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De Fano M, Falorni A, Malara M, Porcellati F, Fanelli CG. Management of Diabetes Mellitus in Acromegaly and Cushing's Disease with Focus on Pasireotide Therapy: A Narrative Review. Diabetes Metab Syndr Obes 2024; 17:2761-2774. [PMID: 39072348 PMCID: PMC11283249 DOI: 10.2147/dmso.s466328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/01/2024] [Indexed: 07/30/2024] Open
Abstract
Patients suffering from acromegaly and Cushing's Disease (CD) face the risk of several clinical complications. The onset of diabetes mellitus (DM) is among the most important: exposure to elevated growth hormone or cortisol levels is associated with insulin resistance (IR). DM contributes to increasing cardiovascular risk for these subjects, which is higher compared to healthy individuals. Hyperglycemia may also be caused by pasireotide, a second-generation somatostatin receptor ligand (SRLs), currently used for the treatment of these diseases. Accordingly, with 2014 medical expert recommendations, the management of hyperglycemia in patients with CD and treated with pasireotide is based on lifestyle changes, metformin, DPP-4 inhibitors (DPP-4i) and, subsequently, GLP-1 Receptor Agonists (GLP-1 RAs). There is no position for SGLT2-inhibitors (SGLT2-i). However, a very recent experts' consensus regarding the management of pasireotide-induced hyperglycemia in patients with acromegaly suggests the use of GLP-1 RAs as first line treatment (in suitable patients) and the use of SGLT2-i as second line treatment in patients with high cardiovascular risk or renal disease. As a matter of fact, beyond the hypoglycemic effect of GLP1-RAs and SGLT2-i, there is increasing evidence regarding their role in the reduction of cardiovascular risk, commonly very high in acromegaly and CD and often tough to improve despite biochemical remission. So, an increasing use of GLP1-RAs and SGLT2-i to control hyperglycemia is desirable in these diseases. Obviously, all of that must be done with due attention in order to minimize the occurrence of adverse events. For this reason, large studies are needed to analyze the presence of potential limitations.
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Affiliation(s)
- Michelantonio De Fano
- Department of Medicine and Surgery, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy
| | - Alberto Falorni
- Department of Medicine and Surgery, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy
| | - Massimo Malara
- Department of Medicine and Surgery, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy
| | - Francesca Porcellati
- Department of Medicine and Surgery, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy
| | - Carmine Giuseppe Fanelli
- Department of Medicine and Surgery, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy
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Varlamov EV, Fleseriu M. Acromegaly and COVID-19, lessons, and new opportunities. Pituitary 2024:10.1007/s11102-024-01404-0. [PMID: 38819618 DOI: 10.1007/s11102-024-01404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
The COVID-19 pandemic created challenges in effective management of patients with acromegaly. Specifically, with regards to timely diagnosis, delays in surgeries, and disruption(s) to routine patient care. A transition to telemedicine did help to overcome safety restrictions that were placed on in-person care. Creation of surgical safety protocols in conjunction with widespread testing for COVID-19 has also helped with the resumption of pituitary surgery cases. However, acromegaly related comorbidities including cardiovascular disease, diabetes mellitus, sleep apnea and respiratory disease, vertebral fractures, and hypopituitarism, may increase the risk of a more severe COVID-19 infection course. Of note and to date, no negative trends in COVID-19 related outcomes have been reported in patients with acromegaly. Nevertheless, anxiety and depression rates in patients with acromegaly are higher than those in the general population. More studies are needed to assess the true impact of the COVID-19 pandemic on morbidity, mortality, and neuropsychiatric health of patients with acromegaly.
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Affiliation(s)
- Elena V Varlamov
- Pituitary Center, Oregon Health & Science University, Portland, OR, 97239, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Maria Fleseriu
- Pituitary Center, Oregon Health & Science University, Portland, OR, 97239, USA.
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.
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Gonzalez-Almazan JA, Cortes-Contreras AP, Flores-Rabasa R, Mendez-Garcia LA, Escobedo G, Navarro Olvera JL, Carrillo-Ruiz JD. Metabolic Syndrome Components in Patients with Pituitary Adenoma. Horm Metab Res 2024; 56:118-127. [PMID: 38081188 DOI: 10.1055/a-2209-0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Pituitary adenomas are benign tumors of the anterior portion of the pituitary gland (adenohypophysis), representing the 25% of all the tumor alterations. Pituitary adenomas are classified by the type of hormone secreted, cellularity, size, and structural alterations by the hormonal segregation. The diagnosis consists on the histopathological identification of cell types and the image-guided by magnetic resonance or tomography; the treatment can be both pharmacological and surgical. Metabolic Syndrome is the set of clinical conditions that increase the risk of cardiovascular diseases with an estimated prevalence of 25% worldwide. The alterations of metabolic syndrome are obesity, hypertension, dyslipidemia, insulin resistance, and diabetes mellitus type II. Pituitary adenomas and metabolic syndrome have an important relationship, hormone-secreting by pituitary adenomas affects a myriad of signaling pathways, which allows a favorable environment for the appearance of the metabolic syndrome. Moreover, patients with pituitary adenomas are shown to have an improvement in metabolic parameters after the medical/surgical treatment. The objective of this review is to explore the possible mechanisms through which PAs contributes to MetSx.
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Affiliation(s)
- Jorge A Gonzalez-Almazan
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico Facultad de Estudios Superiores Iztacala, Tlalnepantla, Mexico
| | - Ana Paula Cortes-Contreras
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Ciudad de Mexico, Mexico
| | - Regina Flores-Rabasa
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Faculty of Health Sciences, Anahuac University Mexico - Southern Campus, Ciudad de Mexico, Mexico
| | | | - Galileo Escobedo
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
| | - José L Navarro Olvera
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
| | - José D Carrillo-Ruiz
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Coordination of Neuroscience, Faculty of Psychology, University Anahuac Mexico, Huixquilucan, Mexico
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Romanisio M, Pitino R, Ferrero A, Pizzolitto F, Costelli S, Antoniotti V, Marzullo P, Aimaretti G, Prodam F, Caputo M. Discordant biochemical parameters of acromegaly remission do not influence the prevalence or aggressiveness of metabolic comorbidities: a single-center study. Front Endocrinol (Lausanne) 2023; 14:1256975. [PMID: 37829686 PMCID: PMC10565344 DOI: 10.3389/fendo.2023.1256975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose The discrepancy between the biomarkers of disease's activity in acromegalic patients (GH and IGF-1) is almost frequent representing a challenge for the development of comorbidities in the long term. The aim of this study was to evaluate the prevalence and severity of metabolic comorbidities (diabetes, hypertension, and dyslipidemia) in surgically treated acromegalic patients with disease control and discordant GH and/or IGF-1 levels compared with those with concordant values. Patients and methods Retrospective monocentric observational study on acromegalic surgically treated patients with biochemical remission (group A) or mild discordant GH or IGF-1 levels (group B). Metabolic complications and medical therapy were assessed at diagnosis and at the last follow-up visit. Severity of the disease was set for drug titration or shift to another molecule or more than before. Results There were 18 patients that met the inclusion criteria [group A: nine patients; group B: nine patients, follow-up 7 years (IQR 5.0;11.25)]. The prevalence of female patients was significantly higher in the remission group compared with the discordant group (p < 0.02). Considering metabolic complications, at the last follow-up, 61.1% was affected by hypertension, 33.3% by diabetes, and 61.1% by dyslipidemia, without differences between groups. Drug characteristics (dose, shift, number) during the follow-up did not differ significantly between groups. Conclusion Metabolic complications, mainly dyslipidemia, are frequent in cured acromegalic patients, but GH/IGF-1 discrepancy does not seem to represent a risk factor for their presence or persistence. More extended studies are needed to confirm our results in a long-term period.
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Affiliation(s)
- Martina Romanisio
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Rosa Pitino
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Alice Ferrero
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Francesca Pizzolitto
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Samuele Costelli
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | | | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Flavia Prodam
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Marina Caputo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
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Gadelha MR, Gordon MB, Doknic M, Mezősi E, Tóth M, Randeva H, Marmon T, Jochelson T, Luo R, Monahan M, Madan A, Ferrara-Cook C, Struthers RS, Krasner A. ACROBAT Edge: Safety and efficacy of switching injected SRLs to oral paltusotine in patients with acromegaly. J Clin Endocrinol Metab 2022; 108:e148-e159. [PMID: 36353760 PMCID: PMC10099171 DOI: 10.1210/clinem/dgac643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
CONTEXT Paltusotine is a once-daily, oral, non-peptide small-molecule somatostatin receptor type 2 (SST2) agonist in clinical development for treatment of acromegaly. OBJECTIVE To evaluate change in IGF-I levels in patients switched from octreotide LAR or lanreotide depot monotherapy to paltusotine. DESIGN Phase 2, open-label, prospective, multicenter, multinational, non-randomized, single-arm exploratory study in which dosage up-titrations were performed in a double-blinded manner. SETTING 26 global sites. PARTICIPANTS Patients with acromegaly switched to paltusotine from injected SRL-based therapy. INTERVENTIONS Patients received 13-week treatment with once-daily oral paltusotine (10-40 mg/day). MAIN OUTCOME MEASURES Primary endpoint was change from baseline to week 13 in IGF-I for patients who switched from long-acting octreotide or lanreotide monotherapy to paltusotine (Group 1). All patients underwent a 4-week paltusotine washout at end of treatment period (weeks 13-17). IGF-I, GH, patient reported outcome, and safety data were collected. RESULTS Forty-seven patients enrolled. In Group 1 (n = 25), IGF-I and GH showed no significant change between SRL baseline and end of paltusotine treatment at week 13 (median change in IGF-I = -0.03×upper limit of normal [ULN], P = 0.6285; GH = -0.05 ng/mL, P = 0.6285). IGF-I and GH rose significantly in the 4 weeks after withdrawing paltusotine (median change in IGF-I = 0.55×ULN, P < 0.0001 [median increase 39%]; GH = 0.72 ng/mL, P < 0.0001 [109.1% increase]). No patients discontinued due to adverse events; no treatment-related serious adverse events were reported. CONCLUSIONS These results suggest once daily, oral paltusotine is effective in maintaining IGF-I values in patients with acromegaly who switched from injected SRLs. Paltusotine was well tolerated with a safety profile consistent with other SRLs.
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Affiliation(s)
- Monica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division-Medical School and Hospital Universitario Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Division of Endocrinology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Mirjana Doknic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emese Mezősi
- University of Pécs Medical School, Pécs, Hungary
| | | | - Harpal Randeva
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Tonya Marmon
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Rosa Luo
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Ajay Madan
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
| | | | | | - Alan Krasner
- Crinetics Pharmaceuticals Inc., San Diego, CA, USA
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Heydari M, Hashemi-Madani N, Emami Z, Khajavi A, Ghorbani M, Malek M, Ataei Kachuee M, Khamseh ME. Post-treatment heterogeneity of cardiometabolic risk in patients with acromegaly: The impact of GH and IGF-1. Endocr Res 2022; 47:1-7. [PMID: 34102938 DOI: 10.1080/07435800.2021.1931298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Metabolic abnormalities are frequently seen in patients with acromegaly. However, it is not clear to what extent growth hormone/insulin-like growth factor-1 (GH/IGF-1) contributes to the development of these abnormalities. OBJECTIVE This study aimed to explore the impact of postoperative GH/IGF-1 on different aspects of metabolic abnormalities in patients with acromegaly. METHODS This retrospective, registry-based study conducted on 102 patients with acromegaly. The impact of GH/IGF-1 on the cardiometabolic risk factors at 3-12 months after surgery has been investigated using linear and logistic regression models. RESULTS In this study, each 1 ng/ml increase in the level of GH was significantly associated with a 2 mg/dl increase in the level of fasting blood glucose (FBG), a 0.5 mmHg increase in the level of systolic blood pressure (SBP), and a 0.9 mmHg increase in the level of diastolic blood pressure (DBP). Upon multivariate analysis, GH, but not IGF-1, significantly increased the odds of diabetes mellitus (DM) (OR; 1.2, 95% CI; 1.0-1.4, p = .025). CONCLUSIONS Our findings indicated at early postoperative stage, GH is significantly associated with the levels of FBG, SBP, and DBP. Moreover, GH, but not IGF-1, appears as a predictive factor for the presence of DM. However, neither GH nor IGF-1 could predict the presence of hypertension HTN, or dyslipidemia in this study. ABBREVIATIONS CVD: Cardiovascular disease; GH: Growth hormone; IGF-1: Insulin-like growth factor 1; BMI: Body mass index; HTN: hypertension; IPTR: Iran Pituitary Tumor Registry; WC: Waist circumference; MRI: Magnetic resonance imaging; FBG: Fasting blood glucose; HbA1C: Glycated hemoglobin; TG: Triglyceride; LDL: Low density lipoprotein; HDL: High density lipoprotein; SBP: Systolic blood pressure; DBP: Diastolic blood pressure.
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Affiliation(s)
- Mahshid Heydari
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Hashemi-Madani
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Department of Neurosurgery and Neuro-Intervention, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Manizhe Ataei Kachuee
- Department of Radiology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Lopes AA, Albuquerque L, Fontes M, Rego D, Bandeira F. Body Composition in Acromegaly According to Disease Activity - Performance of Dual X-Ray Absorptiometry and Multifrequency Bioelectrical Impedance Analysis. Front Endocrinol (Lausanne) 2022; 13:866099. [PMID: 35663315 PMCID: PMC9159810 DOI: 10.3389/fendo.2022.866099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/24/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION the present study aims to evaluate body composition and its relationship with hormonal control in acromegaly, also comparing the performance of Bioelectrical impedance analysis (BIA), a more accessible method, with dual X-ray absorptiometry (DXA), technology frequently used in current studies. METHODS we studied 28 patients (78% female) of whom 13 with active disease, mean age was 52.11 ± 12.53 years; 64% had high blood pressure (HBP) and 50% had type 2 diabetes (T2D). RESULTS Although patients with controlled disease had lower serum GH (1.2 ± 1.68µg/L vs 6.61 ± 6.40µg/L, p=0.001) and IGF-1 (158.89 ± 54.53ng/mL and 503.31 ± 253.25ng/mL, p<0.001), they did not differ in body composition: percentage of fat mass: 36.13 ± 11.84% vs 37.73 ± 8.76%, p=0.691 for BIA and 37.10 ± 10.21% vs 37.89 ± 7.32%, p=0.819 for DXA; muscle mass parameters, BIA: FFMI 18.68 ± 2.38kg/m2vs 19.14 ± 1.59kg/m2, p=0.560; SMI 10.17 ± 1.39kg/m2vs 10.53 ± 1.01kg/m2, p=0.438; DXA: Baumgartner 7.99 ± 1.43kg/m2vs 8.02 ± 1.24kg/m2, p=0.947, respectively for controlled and active disease. Patients with controlled acromegaly had lower fasting glucose (110.33 ± 55.48mg/dL vs 129.77 ± 40.17mg/dL, p=0.033) and were less likely to have persistent T2D (28.6 vs 71.4%, p=0.008) and HBP (38.9 vs 61.1%, p=0.049). There were strong positive correlations between BIA and DXA for fat mass (r=0.929, p<0.001) and muscle mass parameters: SMI X Baumgartner: r=0.890, p<0.001; and FFMI X Baumgartner: r=0.868, p<0.001. CONCLUSION our data showed similar results in body composition assessment by BIA and DXA, with good correlation between the methods, regardless of the hormonal status of acromegaly. Furthermore, in patients with adequate hormonal control, there was preservation of muscle mass and a lower prevalence of metabolic comorbidities, such as T2D and HBP.
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Affiliation(s)
- Aline Alves Lopes
- Post-Graduate Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil
- *Correspondence: Aline Alves Lopes,
| | | | - Mayara Fontes
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Daniella Rego
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Francisco Bandeira
- Post-Graduate Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
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Zhao B, Mao J, Li Y. Primary hepatic neuroendocrine tumor associated with hypertension: A case report. Front Surg 2022; 9:1021806. [PMID: 36873810 PMCID: PMC9981943 DOI: 10.3389/fsurg.2022.1021806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/30/2022] [Indexed: 02/19/2023] Open
Abstract
Background Primary neuroendocrine tumors are exceedingly rare and often misdiagnosed. The combined methods of ultrasonography, computed tomography ,and magnetic resonance imaging are typically applied. The diagnosis of the disease mainly depends on the histopathological examination. Surgical resection is the most effective treatment. Case presentation In the report, we describe the case of a patient with a primary hepatic neuroendocrine tumor (PHNET) associated with hypertension. The patient suffered from uncontrolled hypertension before the operation, and the blood pressure was not well controlled by oral antihypertensive drugs such as nifedipine, valsartan, and hydrochlorothiazide, but the patient's blood pressure completely returned to normal after the operation without drug control. Conclusions We encountered a rare case of a PHNET associated with hypertension via careful screening noticed by the patient at work; furthermore, we hope to collect more cases and find the relationship between neuroendocrine tumors and hypertension.
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Affiliation(s)
- Bin Zhao
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Jie Mao
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yumin Li
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
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Khan SA, Ram N, Masood MQ, Islam N. Prevalence of Comorbidities among Patients with Acromegaly. Pak J Med Sci 2021; 37:1758-1761. [PMID: 34912391 PMCID: PMC8613062 DOI: 10.12669/pjms.37.7.4277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objective Acromegaly is a chronic disorder resulting from excessive secretion of growth hormone and (GH) and insulin-like growth factor 1 (IGF-1) and is associated with several comorbidities. These complications contribute significantly to morbidity and mortality associated with this condition thus early diagnosis leads to better outcomes. There have been studies in other countries to assess the comorbidities associated with acromegaly. However, we do not have any recent data with regards to Pakistan. So, in order to demonstrate the prevalence of demographics, hormonal disorders, and other complications associated with acromegaly we conducted this study. Methods It is a retrospective review of patients' records presented to the tertiary care Hospital, Karachi, Pakistan for the diagnosis and management of acromegaly and the complications associated with this condition between the time periods 2000 till 2020. A total of 89 patients fulfilled the inclusion criteria of acromegaly and were included in the study. Comorbid conditions were described based on current guidelines. Patient baseline characteristics were recorded along with other complications arising during treatment. Results Eighty-nine patients were included. 64% were male, over 70% were older than 30 years old and more than 40% of patients had BMI greater than 30. HTN, pre-hypertension, and CCF were reported in 35.95%, 3.37%, and 6.74%. Diabetes mellitus, hypocortisolism, hypothyroidism, hypogonadism, and hyperprolactinemia were reported in 39.32%, 38.20%, 37.07%, 34.46%, and 16.85% of cases. The prevalence of osteoarthritis, blood disorder, skin changes, thyroid cancer, and spinal stenosis was found out to be around 1.12% each. Conclusions Acromegaly is associated with cardiovascular and endocrinal disorders. Screening for these disorders at the time of diagnosis can lead to early management and better outcomes translating into decreased mortality.
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Affiliation(s)
- Sajjad Ali Khan
- Dr. Sajjad Ali Khan, FCPS. Department of Medicine, Section of Endocrinology, Aga Khan University Hospital, Karachi, Pakistan
| | - Nanik Ram
- Dr. Nanik Ram, FCPS. Department of Medicine, Section of Endocrinology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Qamar Masood
- Dr. Muhammad Qamar Masood, MD. Department of Medicine, Section of Endocrinology, Aga Khan University Hospital, Karachi, Pakistan
| | - Najmul Islam
- Dr. Najmul Islam, FRCP. Department of Medicine, Section of Endocrinology, Aga Khan University Hospital, Karachi, Pakistan
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Hong S, Kim KS, Han K, Park CY. Acromegaly and cardiovascular outcomes: a cohort study. Eur Heart J 2021; 43:1491-1499. [PMID: 34864952 DOI: 10.1093/eurheartj/ehab822] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/02/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Cardiovascular disease is a common complication in acromegaly. We investigated the risk of cardiovascular disease and mortality in patients with acromegaly in a large-scale population using nationwide data in Korea. METHODS AND RESULTS We performed a nationwide, retrospective, observational, cohort study of patients with acromegaly (n = 1874) and age- and sex-matched subjects without acromegaly (n = 9370) for a mean follow-up of 7.5 ± 3.2 years. The study outcomes were myocardial infarction, stroke, atrial fibrillation, congestive heart failure, and all-cause death. All outcomes were analysed by Cox proportional hazards regression analysis while controlling for age, sex, household income, place, Type 2 diabetes, hypertension, and dyslipidaemia. The incidence (per 1000 person-years) of atrial fibrillation (3.06 vs. 1.70; P = 0.001), congestive heart failure (3.11 vs. 1.63; P < 0.001), and all-cause mortality (6.31 vs. 4.03; P < 0.001) in patients with acromegaly was higher than in controls. However, the incidence of myocardial infarction and stroke did not differ between groups. After adjustment for covariates, the risk for atrial fibrillation [hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.09-2.31], congestive heart failure (HR: 1.54; 95% CI: 1.06-2.25), and all-cause mortality (HR: 1.31; 95% CI: 1.01-1.69) was significantly higher in patients with acromegaly. In time lag sensitivity analysis, a higher risk for atrial fibrillation was observed only in the first 4 years after diagnosis in acromegaly patients compared with controls (HR: 3.05; 95% CI: 1.94-4.79). CONCLUSION Patients with acromegaly were at higher risk for atrial fibrillation, congestive heart failure, and all-cause death. The risk of atrial fibrillation had a time-dependent association with acromegaly.
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Affiliation(s)
- Sangmo Hong
- Department of Internal Medicine, Guri Hospital, College of Medicine, Hanyang University, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Republic of Korea
| | - Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, Seoul 06978, Republic of Korea
| | - Cheol-Young Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea
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11
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Giovinazzo S, Puglisi S, Cotta OR, Alibrandi A, Aversa T, Cannavò L, Ferraù F, Cannavò S. Long-term cardiometabolic outcome in patients with pituitary adenoma diagnosed in chilhood and adolescence. Pituitary 2021; 24:483-491. [PMID: 33469831 DOI: 10.1007/s11102-020-01123-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Pituitary adenomas (PAs) rarely occur in childhood and adolescence. Management of PAs in this critical age can be particularly challenging considering the auxological sequelae and potential long-term cardiometabolic consequences. We aimed to describe the clinical characteristics of patients with PA aged < 18years at diagnosis and during long-term follow-up, focusing on the prevalence of cardio-metabolic comorbidities and the impact of different therapeutic strategies. METHODS Clinical data at diagnosis and at last follow-up visit (mean 10.3 ± 9.2 years) of 101 patients aged < 18 years with PA, referred to our University Hospital from 1990 to 2017, were retrospectively evaluated. RESULTS At diagnosis, 11.9% of patients presented with pituitary hormone deficiencies, whose number was positively correlated with pituitary tumor diameter (p < 0.001). At diagnosis, 26.7% of patients were overweight and 15.8% were obese. In patients with hypercortisolism or GH excess the prevalence of obesity was more than 2-fold greater than in general population. No correlation was found between pituitary tumor size and BMI. At baseline, the greater the number of pituitary hormone deficits, the higher BMI (p = 0.039). In prolactinoma patients still on medical therapy at last visit, BMI was higher than at baseline. CONCLUSION We found an increased prevalence of overweight/obesity only in pediatric and adolescent patients with GH- or ACTH-secreting PA. Regarding cardio-metabolic comorbidities other than obesity/overweight, we have not found anything worth of mention. The remission of hypercortisolism positively impacted on BMI, while medical therapy in patients with prolactinoma seemed unable to avoid weight gain, suggesting a careful metabolic management of these patients.
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Affiliation(s)
- Salvatore Giovinazzo
- Endocrine Unit, University Hospital 'G. Martino', Messina, Italy
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi'DETEV, University of Messina, UOC di Endocrinologia, Pad. H, 4° piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Oana R Cotta
- Endocrine Unit, University Hospital 'G. Martino', Messina, Italy
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi'DETEV, University of Messina, UOC di Endocrinologia, Pad. H, 4° piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Laura Cannavò
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Francesco Ferraù
- Endocrine Unit, University Hospital 'G. Martino', Messina, Italy.
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi'DETEV, University of Messina, UOC di Endocrinologia, Pad. H, 4° piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy.
| | - Salvatore Cannavò
- Endocrine Unit, University Hospital 'G. Martino', Messina, Italy
- Department of Human Pathology of Adulthood and Childhood 'G. Barresi'DETEV, University of Messina, UOC di Endocrinologia, Pad. H, 4° piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy
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12
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Carosi G, Mangone A, Sala E, Del Sindaco G, Mungari R, Cremaschi A, Ferrante E, Arosio M, Mantovani G. Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study. Eur J Endocrinol 2021; 185:289-297. [PMID: 34081617 PMCID: PMC8284905 DOI: 10.1530/eje-21-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE High insulin-like growth factor 1 (IGF-1) and unsuppressed growth hormone (GH) levels after glucose load confirm the diagnosis of acromegaly. Management of patients with conflicting results could be challenging. Our aim was to evaluate the clinical and hormonal evolution over a long follow-up in patients with high IGF-1 but normal GH nadir (GHn < 0.4 μg/L according to the latest guidelines). DESIGN Retrospective cohort study. METHODS We enrolled 53 patients presenting high IGF-1 and GHn < 0.4 μg/L, assessed because of clinical suspicion of acromegaly or in other endocrinological contexts (e.g. pituitary incidentaloma). Clinical and hormonal data collected at the first and last visit were analyzed. RESULTS At the first evaluation, the mean age was 54.1 ± 15.4 years, 34/53 were females, median IGF-1 and GHn were +3.1 SDS and 0.06 μg/L, respectively. In the whole group, over a median time of 6 years, IGF-1 and GHn levels did not significantly change (IGF-1 mean of differences: -0.58, P = 0.15; GHn +0.03, P = 0.29). In patients with clinical features of acromegaly, the prevalence of acromegalic comorbidities was higher than in the others (median of 3 vs 1 comorbidities per patient, P = 0.005), especially malignancies (36% vs 6%, P = 0.03), and the clinical worsening overtime was more pronounced (4 vs 1 comorbidities at the last visit). CONCLUSIONS In patients presenting high IGF-1 but GHn < 0.4 μg/L, a hormonal progression is improbable, likely excluding classical acromegaly in its early stage. However, despite persistently low GH nadir values, patients with acromegalic features present more acromegalic comorbidities whose rate increases over time. Close clinical surveillance of this group is advised.
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Affiliation(s)
- Giulia Carosi
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Mangone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa Sala
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberta Mungari
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Arianna Cremaschi
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Correspondence should be addressed to G Mantovani;
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13
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Yang H, Tan H, Huang H, Li J. Advances in Research on the Cardiovascular Complications of Acromegaly. Front Oncol 2021; 11:640999. [PMID: 33869029 PMCID: PMC8050332 DOI: 10.3389/fonc.2021.640999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular-related complications are one of the most common complications in patients with acromegaly, and can lead to an increased risk of death. Hypertension and cardiomyopathy are the main cardiovascular complications. The characteristics of acromegalic cardiomyopathy are concentric biventricular hypertrophy and diastolic dysfunction. In addition, arrhythmia and heart valve disease are common cardiac complications in acromegaly. Although the underlying pathophysiology has not been fully elucidated, the spontaneous overproduction of GH and IGF-1, increasing age, prolonged duration of disease and the coexistence of other cardiovascular risk factors are crucial to cardiac complications in patients with acromegaly. Early diagnosis and appropriate treatment of acromegaly might be beneficial for the prevention of cardiomyopathy and premature death.
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Affiliation(s)
- Han Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology and Metabolism, Chongqing Sixth People’s Hospital, Chongqing, China
| | - Huiwen Tan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianwei Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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14
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Amodru V, Petrossians P, Colao A, Delemer B, Maione L, Neggers SJCMM, Decoudier B, Kamenicky P, Castinetti F, Hana V, Pivonello R, Carvalho D, Brue T, Beckers A, Chanson P, Cuny T. Discordant biological parameters of remission in acromegaly do not increase the risk of hypertension or diabetes: a study with the Liege Acromegaly Survey database. Endocrine 2020; 70:134-142. [PMID: 32562181 DOI: 10.1007/s12020-020-02387-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Acromegaly is a rare disease due to growth hormone (GH)-secreting pituitary adenoma. GH and IGF-1 levels are usually congruent, indicating either remission or active disease; however, a discrepancy between GH and IGF-1 may occur. We aimed to evaluate the outcome of diabetes mellitus (DM) and hypertension (HT) in acromegalic patients with congruent GH and/or IGF-1 levels vs. discordant biochemical parameters. METHODS Retrospective analysis of the data of 3173 patients from the Liege Acromegaly Survey (LAS) allowed us to include 190 patients from 8 tertiary referral centers across Europe, treated by surgery, with available data concerning DM and HT both at diagnosis and at the last follow-up (LFU). We recorded the number of anti-HT and anti-DM drugs used at the first evaluation and at LFU for every patient. RESULTS Ninety-nine patients belonged to the REM group (concordant parameters), 65 patients were considered as GHdis (high random GH/controlled IGF-1), and 26 patients were considered as IGF-1dis (high IGF-1/controlled random GH). At diagnosis, 72 patients (37.8%) had HT and 54 patients had DM (28.4%). There was no statistically significant difference in terms of the number of anti-HT and anti-DM drugs at diagnosis versus LFU (mean duration: 7.3 ± 4.5 years) between all three groups. CONCLUSION The long-term outcome of DM and HT in acromegaly does not tend to be more severe in patients with biochemical discordance in comparison with patients considered as in remission on the basis of concordant biological parameters, suggesting that patients with biochemical discordance do not require a closer follow-up.
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Affiliation(s)
- V Amodru
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - P Petrossians
- Department of Endocrinology, CHU de Liège, Université de Liege, Liège, Belgium
| | - A Colao
- Dipartimento Di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University "Federico II", Naples, Italy
| | - B Delemer
- Service d'endocrinologie, CHU de Reims, Reims, France
| | - L Maione
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - S J C M M Neggers
- Section of Endocrinology Department of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Decoudier
- Service d'endocrinologie, CHU de Reims, Reims, France
| | - P Kamenicky
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - F Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - V Hana
- Third Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R Pivonello
- Dipartimento Di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University "Federico II", Naples, Italy
| | - D Carvalho
- Department of Endocrinology Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - T Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - A Beckers
- Department of Endocrinology, CHU de Liège, Université de Liege, Liège, Belgium
| | - P Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - T Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France.
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15
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Kasuki L, Antunes X, Lamback EB, Gadelha MR. Acromegaly: Update on Management and Long-Term Morbidities. Endocrinol Metab Clin North Am 2020; 49:475-486. [PMID: 32741483 DOI: 10.1016/j.ecl.2020.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acromegaly is a systemic disease associated with great morbidity and increased mortality if not adequately treated. In the past decades much improvement has been achieved in its treatment and in the knowledge of its comorbidities. We provide an update of acromegaly management with current recommendations. We also address long-term comorbidities emphasizing the changing face of the disease in more recent series, with a decrease of cardiovascular disease severity and an increased awareness of comorbidities like bone disease, manifested mainly as vertebral fractures and the change in the main cause of death (from cardiovascular disease to cancer in more recent series).
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Affiliation(s)
- Leandro Kasuki
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil; Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, 156th Resende Street, Rio de Janeiro, RJ, Brazil; Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Ximene Antunes
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil
| | - Elisa Baranski Lamback
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil
| | - Mônica R Gadelha
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil; Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, 156th Resende Street, Rio de Janeiro, RJ, Brazil; Neuropatology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
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16
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Puglisi S, Ferraù F, Ragonese M, Spagnolo F, Cannavò S. Cardiometabolic Risk in Acromegaly: A Review With a Focus on Pasireotide. Front Endocrinol (Lausanne) 2020; 11:28. [PMID: 32117056 PMCID: PMC7017075 DOI: 10.3389/fendo.2020.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Acromegaly is a disease due to chronic GH excess and a consequent rise in IGF-1 levels. This rare endocrine condition is associated with metabolic alterations such as hyperglycaemia, dyslipidaemia, and systemic arterial hypertension, which, in addition to GH excess-related cardiovascular changes, play critical roles in increasing cardiovascular risk and mortality rates. Biochemical control of acromegaly, achieved by means of surgical, and/or medical treatment, positively impacts on cardiovascular risk factors and metabolic alterations, reducing overall patient mortality. However, treatment modalities of acromegaly and disease control differently impact on glucose homeostasis and lipid changes, and consequently on cardiometabolic risk. In this regard, pasireotide was shown to significantly influence glucose metabolism. This review summarizes the cardiometabolic consequences of acromegaly and its treatment, focusing on available data around the effects of medical therapy with pasireotide on factors that influence cardiometabolic risk.
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Affiliation(s)
- Soraya Puglisi
- Endocrine Unit, University Hospital G. Martino, Messina, Italy
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesco Ferraù
- Endocrine Unit, University Hospital G. Martino, Messina, Italy
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- *Correspondence: Francesco Ferraù ;
| | - Marta Ragonese
- Endocrine Unit, University Hospital G. Martino, Messina, Italy
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Federica Spagnolo
- Endocrine Unit, University Hospital G. Martino, Messina, Italy
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Salvatore Cannavò
- Endocrine Unit, University Hospital G. Martino, Messina, Italy
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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