A Case and Review of Acromegaly-Induced Cardiomyopathy and the Relationship Between Growth Hormone and Heart Failure: Cause or Cure or Neither or Both?

Schwarz, Ernst R.; Jammula, Praveen; Gupta, Rajiv; Rosanio, Salvatore

doi:10.1177/1074248406296676

Cited by 7 publications

(4 citation statements)

References 121 publications

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“…Administration of synthetic GSH, such as hexarelin and GHRP-6, have also demonstrated improvements in patients and animals with ischemic cardiomyopathy or dialated cardiomyopathy (DCM), independent of IGF-1 [71-75]. However, the role of ghrelin in the treatment of acromegaly-induced cardiomyopathy remains controversial [76]. …”

Section: Ghrelin and Cardiovascular Diseasesmentioning

confidence: 99%

Ghrelin and Cardiovascular Diseases

Zhang¹,

Yin²,

Qi³

et al. 2010

CCR

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Ghrelin, a newly discovered bioactive peptide, is a natural endogenous ligand of the growth hormone (GH) secretagogue receptor and initially identified as a strong stimulant for the release of GH. Subsequent research has shown that ghrelin and its various receptors are ubiquitous in many other organs and tissues. Moreover, they participate in the regulation of appetite, energy, bodyweight, metabolism of glucose and fat, as well as modulation of gastrointestinal, cardiovascular, pulmonary, immune functions and cell proliferation/apoptosis. Increasing evidence has demonstrated that ghrelin has a close relationship with cardiovascular system. Ghrelin and its receptors are widely distributed in cardiovascular tissues, and there is no doubt that the effects of ghrelin in the cardiovascular system are mediated not only via its growth-hormone-releasing effect but also by its direct effects on the heart. Exogenous administration of ghrelin can dilate peripheral blood vessels, constrict coronary artery, improve endothelial function, as well as inhibit myocardial cell apoptosis. So, ghrelin may have cardiovascular protective effect, including lowering of blood pressure, regulation of atherosclerosis, and protection from ischemia/reperfusion injury as well as improving the prognosis of myocardial infarction and heart failure. Some of these new functions of ghrelin may provide new potential therapeutic opportunities for ghrelin in cardiovascular medicine. In this paper, we will review the existing evidence for cardiovascular effects of ghrelin, including the cardiovascular function, the variations in ghrelin plasma levels in pathophysiologicalogical conditions, the possible protective mechanisms of ghrelin, as well as its future potential therapeutic roles.

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Section: Ghrelin and Cardiovascular Diseasesmentioning

confidence: 99%

Ghrelin and Cardiovascular Diseases

Zhang¹,

Yin²,

Qi³

et al. 2010

CCR

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“…Other reports describe how the classic treatments of acromegaly, including surgical resection of the pituitary adenoma, somatostatin analogs and GH antagonists, and stereotactic radiosurgery or fractionated radiation, might improve cardiac function in the short term but probably have very little effect on long-term prognosis [23, 24]. Successful later case reports support the idea of the use of traditional heart failure therapy, which consists of ACEIs, angiotensin receptor blockers, β-blockers, aldosterone antagonists, and diuretics, to further improve cardiovascular function because GH/IGF-1 control alone is insufficient [25, 26]. Heart transplant is an option for end-stage heart failure [24, 27].…”

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report

Wang

Liu

et al. 2019

J Med Case Reports

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Background Congestive heart failure is rarely observed in patients with acromegaly. Excessive growth hormone secretion and elevation of insulin-like growth factor 1 contribute to pathological changes in myocyte growth and structure, cardiac contractility, vascular function, and in later stage may progress to cardiac dysfunction. Early recognition of the condition is paramount, though the insidious progression of the disease commonly results in late diagnosis. Current standard regimens of pharmacological therapy, surgical treatment, radiotherapy are designed to normalize serum levels of both insulin-like growth factor 1 and growth hormone. In patients with late-stage heart failure due to acromegalic cardiomyopathy, cardiac resynchronization therapy might be a desirable treatment to help cardiac synchronization, improve symptoms, and eventually reduce hospital admissions together with mortality rates. Case presentation We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160–200 ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient’s symptoms were successfully alleviated, and he was discharged from the hospital. Conclusions Congestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.

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“…Phenotypic cardiac manifestations include left ventricular (LV) hypertrophy and may ultimately manifest as heart failure. These findings are attributed to the role of excess secretion of growth hormone (GH) and insulin-like growth factors in the development of cardiac myocytes, and alteration of cardiac structure and function 3. In this case, LV hypertrophy was noted in a patient with acromegaly who developed an induced LV outflow tract (LVOT) gradient in the setting of dobutamine stress echocardiography.…”

Section: Introductionmentioning

confidence: 86%

Acromegaly-induced cardiomyopathy with dobutamine-induced outflow tract obstruction

Abdelsalam

Nippoldt

2016

BMJ Case Reports

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SUMMARYA 50-year-old man with a history of acromegaly was referred for preoperative cardiac evaluation preceding trans-sphenoidal resection of a pituitary macroadenoma. Dobutamine stress echocardiography was negative for myocardial ischaemia. Resting left ventricular (LV) LV ejection fraction (LVEF) was 64% and there was hypertrophy of ventricular septum (18 mm) without resting LV outflow tract obstruction. With 40 mg/kg/min of dobutamine, the LVEF became hyperdynamic at 80%, and there was a maximal instantaneous LV outflow tract gradient of 77 mm Hg. There was no delayed myocardial enhancement on cardiac MRI and the pattern of hypertrophy was concentric. Acromegaly-induced cardiomyopathy can mimic hypertrophic cardiomyopathy in the setting of dobutamine provocation. Because cardiomyopathy is an important cause of mortality in acromegaly, diagnosis and appropriate management are critical to improve survival. BACKGROUND

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A Case and Review of Acromegaly-Induced Cardiomyopathy and the Relationship Between Growth Hormone and Heart Failure: Cause or Cure or Neither or Both?

Cited by 7 publications

References 121 publications

Ghrelin and Cardiovascular Diseases

Ghrelin and Cardiovascular Diseases

Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report

Acromegaly-induced cardiomyopathy with dobutamine-induced outflow tract obstruction

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