Evidence of Subclinical Heart Muscle Dysfunction in Acromegaly

Jonas, Ernesto; Aloia, John F.; Lane, Frank

doi:10.1378/chest.67.2.190

Cited by 33 publications

(5 citation statements)

References 13 publications

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“…The other reports (Bodem et al, 1976;Martins et al, earne et al, 1975Martins et al, earne et al, ) 1977. Our study does not support the findings of a i almost all acro-report on 10 acromegalic patients, in which a high ic feature, was not incidence of subclinical muscle disease was suggestrecognised that a ed on the basis of systolic time interval measureventricular hyperments alone (Jonas et al, 1975). However, the PEP/ is aortic stenosis) LVET ratio was strikingly abnormal in only 2 thickening (Maron patients in the above report, 1 of whom had preacromegalic hearts viously had a myocardial infarction; in the other patients the abnormal ratios were largely the result r ejection fraction of a shortened left ventricular ejection time with ance is well estab-a normal pre-ejection period, which is not the xists between the pattern that theoretical considerations would predict 1 from echocardioin subclinical myocardial disease.…”

Section: Discussioncontrasting

confidence: 97%

Heart size and function in acromegaly.

Mather¹,

Boyd²,

Jenkins³

1979

Heart

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SUMMARY Cardiac size and function was studied in 23 acromegalic patients using echocardiography and systolic time interval measurements. Thirteen patients (56%) had increased left ventricular mass, and in the 20 treated patients this correlated well with the mean of the recent basal growth hormone levels. It is suggested that myocardial hypertrophy may regress in proportion to the degree of control of growth hormone levels. The ejection fraction was normal in all patients except one, and increased left ventricular mass was not associated with detectable impairment of left ventricular performance. Thus, most acromegalic hearts function normally even when their mass is considerably increased, though the longterm effects of this are unknown. Echocardiography will be valuable in the serial monitoring of the cardiac effects of acromegaly.

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Section: Discussioncontrasting

confidence: 97%

Heart size and function in acromegaly.

Mather¹,

Boyd²,

Jenkins³

1979

Heart

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“…Secondly, the spectrum of abnormalities present in the patients, whether determined clinically, radiographically, electro-or echocardiographicallv, was verv similar to that found in previous studies of cardiovascular disease in acomegaly (Jonas et al 1975;Hearne et al 1975;Martins et al 1977;Savage et al 1979;Lie & Grossman 1980). The increased risk of cardiovascular disease in acromegaly seems to be related more to the dura¬ tion of the illness than the absolute serum GH levels (Martins et al 1977;Eastman et al 1979;Lie & Grossman 1980;O'Keefe et al 1982).…”

Section: Discussionsupporting

confidence: 79%

Progression of cardiovascular disease in acromegalic patients treated by external pituitary irradiation

Baldwin

Cundy

Butler³

et al. 1985

Acta Endocrinologica

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Cardiovascular complications are a major cause of morbidity and mortality in acromegaly and seem to be related to the long duration of the disorder.Conventional external pituitary irradiation for acromegaly produces a consistent, but slow, fall in elevated serum growth hormone (GH) levels. It has not been established whether such treatment is effective in preventing the development of cardiovascular complications. The evolution of cardiovascular disease has therefore been studied in 11 acromegalic patients followed up for a mean 10 years (range 3\p=n-\17) after external pituitary irradiation. At the final follow-up fasting serum GH were significantly (P < 0.01) lower than pre-irradiation levels, but cardiovascular events (myocardial infarction, dysrhythmias, hypertension, major arterial disease, heart failure) increased significantly in prevalence (P < 0.01) during this period. Electrocardiographic abnormalities also increased in prevalence. At the final follow-up 6 patients had cardiomegalv on chest X-ray and echocardiographs (10 patients) were abnormal in every case. All 11 patients had evidence of complete or partial anterior hypopituitarism. We confirm that external pituitary irradiation is effective in reducing elevated serum GH levels in acromegaly, but suggest that such a slow reduction in serum GH levels does not retard the development of cardiovascular complications.

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“…The secondary causes of diabetes and hypertension, such as thyrotoxicosis, phaeochromocytoma, Cushing's syndrome and acromegaly, are occasionally seen [3,[24][25][26][27][28]. Some oral contraceptive preparations may also induce the combination.…”

Section: Classification Of Hypertensionmentioning

confidence: 99%

“…There are usually clinical clues to the presence of thyrotoxicosis, phaeochromocytoma, Cushing's syndrom.e or acromegaly [24][25][26][27][28]. Renal hypertension, other than that due to diabetic nephropathy, is more difficult to exclude but an intravenous urogram is indicated only where there are unequal renal sizes on plain abdominal radiography, abnormal cells in urine specimens or specific reasons to expect other renal pathology.…”

Section: Investigation and Management Of Hypertension In Diabetesmentioning

confidence: 99%

Diabetes and arterial hypertension

1983

Diabetologia

131

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The epidemiology, pathogenesis, significance and management of hypertension in diabetic subjects are discussed. In Type 1 diabetes the presence of diastolic hypertension is closely related to the presence of diabetic nephropathy, from the stage of persistent proteinuria onwards. There may also be some elevation of systolic pressure. The apparent increased prevalence of hypertension in Type 2 diabetes is largely explicable, directly or indirectly, by obesity but there may be an excess of systolic hypertension among elderly patients. Hypertension in the diabetic population is associated with an increased incidence of both microvascular and macrovascular complications, but whether the high blood pressure is causal is not clear. The possible roles of sodium and insulin, the renin-angiotensin system, catecholamines and physical factors are explored. All current antihypertensive agents have additional limitations and disadvantages when used in diabetic patients: diuretics and beta-blockers are probably the initial drugs of choice. Only in the case of diabetic nephropathy is there yet reasonable evidence of antihypertensive treatment reducing the rate of progression of the disease.

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Evidence of Subclinical Heart Muscle Dysfunction in Acromegaly

Cited by 33 publications

References 13 publications

Heart size and function in acromegaly.

Heart size and function in acromegaly.

Progression of cardiovascular disease in acromegalic patients treated by external pituitary irradiation

Diabetes and arterial hypertension

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