The Prevalence of Cancer and Its Relation to Disease Activity in Patients With Acromegaly: Two Centers' Experience

Uçan, Bekir; Kızılgül, Muhammed; Karci, Alper Cagri; Duger, Hakan; Sencar, Muhammed Erkam; Imga, Narin Nasiroglu; Demirci, Taner; Berker, Dilek; Çakal, Erman

doi:10.4158/ep-2020-0398

Cited by 12 publications

(6 citation statements)

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“…Although some research still indicated a similar risk of thyroid cancer in acromegaly [ 17 , 32 , 33 ], the difference in cancer spectrum in various regions might partially explain these conflicts. In our center, thyroid cancers accounted for 49.7% of new cancers, and females were at higher risk, which was similar to large-scale research in Korea [ 19 ], as well as several small-scale studies in China [ 23 , 34 ] and Japan [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies suggested a higher cancer risk in acromegaly [ 5 , 10 , 11 ], while some population-based or multicenter studies also indicated a similar risk to the general population [ 12 – 14 ]. Additionally, although preclinical research supported that elevated GH promotes tumorigenesis [ 15 , 16 ], the result in clinical studies varied [ 4 , 11 , 17 ]. Several multicentral studies suggested that a higher posttreatment GH or IGF-1 may be related to higher cancer risk [ 12 , 18 ], while some showed no difference [ 11 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among all cancers, thyroid cancer and colorectal cancer are considered to be most likely to increase in many previous studies [ 20 ], as well as benign thyroid nodules [ 21 – 23 ] and colorectal polyps [ 20 , 24 ]. However, although the latest meta-analysis indicated an elevated standardized incidence ratio (SIR) of thyroid cancer (9.2, 95% CI: 4.2–19.9), there were also large-scale studies indicating a similar risk to the general population [ 17 , 25 ]. Some clinical practice guidelines have suggested colonoscopy and thyroid ultrasound for acromegaly when needed [ 26 , 27 ], while some considered it nonbeneficial [ 8 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

et al. 2023

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Purpose To evaluate the incidence of malignancies in acromegaly and to identify risk factors for newly-diagnostic cancers, especially the excessive growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Methods A retrospective cohort including 1738 consecutive hospitalized patients with acromegaly in a single referral center between 2012 and 2020 (mean follow-up 4.3 years). A gender- and age-matched case-control study (280 patients from the cohort) was performed for risk factor analysis. Results One hundred thirteen malignancies (67 diagnosed after acromegaly) were observed. The overall newly-diagnostic cancer risk of acromegaly was higher than the general population (standardized incidence ratio (SIR) 2.81; 95% CI 2.18–3.57). The risk of thyroid cancer (n = 33, SIR 21.42; 95% CI 13.74–30.08) and colorectal cancer (n = 8, SIR 3.17; 95% CI 1.37–6.25) was elevated. In the overall cohort, IGF-1 (ULN: 1.27 vs. 0.94, p = 0.057), GH (1.30 vs. 1.00 ng/ml, p = 0.12), and disease-controlled rate (34.9% vs. 45.9%, p = 0.203) at the last visit did not reach significance between patients with and without post-diagnostic cancer. In the case-control study, GH (1.80 vs. 0.90 ng/ml, p = 0.018) and IGF-1 (ULN: 1.27 vs. 0.91, p = 0.003) at the last visit were higher in patients with post-diagnostic cancers, with a lower disease-controlled rate. Elder age was a risk factor for cancer. Other metabolic comorbidities and the size of pituitary tumors were similar. Conclusion The risk of malignancies, especially thyroid cancer, was increased in patients with acromegaly in our center. More cancer screening should be considered when managing acromegaly, especially in patients with higher posttreatment GH and IGF-1.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

et al. 2023

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“…A normal age- and sex-adjusted normal ranges of circulating IGF-1 levels and a postoperative random GH level of <1 ng/mL or GH level of <0.4 ng/mL after a glucose load were used as the remission criteria. Patients were categorized into the control group when IGF-1 was within age- and sex-adjusted normal ranges and were otherwise categorized into the active disease group [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

The role of elastography in the assessment of thyroid nodules in acromegaly

DÜĞER¹,

KIZILGÜL²,

AKHANLI³

et al. 2023

Turkish Journal of Medical Sciences

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Background/aim Nodular thyroid disease is a frequent finding seen in patients with acromegaly. Ultrasound-elastography (US-E) appears to be a helpful tool for the diagnosis of thyroid cancer. The aims of this study were to evaluate thyroid nodules in acromegaly and to assess the diagnostic accuracy of US-E in detecting thyroid cancer in this population. Material and methods US-E was applied to 166 nodules detected in 102 acromegalic patients and to 105 nodules found in 95 nonacromegalic subjects. The lesions were classified according to the elasticity scores (ES) as soft (ES 1–2) or hard (ES 3–4). Results Mean age was 55.1 ± 12.47 years [59 (58%) women]. The prevalence of hard nodules (ES 3 and 4) was significantly higher in the group of acromegalic patients than in control subjects (48% to 20%, p < 0.001). Mean ES was higher in patients with acromegaly (2.45 to 2.22, p: 0.001), however, the mean strain index (SI) was similar between groups (1.53 to 1.65, p: 0.204). Conclusion Thyroid nodules in acromegaly patients have a higher elasto score and the prevalence of hard nodules is higher in active disease. However, increased stiffness of nodules by US-E in patients with acromegaly does not seem to estimate the malignancy of the nodules.

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“…The patients who achieved age and gender-adjusted IGF-1 levels normalization after cabergoline treatment and who were with persistent increased IGF-1 levels were considered to be with controlled and active diseases, respectively. In cases with discrepant GH and IGF-1 levels, only IGF-1 values were used for the decision of remission as recommended (2,12).…”

Section: Subject Selection and Measurementsmentioning

confidence: 99%

Efficacy of cabergoline add-on therapy in patients with acromegaly resistance to somatostatin analogs treatment and the review of literature

Kızılgül

Duger

Nasiroglu

et al. 2022

Archives of Endocrinology and Metabolism

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Objectives: It is reported that adding cabergoline to somatostatin analog (SSA) normalizes IGF-1 levels approximately in one-third of patients with acromegaly. We investigated the effect of combination therapy and potential predictors of response in patients with acromegaly who do not respond to SSA therapy alone. Subjects and methods: Fifty acromegaly patients (M/F 23/27, mean age 50.88 ± 12.34 years) were divided into two groups as the active and control groups in this connection. Before and after treatment, we not only evaluated serum GH and IGF-1 levels and tumor size but also analyzed the factors relevant to the effect of the combined therapy. Results: Adding cabergoline to SSA treatment led to IGF-1 normalization in 42% (21/50) of patients. Mean GH levels decreased from 2.64 ± 1.79 to 1.34 ± 0.99 ng/mL (p < .0001) and IGF-1 levels decreased from 432.92 ± 155.61 to 292.52 ± 126.15 ng/mL (p < .0001). GH and IGF-1 reduction in percent (%) were significantly higher in the controlled group (63% to 40%, p = 0.023 and 45% to 19%, p = 0.0001). Moreover, tumor size decrease was significantly higher in controlled group (-3.6 cm to -1.66 cm, p = 0.005). Conclusion: According to the results of our study, the addition of cabergoline to SSA normalized IGF-1 levels in a considerable amount of acromegaly patients with a moderately elevated IGF-1 level, regardless of serum PRL levels. Besides, cabergoline treatment was also influential in patients with higher IGF-1 levels despite a lower remission rate.

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The Prevalence of Cancer and Its Relation to Disease Activity in Patients With Acromegaly: Two Centers' Experience

Cited by 12 publications

References 37 publications

Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

The role of elastography in the assessment of thyroid nodules in acromegaly

Efficacy of cabergoline add-on therapy in patients with acromegaly resistance to somatostatin analogs treatment and the review of literature

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