightly lower in patients with acromegaly and VFs than in those without VFs (P = .05). In multiple logistic analysis, GH was independently associated with risk for VFs (P = .003). The preoperative serum GH cutoff value that predicted VFs was 12 ng/mL. CONCLUSION: For the first time, high prevalence of radiological VFs is reported in patients with recent diagnosis of acromegaly. Therefore, we can hypothesize that VFs are an early phenomenon of acromegaly and related to GH levels. VF assessment should be included in the workup at the diagnosis of acromegaly.
Authors: Stefano Frara; Luigi di Filippo; Mauro Doga; Paola Loli; Felipe F Casanueva; Andrea Giustina Journal: Pituitary Date: 2022-07-18 Impact factor: 3.599
Authors: Sabrina Chiloiro; Antonella Giampietro; Irene Gagliardi; Marta Bondanelli; Miriam Veleno; Maria Rosaria Ambrosio; Maria Chiara Zatelli; Alfredo Pontecorvi; Andrea Giustina; Laura De Marinis; Antonio Bianchi Journal: Pituitary Date: 2022-08-03 Impact factor: 3.599