Challenges in the diagnosis and management of acromegaly: a focus on comorbidities

Abstract

IntroductionAcromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life.MethodsWe conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment.Findings and conclusionsSuccessful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.

Diagnosing endocrine hypertension: a practical approach

“…It is associated with a range of comorbidities. Aside from somatic overgrowth evident in hand and feet enlargement, coarse facial features and soft tissue hypertrophy, other common comorbidities include diabetes, dyslipidemia, carpal tunnel syndrome, osteoarthritis and obstructive sleep apnea . The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases .…”

“…The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases . The diagnosis of acromegaly can be made based on an elevated serum insulin‐like growth factor 1 level (range is age and laboratory‐dependent) and a non‐suppressed GH in response to oral glucose tolerance testing . GH itself is secreted episodically; hence, an isolated GH level has little diagnostic value.…”

MECHANISMS IN ENDOCRINOLOGY: Clinical and pharmacogenetic aspects of the growth hormone receptor polymorphism

“…Uncontrolled acromegaly is associated with increased mortality and several morbidities are commonly present, including IGT and T2DM, arterial hypertension, dyslipidemia, sleep apnea and malignancies (53,54). Currently, acromegaly is treated by a combination of surgery, radiotherapy and three classes of drugs: dopamine-agonists (cabergoline), somatostatin analogs (octreotide, lanreotide, pasireotide) and GHR antagonists (pegvisomant).…”

Pathogenic relations between metabolic and gynecologic disorders in acromegaly: a clinical case report

“…Период от появления первых симптомов заболе-вания до подтверждения диагноза обычно составляет 7-10 лет [7], в связи с чем различные системы орга-нов долгое время функционируют в условиях уси-ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва Луценко А.С. *, Воротникова С.Ю., Станоевич И.В., Зенкова Т.С., Азизян В.Н., Григорьев А.Ю., Белая Ж.Е.…”

“…Своевременное лечение основного заболевания и кор-рекция осложнений (табл. 1) способствуют увеличе-нию продолжительности жизни [7]. Первый этап диагностики включает в себя оценку клинических проявлений, определение ИРФ-1 и оценку снижения уровня СТГ после нагрузки глю-козой в ходе перорального глюкозотолерантного теста.…”