Cardiovascular Complications Of Acromegaly

Abstract

Acromegaly is associated with increased mortality and decreased life expectancy. Cardiovascular disease is the principal cause of premature mortality in patients with acromegaly, accounting for about 60% of deaths. GH and/or IGF-I exert direct cardiac effects: enhance cardiac contractility, stimulate cardiomyocyte growth, influence calcium influx in cardiomyocytes. Cardiac remodelling is influenced by hypertension and insulin resistance. Among cardiovascular risk factors arterial hypertension, reported in 35% of patients with acromegaly, ranks among most important negative prognostic factors for mortality. Hypertension plays significant role in the development of cardiac hypertrophy, especially in older acromegalic patients and diastolic blood pressure is best predictive factor for cardiac hypertrophy. Therefore, early and aggressive hypertension treatment is essential for prognosis in acromegaly. Other important risk factors are: valvular defects, arrhythmias, endothelial dysfunction, heart failure, lipid abnormalities and coronary artery disease. Numerous studies suggest that patients with acromegaly are under threat of arrhythmias, especially those with structural heart abnormalities. Congestive heart failure as end-stage acromegalic cardiomyopathy occurs usually in older patients, with long-term uncontrolled disease and other cardiovascular and metabolic complications. Relation between acromegaly and coronary artery disease is controversial as it seems to be connected rather with classical cardiovascular risk factors than GH and IGF-1 overexpresion.

Quality of Life in Patients with Acromegaly – a Romanian Single Center Cross-Sectional Study

“…Of all complications associated or due to acromegaly, articular and bone complications (characterized by vertebral fracture risk, bone microarchitecture alteration, bone turnover increase) (24), type 2 diabetes mellitus, dyslipidemia and cardiovascular complications (ventricle functional impairment, especially left ventricular diastolic dysfunction) (25), seem to lower patients' quality of life, by decreasing their performance of daily life activities, cardiovascular disease representing the leading cause of death in these patients (26), accounting for approximately 60% of deaths (27). Interestingly, neither ophthalmological complications, nor obstructive sleep apnea syndrome decreased QoL.…”

Clinical Challenges for Anesthesiologist Facing Patient With Acromegaly. Case Report

“…Cardiac complications are often present in acromegalic patients and it is the principle cause of premature mortality in these patients accounting for about 60% (12). Acromegalic patients due to GH and IGF-1 exert present cardiac remodeling which causes left ventricular hypertrophy, increased risk of arrythmias, systolic and diastolic dysfunction that leads to congestive heart failure (usually in older patients).…”

Myokines in Acromegaly: An Altered Irisin Profile

“…Acromegaly is a chronic systemic disease, most often caused by a benign somatotroph pituitary adenoma and may be considered a natural model of chronic GH excess. Metabolic complications are common in this disease and contribute to a 1.5-2.5 times higher standardized mortality ratio with cardiovascular disease as a major cause of death (18,19). GH antagonizes insulin action and increases lipolysis causing insulin resistance and lipotoxicity (20)(21)(22)(23).…”