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Siegel S, Giese S, Honegger J, Friedel AL, Grzywotz A, Wrede KH, Sure U, Unger N, Kreitschmann-Andermahr I. Exploring potential influencing factors of inadherence to specialist aftercare and long-term medication in patients with acromegaly. Pituitary 2024; 27:403-415. [PMID: 38787509 PMCID: PMC11289155 DOI: 10.1007/s11102-024-01400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To improve the understanding of adherence as one major factor of disease control in acromegaly patients, we systematically assessed patients' motivations to adhere to advised follow-up schedules and recommended medication for acromegaly. METHODS Cross-sectional, postal questionnaire study on adult patients with acromegaly, operated upon a growth hormone producing pituitary adenoma more than 1 year ago in two tertiary treatment centers. We assessed demographic and clinical characteristics, disease status, adherence to acromegaly medication and/or aftercare, and the five dimensions defined by the World Health Organization influencing adherence. Wherever applicable, we included validated short scales. The answers of 63 patients (33 f, 30 m; mean age 56.1 y) were analyzed. RESULTS Patients with problems in adherence to aftercare had a significantly lower subjective symptomload than those adherent to aftercare (p = 0.026) and a lower perceived need for treatment (p = 0.045). Patients with adherence problems to medication had a higher subjective symptomload than those without (p = 0.056). They also tended to have shorter consultations, were significantly more often dissatisfied with the duration of their medical consultations (42% vs 4.8%, p = 0.019) and tended to find that their physician explained potential difficulties with adherence less well than patients without adherence problems (p = 0.089). CONCLUSIONS To our knowledge, this is the first study which explored adherence to medication and aftercare in patients with acromegaly, taking into account potential influencing factors from all areas defined by the WHO model of adherence. Of the modifiable factors of adherence, patient-doctor relationship seemed to play a crucial role and could be one leverage point to improve adherence.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sabrina Giese
- Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jürgen Honegger
- Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Anna Lena Friedel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Medical Education, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Karsten Henning Wrede
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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Pelsma ICM, Kroon HM, van Trigt VR, Pereira AM, Kloppenburg M, Biermasz NR, Claessen KMJA. Clinical and radiographic assessment of peripheral joints in controlled acromegaly. Pituitary 2022; 25:622-635. [PMID: 35726113 PMCID: PMC9345810 DOI: 10.1007/s11102-022-01233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Acromegalic arthropathy is a well-known phenomenon, occurring in most patients regardless of disease status. To date, solely hips, knees, hands, and spinal joints have been radiographically assessed. Therefore, this study aimed to assess the prevalence of joint symptoms and radiographic osteoarthritis (OA) of new, and established peripheral joint sites in well-controlled acromegaly. METHODS Fifty-one acromegaly patients (56% female, mean age 64 ± 12 years) in long-term remission for 18.3 years (median, IQR 7.2-25.4) were included. Nineteen patients currently received pharmacological treatment. Self-reported joint complaints were assessed using standardized interviews. Self-reported disability of the upper and lower limbs, and health-related quality of life (HR-QoL) were evaluated using validated questionnaires. Radiographic OA [defined as Kellgren & Lawrence (KL) ≥ 2] was scored using (modified) KL methods. RESULTS Radiographic signs of OA were present in 46 patients (90.2%) with ≥ 2 joints affected in virtually all of these patients (N = 44; 95.7%). Radiographic MTP1 OA was as prevalent as radiographic knee OA (N = 26, 51.0%), and radiographic glenohumeral OA was similarly prevalent as hip OA [N = 21 (41.2%) vs. N = 24 (47.1%)]. Risk factors for radiographic glenohumeral OA were higher pre-treatment IGF-1 levels [OR 1.06 (1.01-1.12), P = 0.021], and current pharmacological treatment [OR 5.01 (1.03-24.54), P = 0.047], whereas no risk factors for MTP1 joint OA could be identified. CONCLUSION Similar to previously-assessed peripheral joints, clinical and radiographic arthropathy of the shoulder and feet were prevalent in controlled acromegaly. Further studies on adequate management strategies of acromegalic arthropathy are needed.
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Affiliation(s)
- Iris C M Pelsma
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria R van Trigt
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
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3
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Omma T, Tunc AR, Fırat SN, Taskaldıran I, Culha C, Ersoz Gulcelik N. Pedabarography May Play a Role in Foot Plantar Scanning in Acromegaly. Int J Clin Pract 2022; 2022:9882896. [PMID: 35685582 PMCID: PMC9158791 DOI: 10.1155/2022/9882896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS Acromegaly is associated with symptoms in many organs, including the heart, colon, skin, bones, and many joints. Patients with long-term treatment or biochemical control still suffer from acromegaly arthropathy (AA). Primarily, the weight-bearing joints of the lower extremity are affected and at last deformation emerges. The aim of this study is to detect the changes in the feet with pedabarography in patients with acromegaly. MATERIALS AND METHODS Nineteen patients with acromegaly (4 males and 15 females) and 13 healthy controls (1 male and 12 females) were included in the study (p=0.31). There was no difference between acromegaly patients and controls in terms of gender, age, and BMI; median age and BMI were (54 (20-67) vs. 52 (30-58), p=0.85) and (32.5 (20.3-42.7) vs. 29.5 (22.4-38.6), p=0.93), respectively. Static plantar pressures of bilateral foot of all participants in the standing position were measured by pedabarography. RESULTS In pedabarographic analysis, there were only significant difference in rearfoot surface right and rearfoot surface left (p=0.04 and p=0.01), respectively. The mean of the right rearfoot surface (43.5 cm2 vs. 36.6 cm2) and the mean of the left rear foot surface were higher than the controls (47.4 cm2 vs. 40.2 cm2). Forefoot surface, forefoot load, forefoot weight ratio, rearfoot load, total foot surface, total load, total peak pressure, and total average pressure were higher in left foot in both groups, but there was no difference between the two groups. CONCLUSION In our study, there was a significant difference between acromegaly patients and healthy controls, only on the right rarefoot surface and the left rarefoot surface, and was higher on the left in both groups. These patients often experience changes in the hindfoot and heel, and foot surface area and pressure distribution may vary. Early diagnosis and proper treatment of the disease can prevent the development of complications and improve the quality of life. Foot scanning using pedabarography in the management of AA is a useful tool that can be used to manufacture customized orthopedic insoles and ergonomic shoe designs to prevent irreversible damage and reduce overload and lower extremity pain.
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Affiliation(s)
- Tulay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Azize Reda Tunc
- Department of Physiotherapy, Lokman Hekim University, Faculty of Health Sciences, 06510 Ankara, Turkey
| | - Sevde Nur Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Isılay Taskaldıran
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Cavit Culha
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Training and Research Hospital, 06010 Ankara, Turkey
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Pelsma ICM, Biermasz NR, van Furth WR, Pereira AM, Kroon HM, Kloppenburg M, Claessen KMJA. Progression of acromegalic arthropathy in long-term controlled acromegaly patients: 9 years of longitudinal follow-up. J Clin Endocrinol Metab 2021; 106:188-200. [PMID: 33099640 DOI: 10.1210/clinem/dgaa747] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Joint complaints in patients with acromegaly are common, although the long-term disease course is largely unknown. OBJECTIVE This study aims to evaluate the long-term course of acromegalic arthropathy. DESIGN AND SETTING A prospective longitudinal cohort study was conducted in controlled acromegaly patients followed at a tertial referral center, with 3 study visits: at baseline and after a median of 2.6 and 9.1 years. PATIENTS We included 31 patients with biochemically controlled acromegaly for 2 or more years (49% female; median age, 60 years) at baseline. MAIN OUTCOME MEASURES Radiographic arthropathy of the knee, hip, hand, and cervical and lumbar spine were evaluated using Kellgren and Lawrence (KL) scores, developed for assessment of primary osteoarthritis (OA). Radiographic progression was defined as a KL increase above the smallest detectable change. Joint symptoms were assessed using self-reported questionnaires. Progression was defined using existing clinically important cutoff values. Risk factors for progression were investigated using a multivariable model. RESULTS All patients had definite radiographic OA at 1 or more joints at baseline. Radiographic progression was observed in 29%, 48%, 84%, and 94% of patients in the knees, hips, hands, and axial joints, respectively. Deterioration in hand-related pain and function was observed in 10 (32.3%) and 11 patients (35.5%), respectively. Solely baseline KL scores of the hip were associated with hip OA progression (OR 1.88; 95% CI, 1.09-3.16). CONCLUSIONS Acromegalic arthropathy showed significant radiographic progression over 9.1 years of follow-up in patients in remission, whereas clinical progression was observed less frequently. Future studies should focus on adequate prevention and treatment strategies of acromegalic arthropathy.
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Affiliation(s)
- Iris C M Pelsma
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, ZA, Leiden, the Netherlands
- Department of Epidemiology, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
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5
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Ozturk Gokce B, Gogus F, Bolayir B, Tecer D, Gokce O, Eroglu Altinova A, Balos Toruner F, Akturk M. The evaluation of the tendon and muscle changes of lower extremity in patients with acromegaly. Pituitary 2020; 23:338-346. [PMID: 32200458 DOI: 10.1007/s11102-020-01037-z] [Citation(s) in RCA: 4] [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] [Indexed: 01/18/2023]
Abstract
PURPOSE Although it is well known that acromegaly causes enlargement in the extremities, studies investigating the effects of acromegaly on tendons, muscles and soft tissue are limited. The aims of our study were to investigate tendons, the presence of enthesitis, soft tissue, muscle groups in terms of thickness and pennation angle (PA) which is an indicator of microstructure and strength of the muscle, of the lower extremities. METHODS Thirty-nine patients with acromegaly and thirty-nine healthy control subjects similar for age, sex and body mass index were enrolled. Lower extremity tendons, skin, muscle groups were evaluated by ultrasound. RESULTS The thicknesses of heel skin, heel pad, plantar fascia and Achilles tendon were higher in acromegaly than the control group (p < 0.05). The incidence of Achilles enthesitis were increased in the acromegaly group (p < 0.05). The thicknesses of the gastrocnemius medial head, vastus medialis, lateralis muscles for both sides and the left rectus femoris muscle were found to be lower in the acromegaly patients than controls (p < 0.05). However, thicknesses of vastus intermedius, gastrocnemius lateral head and soleus were similar between the acromegaly and control groups (p > 0.05). PA values of the right and left vastus medialis and the right vastus lateralis were found to be decreased in the acromegaly group (p < 0.05). Myostatin levels were lower in acromegaly group (p < 0.05). CONCLUSIONS Acromegaly may cause to an increase in tendon and soft tissue thickness, enthesitis formation, decrease in the thickness of some muscles, and deterioration in microstructures in lower extremity.
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Affiliation(s)
- Birsen Ozturk Gokce
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Basak Bolayir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey.
| | - Duygu Tecer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Onur Gokce
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
| | - Fusun Balos Toruner
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
| | - Mujde Akturk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
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6
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Colao A, Grasso LFS, Di Cera M, Thompson-Leduc P, Cheng WY, Cheung HC, Duh MS, Neary MP, Pedroncelli AM, Maamari R, Pivonello R. Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study. J Endocrinol Invest 2020; 43:529-538. [PMID: 31741320 PMCID: PMC7067716 DOI: 10.1007/s40618-019-01138-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/26/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical control status and onset of selected comorbidities in patients with acromegaly. METHODS Medical charts of adults with confirmed acromegaly and ≥ 6 months of follow-up at an Italian endocrinology center were reviewed. Patients were followed from the first diagnosis of acromegaly at the center until loss to follow-up, chart abstraction, or death. Biochemical control status was assessed annually and defined as IGF-1 ≤ the upper limit of normal, or GH ≤ 2.5 µg/L in the few cases where IGF-1 was unavailable. Time-varying Cox models were used to assess the association between biochemical control status and comorbidities. RESULTS Among 150 patients, 47% were female, average age at diagnosis was 43.1, and mean length of follow-up was 10.4 years. Biochemical control was significantly associated with a lower hazard of diabetes (HR = 0.36, 95% CI 0.15; 0.83) and cardiovascular system disorders (HR = 0.54, 95% CI 0.31; 0.93), and a higher hazard of certain types of arthropathy (HR = 1.68, 95% CI 1.04; 2.71); associations for other comorbidities did not reach statistical significance. CONCLUSION Results further support the importance of achieving biochemical control, as this may reduce the risk of high-burden conditions, including diabetes and cardiovascular system disorders. The association for arthropathy suggests irreversibility of this impairment. Due to limitations, caution is required when interpreting these results.
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Affiliation(s)
- A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy.
| | - L F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy
| | - M Di Cera
- Dipartimento di Medicina e Scienze della Saluta di V. Tiberio, Università degli Studi del Molise, Campobasso, Italy
| | | | - W Y Cheng
- Analysis Group, Inc., Boston, MA, USA
| | | | - M S Duh
- Analysis Group, Inc., Boston, MA, USA
| | - M P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - R Maamari
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy
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7
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Gatto F, Campana C, Cocchiara F, Corica G, Albertelli M, Boschetti M, Zona G, Criminelli D, Giusti M, Ferone D. Current perspectives on the impact of clinical disease and biochemical control on comorbidities and quality of life in acromegaly. Rev Endocr Metab Disord 2019; 20:365-381. [PMID: 31342434 DOI: 10.1007/s11154-019-09506-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acromegaly is a rare chronic, systemic disorder caused by excessive growth hormone (GH) secretion from a somatotroph pituitary adenoma. GH hypersecretion leads to overproduction of insulin-like growth factor-1 (IGF-1), which contributes to the somatic overgrowth, physical disfigurement, onset of multiple systemic comorbidities, reduced quality of life (QoL) and premature mortality of uncontrolled patients. Somatostatin receptor ligands, dopamine agonists and a GH receptor antagonist are currently available for medical therapy of acromegaly. The main aim of treatment is biochemical normalisation, defined as age-normalised serum IGF-1 values and random GH levels <1.0 μg/L. However, there is an increasing evidence suggesting that achieving biochemical control does not always decrease the burden of disease-related comorbidities and/or improve patients' QoL. This lack of correlation between biochemical and clinical control can be due to both disease duration (late diagnosis) or to the peculiarity of a given comorbidity. Herein we conducted ad hoc literature searches in order to find the most recent and relevant reports on biochemical and clinical disease control during medical treatment of acromegaly. Particularly, we analyse and describe the relationship between biochemical, as well as clinical disease control in patients with acromegaly receiving medical therapy, with a focus on comorbidities and QoL. In conclusion, we found that current literature data seem to indicate that clinical disease control (besides biochemical control), encompassing clinical signs and symptoms, comorbidities and QoL, emerge as a primary focus of acromegaly patient management.
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Affiliation(s)
- Federico Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy.
| | - Claudia Campana
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Francesco Cocchiara
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Giuliana Corica
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Mara Boschetti
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Gianluigi Zona
- Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Diego Criminelli
- Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Massimo Giusti
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Diego Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy.
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy.
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8
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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9
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Ezzat S, Wang R, Pintilie M, Asa SL. FGFR4 polymorphic alleles modulate mitochondrial respiration: A novel target for somatostatin analog action in pituitary tumors. Oncotarget 2018; 8:3481-3494. [PMID: 27966451 PMCID: PMC5356897 DOI: 10.18632/oncotarget.13843] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/16/2016] [Indexed: 01/09/2023] Open
Abstract
We reported that a single nucleotide polymorphism (SNP) at codon 388 of the fibroblast growth factor receptor 4 (FGFR4-Gly388Arg) can result in distinct proteins that alter pituitary cell growth and function. Here, we examined the differential properties of the available therapeutic somatostatin analogs, octreotide and pasireotide, in pituitary tumor cells expressing the different FGFR4 isoforms. Consistent with their enhanced growth properties, FGFR4-R388-expressing cells show higher mitochondrial STAT3 serine phosphorylation driving basal and maximal oxygen consumption rate (OCR) than pituitary cells expressing the more common FGFR4-G388 isoform. While both somatostatin analogs reduce the OCR in FGFR4-G388 cells, pasireotide was more effective in decreasing OCR in cells expressing the variant FGFR4-R388 isoform. Down-regulation of somatostatin receptor 5 (SSTR5) abrogated the effect of pasireotide, demonstrating its involvement in mediating this action. The effects on OCR were recapitulated by introducing a constitutively active serine STAT3 but not by a tyrosine-active mutant. Moreover, pharmacologic inhibition demonstrated the role for the phosphatase PP2A in mediating the dephosphorylation of STAT3-S727 by pasireotide. Our data indicate that FGFR4 polymorphic isoforms mediate signaling that yields mitochondrial therapeutic targets of relevance to the actions of different somatostatin analogs.
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Affiliation(s)
- Shereen Ezzat
- Department of Medicine, The Endocrine Oncology Site Group, Princes Margaret Cancer Centre, and the Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Ri Wang
- Department of Statistics, University of Waterloo, Toronto, Canada
| | - Melania Pintilie
- Department of Biostatistics, University of Toronto, Toronto, Canada
| | - Sylvia L Asa
- Department of Pathology, University Health Network, Toronto, Canada
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Bima C, Chiloiro S, Mormando M, Piacentini S, Bracaccia E, Giampietro A, Tartaglione L, Bianchi A, De Marinis L. Understanding the effect of acromegaly on the human skeleton. Expert Rev Endocrinol Metab 2016; 11:263-270. [PMID: 30058934 DOI: 10.1080/17446651.2016.1179108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acromegaly, caused in most cases by Growth Hormone (GH)-secreting pituitary adenomas, is characterized by increased skeletal growth and enlargement of the soft tissue, because GH and its effector Insulin-like Growth factor-1 are important regulators of bone homeostasis and have a central role in the longitudinal bone growth and maintenance of bone mass. Areas covered: Despite the anabolic effect of these hormones is well known, as a result of the stimulation of bone turnover and especially of bone formation, many acromegalic patients are suffering from a form of secondary osteoporosis with increased risk of fractures. Expert commentary: In this review, we summarize the pathophysiology, diagnosis, clinical picture, disease course and management of skeletal complications of acromegaly, focusing in particular on secondary osteoporosis and fracture risk in acromegaly.
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Affiliation(s)
- C Bima
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - S Chiloiro
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - M Mormando
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - S Piacentini
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - E Bracaccia
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - A Giampietro
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - L Tartaglione
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - A Bianchi
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
| | - L De Marinis
- a Pituitary Unit, Department of Endocrinology , Catholic University of "Sacred Heart", School of Medicine , Rome , Italy
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11
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Abate M, Guelfi M, Pantalone A, Vanni D, Schiavone C, Andia I, Salini V. Therapeutic use of hormones on tendinopathies: a narrative review. Muscles Ligaments Tendons J 2016; 6:445-452. [PMID: 28217565 DOI: 10.11138/mltj/2016.6.4.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hormones can modify tendon homeostasis, some of them leading to tendon damage, while others are essentials for healing. This narrative review summarizes the current knowledge on the topic, focusing on the hormones normally secreted by endocrine glands. METHODS A search in PubMed, Web of Knowledge and EMBASE, using the terms tendinopathy or tendon, combined with estrogens, testosterone, thyroid and parathyroid hormones, glucocorticoids and growth hormone, independently, was performed. Relevant articles focusing on the correlation between hormones and tendons, and their therapeutic use in tendinopathies, were selected. RESULTS Tendon abnormalities observed in subjects with hyperparathyroidism, hypercortisolism and acromegaly are described. At present, experimental studies and preliminary observations in humans suggest that parathyroid and growth hormones, locally administered, are promising therapeutic tools in specific tendon disorders. Local injections of glucocorticoids are useful in several tendinopathies, exploiting their anti-inflammatory and anti-proliferative properties, but carry the risk of further tendon degeneration and ruptures, due to the detrimental direct effect of glucocorticoids on the tendon structure. CONCLUSION Because tendons injuries are frequent, often with long lasting sequels, it is important to improve our understanding concerning the therapeutic potential of hormones on healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Matteo Guelfi
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Andrea Pantalone
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Daniele Vanni
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Isabel Andia
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Vincenzo Salini
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
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Claessen KMJA, Mazziotti G, Biermasz NR, Giustina A. Bone and Joint Disorders in Acromegaly. Neuroendocrinology 2016; 103:86-95. [PMID: 25633971 DOI: 10.1159/000375450] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022]
Abstract
Acromegaly is a chronic, progressive disease caused by a growth hormone (GH)-producing pituitary adenoma, resulting in elevated GH and insulin-like growth factor 1 concentrations. Following appropriate therapy (surgery, radiotherapy and/or medical treatment), many systemic GH-induced comorbid conditions improve considerably. Unfortunately, despite biochemical control, acromegaly patients suffer from a high prevalence of late manifestations of transient GH excess, significantly impairing their quality of life. In this overview article, we summarize the pathophysiology, diagnosis, clinical picture, disease course and management of skeletal complications of acromegaly, focusing on vertebral fractures and arthropathy.
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Affiliation(s)
- Kim M J A Claessen
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands
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13
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Claessen KM, Pereira AM, Biermasz NR. Outcome of complications in acromegaly patients after long-term disease remission. Expert Rev Endocrinol Metab 2015; 10:499-510. [PMID: 30298766 DOI: 10.1586/17446651.2015.1068116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acromegaly patients suffer from pathologically high growth hormone (GH) and IGF-1 levels that in 99% of cases is due to a GH-producing pituitary adenoma. During active disease, GH excess is associated with a number of pathological conditions, such as hypertension, hypertrophic cardiomyopathy, sleep apnea, arthropathy, vertebral fractures and insulin resistance. After adequate treatment in the form of transsphenoidal surgery, radiotherapy, medical treatment or by a combination of these treatment modalities, several comorbid conditions improve considerably. However, despite long-term biochemical disease control, the prevalence of late manifestations of GH excess is high and significantly impair quality of life. In addition, there is evidence that adequate treatment is not able to normalize mortality risk in these patients. In this review, we critically evaluate the long-term consequences of acromegaly after treatment, focusing on comorbid conditions, quality of life and mortality. We also discuss ongoing challenges in the management of acromegaly patients.
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Affiliation(s)
| | - Alberto M Pereira
- a Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- a Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
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14
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Burness CB, Dhillon S, Keam SJ. Lanreotide Autogel®: A Review of its Use in the Treatment of Patients with Acromegaly. Drugs 2014; 74:1673-91. [DOI: 10.1007/s40265-014-0283-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Ultrasonographic measurement of femoral cartilage thickness in acromegalic patients. Clin Rheumatol 2014; 34:157-61. [DOI: 10.1007/s10067-014-2543-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/24/2022]
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16
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Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions. Musculoskelet Surg 2013; 97 Suppl 2:S137-44. [PMID: 23949935 DOI: 10.1007/s12306-013-0282-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.
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17
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Russo A, Zappia M, Reginelli A, Carfora M, D'Agosto GF, La Porta M, Genovese EA, Fonio P. Ankle impingement: a review of multimodality imaging approach. Musculoskelet Surg 2013; 97 Suppl 2:S161-8. [PMID: 23949938 DOI: 10.1007/s12306-013-0286-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/13/2013] [Indexed: 12/01/2022]
Abstract
Ankle impingement is defined as entrapment of an anatomic structure that leads to pain and decreased range of motion of the ankle and can be classified as either soft tissue or osseous (Bassett et al. in J Bone Joint Surg Am 72:55-59, 1990). The impingement syndromes of the ankle are a group of painful disorders that limit full range of movement. Symptoms are due to compression of soft-tissues or osseous structures during particular movements (Ogilvie-Harris et al. in Arthroscopy 13:564-574, 1997). Osseous impingement can result from spur formation along the anterior margin of the distal tibia and talus or as a result of a prominent posterolateral talar process, the os trigonum. Soft-tissue impingement usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury. Soft-tissue impingement most often occurs in the anterolateral gutter, the medial ankle, or in the region of the syndesmosis (Van den Bekerom and Raven in Knee Surg Sports Traumatol Arthrosc 15:465-471, 2007). The main impingement syndromes are anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performer and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. MR imaging is the most useful imaging modality in evaluating suspected soft-tissue impingement or in excluding other ankle pathology such as an osteochondral lesion of the talus. MR imaging can reveal evidence of previous ligamentous injury and also can demonstrate thickened synovium, fibrosis, or adjacent reactive soft-tissue edema. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes. In the majority of cases, ankle impingement is treated with conservative measures, with surgical debridement via arthroscopy or an open procedure reserved for patients who have refractory symptoms. In this article, we describe the clinical and potential imaging features, for the four main impingement syndromes of the ankle: anterolateral, anterior, anteromedial, posterior, and posteromedial impingement.
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Affiliation(s)
- A Russo
- Department of Radiology, S. G. Moscati Hospital, Aversa, Italy.
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18
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Stoppino LP, Ciuffreda P, Rossi M, Lelario M, Bristogiannis C, Vinci R, Genovese EA, Macarini L. Lesions of the rotator cuff footprint: diagnostic performance of MR arthrography compared with arthroscopy. Musculoskelet Surg 2013; 97 Suppl 2:S197-S202. [PMID: 23949942 DOI: 10.1007/s12306-013-0289-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND To evaluate the diagnostic performance of magnetic resonance arthrography (MR-A) of the shoulder in the diagnosis of rotator cuff tears involving the humeral insertion of the supraspinatus and infraspinatus tendon (footprint), using arthroscopy as the reference standard. MATERIALS AND METHODS The study population included 90 consecutive patients with history and clinical diagnosis of instability of the shoulder, rotator cuff tear or posterosuperior glenoid impingement. A total of 108 MR arthrograms were performed, since 18 patients had undergone a bilateral procedure. Arthroscopy, which was performed within 45 days after MR-A, was used as the reference standard. Sensitivity, specificity, accuracy, positive and negative predictive values were then calculated. RESULTS Magnetic resonance arthrography showed a sensitivity of 92 % and a specificity of 78 % for the overall detection of tears involving the rotator cuff footprint. The diagnostic accuracy was 90 %, and the positive and negative predictive values were 95 and 64 %, respectively. Ten lesions were non-classifiable on surgery, of which eight were non-classifiable on MR-A also. CONCLUSIONS Magnetic resonance arthrography is extremely accurate for the detection and classification of rotator cuff footprint tears. Most of these lesions are articular-sided (partial articular-sided supraspinatus tendon avulsion lesions) with predominance in younger patients and concealed type of tear (concealed interstitial delamination lesions).
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Affiliation(s)
- L P Stoppino
- Department of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n.1, 71100, Foggia, Italy.
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Spiga S, Vinci V, Tack S, Macarini L, Rossi M, Coppolino F, Boi C, Genovese EA. Diagnostic imaging of ankle impingement syndromes in athletes. Musculoskelet Surg 2013; 97 Suppl 2:S145-S153. [PMID: 23949936 DOI: 10.1007/s12306-013-0280-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
The chronic ankle pain is a very frequent clinical problem, which is often characterized by a painful mechanical limitation of full-range ankle movement. A large amount of causes are involved in its pathogenesis, but the most common forms are secondary to an osseous or soft tissue abnormality. Especially for professional athletes, impingement lesions are the most important causes of chronic pain; however, this symptomatology can also affect ordinary people, mostly in those who work in environments that cause severe mechanical stress on the joints. This group of pathologies is characterized by a joint conflict secondary to an abnormal contact among bone surfaces or between bones and soft tissues. Diagnosis is mainly clinic and secondly supported by imaging in order to localize the critical area of impingement and determine the organic cause responsible for the joint conflict. Treatments for different forms of impingement are similar. Usually, the first step is a conservative approach (rest, physiotherapy, ankle bracing, shoe modification and local injection of corticosteroids), and only in case of unsuccessful response, the second step is the operative treatment with open and arthroscopic techniques. The aim of the study is to describe different MR imaging patterns, comparing our data with those reported in the literature, in order to identify the best accurate diagnostic protocol.
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Affiliation(s)
- S Spiga
- Department of Radiology, University of Cagliari, Cagliari, Italy
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20
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Lubrano E, Astorri D, Taddeo M, Salzmann A, Cesarano E, Brunese L, Giganti M, Spadaro A. Rehabilitation and surgical management of ankylosing spondylitis. Musculoskelet Surg 2013; 97 Suppl 2:S191-S195. [PMID: 23949941 DOI: 10.1007/s12306-013-0285-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease which, if untreated, may progress to severe damage of the spine with functional impairment, disability and poor quality of life. An increased mortality has been reported in AS patients compared to the general population. AS requires combined management (pharmacological and non-pharmacological) and advice by different health professionals. Even the pharmacological treatment in the last decade has dramatically changed the outcome, the severity of the disease might require a surgical approach for the hip involvement with total hip replacement, or the corrective spinal surgery. However, this surgery deserves some careful approaches since the complexity of the disease. Rehabilitation still represents a cornerstone of the global management of AS patients. The present review summarizes the state of art of surgical management of these two diseases.
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Affiliation(s)
- E Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
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21
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Genovese E, Spiga S, Vinci V, Aliprandi A, Di Pietto F, Coppolino F, Scialpi M, Giganti M. Femoroacetabular impingement: role of imaging. Musculoskelet Surg 2013; 97 Suppl 2:S117-S126. [PMID: 23949933 DOI: 10.1007/s12306-013-0283-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
The femoroacetabular impingement (FAI) is an impingement characterized by repetitive abutment between the femur and the acetabular rim during hip motion due to loss of joint clearance (Imam and Khanduja in Int Orthop 35(10):1427-1435, 2011; James et al. in AJR Am J Roentgenol 187(6):1412-1419, 2006). Femoroacetabular impingement (FAI) can be classified as either cam or pincer type, and it can be differentiated on the basis of a predominance of either a femoral or an acetabular abnormality (Pfirrmann et al. in Radiology 244(2):626, 2007; Ganz et al. in Clin Orthop Relat Res 466(2):264-272, 2008). In cases of cam FAI, the nonspherical shape of the femoral head at the femoral head-neck junction and reduced depth of the femoral waist lead to abutment of the femoral head-neck junction against the acetabular rim. In cases of pincer FAI, acetabular overcoverage limits the range of motion and leads to a conflict between the acetabulum and the femur. The most important role of preoperative MR evaluation in patients affected by FAI is the accurate assessment of the damage's extension.
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Affiliation(s)
- E Genovese
- Radiology Department, Cagliari University, Cagliari, Italy.
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22
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Ciuffreda P, Lelario M, Milillo P, Vinci R, Coppolino F, Stoppino LP, Genovese EA, Macarini L. Mechanism of traumatic knee injuries and MRI findings. Musculoskelet Surg 2013; 97 Suppl 2:S127-S135. [PMID: 23949934 DOI: 10.1007/s12306-013-0279-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
Bone bruises are focal abnormalities in subchondral bone marrow due to trabecular microfractures as a result of traumatic force. These trauma-induced lesions are better detected with magnetic resonance (MR) imaging using water-sensitive sequences. Moreover, the pattern of bone bruise is distinctive and allows us to understand the dynamics of trauma and to predict associated soft injuries. This article discusses the mechanism of traumatic injury and MR findings.
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Affiliation(s)
- P Ciuffreda
- Department of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n.1, 71122, Foggia, Italy
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23
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Biermasz NR, van 't Klooster R, Wassenaar MJE, Malm SH, Claessen KMJA, Nelissen RGHH, Roelfsema F, Pereira AM, Kroon HM, Stoel BC, Romijn JA, Kloppenburg M. Automated image analysis of hand radiographs reveals widened joint spaces in patients with long-term control of acromegaly: relation to disease activity and symptoms. Eur J Endocrinol 2012; 166:407-13. [PMID: 22170798 DOI: 10.1530/eje-11-0795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Arthropathy is an invalidating complication of acromegaly. Although acromegalic arthropathy shares features with primary osteoarthritis, joint spaces are widened rather than narrowed in patients with long-term cure of acromegaly. The late effects of acromegaly on hand joints have not been characterized. Therefore, the objective of the current study was to assess joint space widths (JSWs) of hand joints in patients with long-term control of acromegaly and to identify factors associated with JSW. METHODS A cross-sectional study was carried out in 89 patients (age 58 ± 12 years, 49% women) with long-term controlled acromegaly and 471 controls without hand symptoms (age 46 ± 12 years, 42% women). Radiological JSWs of individual hand joints were measured by automated image analysis. RESULTS Patients had wider mean joint spaces than controls: metacarpo-phalangeal (MCP) joints were ~24%, proximal interphalangeal joints ~21%, and distal interphalangeal joints were ~20% wider (patients vs controls; P < 0.001 for all joints). Mean JSW exceeded the 95th percentile of the values obtained in controls in 64% of patients. Higher IGF1 and GH concentrations at diagnosis were associated with larger JSWs (adjusted β for pretreatment GH in tertiles: 0.09 (95% confidence interval (CI) 0.03-1.84) and for IGF1 in tertiles: 0.14 (95% CI 0.05-0.23) at the MCP joints in acromegalic patients. In male patients, but not in female patients, increased JSWs were associated with more self-reported pain (P = 0.02). CONCLUSIONS Using a new semi-automated image analysis of hand radiographs, acromegalic patients with long-term disease control appeared to have increased joint spaces of all hand joints. JSWs were positively related to disease activity at diagnosis, but not to duration of follow-up, suggesting irreversible cartilage hypertrophy. Irreversible cartilage hypertrophy may partly explain persisting hand complaints despite long-term disease control.
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Affiliation(s)
- N R Biermasz
- Department of Endocrinology and Metabolism C4-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Katznelson L, Atkinson JLD, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocr Pract 2011; 17 Suppl 4:1-44. [PMID: 21846616 DOI: 10.4158/ep.17.s4.1] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Laurence Katznelson
- Departments of Medicine and Neurosurgery, Stanford University, Stanford, California, USA
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25
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Abstract
Although acromegaly is a rare disease, the clinical, economic and health-related quality of life (HRQoL) burden is considerable due to the broad spectrum of comorbidities as well as the need for lifelong management. We performed a comprehensive literature review of the past 12 years (1998-2010) to determine the benefit of disease control (defined as a growth hormone [GH] concentration <2.5 μg/l and insulin-like growth factor [IGF]-1 normal for age) on clinical, HRQoL, and economic outcomes. Increased GH and IGF-1 levels and low frequency of somatostatin analogue use directly predicted increased mortality risk. Clinical outcome measures that may improve with disease control include joint articular cartilage thickness, vertebral fractures, left ventricular function, exercise capacity and endurance, lipid profile, and obstructive apnea events. Some evidence suggests an association between controlled disease and improved HRQoL. Total direct treatment costs were higher for patients with uncontrolled compared to controlled disease. Costs incurred for management of comorbidities, and indirect cost could further add to treatment costs. Optimizing disease control in patients with acromegaly appears to improve outcomes. Future studies need to evaluate clinical outcomes, as well as HRQoL and comprehensive economic outcomes achieved with controlled disease.
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Affiliation(s)
- A. Ben-Shlomo
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, 110 George Burns Rd, Los Angeles, CA 90048 USA
| | | | | | - S. Pulgar
- Novartis Pharmaceuticals Corporation, Florham Park, NJ USA
| | - S. Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, 110 George Burns Rd, Los Angeles, CA 90048 USA
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Abstract
Somatostatin analogs (SA) are widely used in acromegaly, either as first-line or adjuvant treatment after surgery. First-line treatment with these drugs is generally used in the patients with macroadenomas or in those with clinical conditions so severe as to prevent unsafe reactions during anesthesia. Generally, the response to SA takes into account both control of GH and IGF-I excess, with consequent improvement of clinical symptoms directly related to GH and IGF-I excess, and tumor shrinkage. This latter effect is more prominent in the patients treated first-line and bearing large macroadenomas, but it is also observed in patients with microadenomas, even with little clinical implication. Predictors of response are patients' gender, age, initial GH and IGF-I levels, and tumor mass, as well as adequate expression of somatostatin receptor types 2 and 5, those with the highest affinity for octreotide and lanreotide. Only sporadic cases of somatostatin receptor gene mutation or impaired signaling pathways have been described in GH-secreting tumors so far. The response to SA also depends on treatment duration and dosage of the drug used, so that a definition of resistance based on short-term treatments using low doses of long-acting SA is limited. Current data suggest that response to these drugs is better analyzed taking together biochemical and tumoral effects because only the absence of both responses might be considered as a poor response or resistance. This latter evidence seems to occur in 25% of treated patients after 12 months of currently available long-acting SA.
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Affiliation(s)
- Annamaria Colao
- Department of Clinical and Molecular Endocrinology and Oncology, University “Federico II,” Naples, Italy.
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Doessing S, Holm L, Heinemeier KM, Feldt-Rasmussen U, Schjerling P, Qvortrup K, Larsen JO, Nielsen RH, Flyvbjerg A, Kjaer M. GH and IGF1 levels are positively associated with musculotendinous collagen expression: experiments in acromegalic and GH deficiency patients. Eur J Endocrinol 2010; 163:853-62. [PMID: 20858702 DOI: 10.1530/eje-10-0818] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Disproportionate growth of musculoskeletal tissue is a major cause of morbidity in both acromegalic (ACRO) and GH-deficient (GHD) patients. GH/IGF1 is likely to play an important role in the regulation of tendon and muscle collagen. We hypothesized that the local production of collagen is associated with the level of GH/IGF1. DESIGN AND METHODS As primary outcomes, collagen mRNA expression and collagen protein fractional synthesis rate (FSR) were determined locally in skeletal muscle and tendon in nine ACRO and nine GHD patients. Moreover, muscle myofibrillar protein synthesis and tendon collagen morphology were determined. RESULTS AND CONCLUSIONS Muscle collagen I and III mRNA expression was higher in ACRO patients versus GHD patients (P<0.05), whereas collagen protein FSR did not differ significantly between ACRO and GHD patients in muscle (P=0.21) and tendon (P=0.15). IGF1Ea and IGF1Ec mRNA expression in muscle was higher in ACRO patients versus GHD patients (P<0.01). Muscle IGF1Ea mRNA expression correlated positively with collagen I mRNA expression (P<0.01). Tendon collagen fibrillar area tended to be higher in GHD patients relative to ACRO patients (P=0.07). Thus, we observed a higher expression for collagen and IGF1 mRNA in local musculotendinous tissue in ACRO patients relative to GHD patients. Moreover, there was a tendency towards a higher collagen protein FSR and a smaller collagen fibril diameter in ACRO patients relative to GHD patients. The results indicate a collagen-stimulating role of local IGF1 in human connective tissue and add to the understanding of musculoskeletal pathology in patients with either high or low GH/IGF1 axis activity.
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Affiliation(s)
- Simon Doessing
- Department of Orthopaedic Surgery M, Faculty of Health Sciences, Institute of Sports Medicine, Bispebjerg Hospital and Centre for Healthy Aging, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark.
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Attanasio R, Lanzi R, Losa M, Valentini F, Grimaldi F, De Menis E, Davì MV, Battista C, Castello R, Cremonini N, Razzore P, Rosato F, Montini M, Cozzi R. Effects of lanreotide Autogel on growth hormone, insulinlike growth factor 1, and tumor size in acromegaly: a 1-year prospective multicenter study. Endocr Pract 2009; 14:846-55. [PMID: 18996812 DOI: 10.4158/ep.14.7.846] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of lanreotide Autogel on growth hormone and insulinlike growth factor 1 (IGF-1) concentrations and tumor size in patients with acromegaly. METHODS Between September 2004 and March 2006, patients with active acromegaly who had not previously been treated with somatostatin analogues or received irradiation were enrolled in a 1-year, prospective, open, multicenter study. Lanreotide Autogel was injected subcutaneously starting with 90 mg every 4 weeks for 2 cycles and then individually titrated, aiming for safe growth hormone concentrations (<2.5 ng/mL) and normal age-matched IGF-1 concentrations. Tumor shrinkage, clinical score, pituitary function, and safety parameters were evaluated. RESULTS Twenty-seven patients (15 women, 12 men) were enrolled. One patient withdrew because of treatment intolerance, and 5 proceeded to neurosurgery 6 months into the study. Lanreotide Autogel was the primary treatment in 19 patients (4 with microadenoma, 15 with macroadenoma) and the adjuvant treatment in 8 patients in whom it followed a previous unsuccessful neurosurgery. In the 26 patients, safe growth hormone values were achieved in 11 (42%), normal IGF-1 values in 14 (54%), and both targets were achieved in 10 (38%). Tumors shrank in 16 of the 22 patients (73%) in whom tumor shrinkage could be evaluated. The maximal vertical diameter of the tumor decreased by a mean of 24% (range, 0% to 50%), from 14.4 +/- 8.4 mm to 10.4 +/- 7 mm, and tumor volume decreased by a mean of 44% (range, 0% to 76%), from 2536 mm3 (range, 115-7737 mm(3)) to 1461 mm(3) (range, 63-6217 mm(3)) (both P<.015). Symptom scores and lipid levels significantly improved. In the 26 patients, glucose metabolism deteriorated in 3 (12%) and improved in 4 (15%). New biliary alterations appeared in 26%. Pituitary function and safety parameters did not change. CONCLUSIONS Lanreotide Autogel treatment, titrated for optimal hormonal control, effectively controls IGF-1 and growth hormone levels, shrinks tumors, reduces acromegalic symptoms, and is well tolerated.
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Affiliation(s)
- Roberto Attanasio
- Division of Endocrinology, Joined Hospitals of Bergamo, Italy Pituitary Unit, Galeazzi Institute IRCCS, Milan, Italy
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Wassenaar MJE, Biermasz NR, van Duinen N, van der Klaauw AA, Pereira AM, Roelfsema F, Smit JWA, Kroon HM, Kloppenburg M, Romijn JA. High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case-control study. Eur J Endocrinol 2009; 160:357-65. [PMID: 19050166 DOI: 10.1530/eje-08-0845] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the prevalence and rheumatological and radiological characteristics of arthropathy in patients after long-term cure of acromegaly in comparison with age-matched controls. DESIGN Case-control study. PATIENTS We compared 89 patients with adequate biochemical control of acromegaly (mean 14 years) and 67 age-matched controls. MEASUREMENTS Study parameters were the results of symptom questionnaires, structured physical examination and radiographs of the spine, hip, knee and hand. The diagnosis of osteoarthritis was based on a) radiological osteoarthritis determined by Kellgren and Lawrence and b) clinical osteoarthritis determined by the American College of Rheumatology (ACR) criteria. For the radiological comparison with controls, a Dutch reference group was used. RESULTS Pain/stiffness at > or =1 joint site was reported by 72% of patients, most frequently in the spine and hands. Radiological osteoarthritis at > or =1 joint site was present in 99% of patients, most frequently in the spine and hip, and increased at all joint sites in comparison with controls (odds ratios: 2-20). Despite long-term cure of acromegaly, the characteristic widening of joint spaces was still present. In addition, severe osteophytosis was present. Representative radiographs of these typical features are included in the manuscript. According to the ACR criteria, clinical osteoarthritis at > or =1 joint site was present in 63% of patients, most frequently in the spine and hand. Patients had a higher prevalence of osteoarthritis than controls at all joint sites according to all scoring methods and at a younger age. CONCLUSIONS Prior GH excess has irreversible, deleterious late effects on the clinical and radiological aspects of joints in patients with long-term cure of acromegaly.
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Affiliation(s)
- M J E Wassenaar
- Department of Endocrinology and Metabolic Diseases C4-R Radiology, Leiden University Medical Centre, Leiden, The Netherlands
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Ehrnborg C, Rosén T. Physiological and pharmacological basis for the ergogenic effects of growth hormone in elite sports. Asian J Androl 2008; 10:373-83. [DOI: 10.1111/j.1745-7262.2008.00403.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Acromegaly is a rare and chronic condition that is characterized by sustained unregulated hypersecretion of growth hormone (GH). More than 99% of the cases of acromegaly are due to a pathologic proliferation of pituitary somatotrophs presenting in the form of a pituitary adenoma. The excessive amounts of GH and its target hormone, insulin like growth factor-1 (IGF-1) cause metabolic changes and tissue enlargement that, collectively, lead to significant morbidity and a two to threefold increase in mortality. Thus, early diagnosis has proved to be crucial to improve survival and quality of life in this condition. The development of radioimmunoassay (RIA) in the 1960s provided clinicians with a biochemical tool to diagnose acromegaly. Many limitations were inherent to this methodology which necessitated the development of more sensitive tools, such as immunoradiometric (IRMA) or immunoluminometric (ILMA) assays for GH and IGF-1 measurements. These newer assays have not come without imperfections. The reference ranges to describe normalcy of the somatotropic axis and the biochemical criteria of "cure" of acromegaly are areas of great debate. Nevertheless, the current international consensus agrees that the diagnosis of acromegaly should be based on both clinical presentation and biochemical data.
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Affiliation(s)
- Rocio A Cordero
- Division of Metabolism, Endocrinology and Diabetes, Department of Neurosurgery, The University of Michigan and the DVA Medical Center, 3920 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5354, USA.
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Colao A, Auriemma RS, Pivonello R, Galdiero M, Lombardi G. Medical consequences of acromegaly: what are the effects of biochemical control? Rev Endocr Metab Disord 2008; 9:21-31. [PMID: 18163212 DOI: 10.1007/s11154-007-9062-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This chapter discusses the effects of biochemical control of acromegaly on cardiovascular diseases, metabolic complications, respiratory abnormalities, malignancies and bone alterations. Acromegaly is associated with increased morbidity and mortality for cardiovascular and respiratory complications, whereas neoplasms seem to be a minor cause of increased risk of death. Other associated diseases are osteoarthritis, carpal tunnel syndrome, fatigue, visual abnormalities and reproductive disorders. Acromegaly results in premature death because of prolonged elevation of GH an IGF-I levels, and a strong biochemical control improves well-being and restores life expectancy to normal. The main goals of medical treatment of acromegaly include normalization of biochemical markers of disease activity, improvement in signs and symptoms of the disease, removal or reduction of tumor mass and preservation of pituitary function.
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Affiliation(s)
- Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, via S Pansini 5, 80131, Naples, Italy.
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Colao A, Pivonello R, Di Somma C, Tauchmanovà L, Savastano S, Lombardi G. Growth hormone excess with onset in adolescence: clinical appearance and long-term treatment outcome. Clin Endocrinol (Oxf) 2007; 66:714-22. [PMID: 17388794 DOI: 10.1111/j.1365-2265.2007.02809.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Limited data are available on clinical presentation and treatment strategy in patients with GH-secreting adenomas with onset in adolescence. OBJECTIVE To report results of diagnosis and treatment in adolescents with GH and IGF-I excess. DESIGN Analytical, observational, retrospective. SUBJECTS Thirteen patients (five females and eight males, age 15-20 years) all with macroadenoma (two extrasellar, 11 invasive). MAIN OUTCOME MEASURES Height, body mass index (BMI), GH and IGF-I levels, tumour volume at diagnosis and after treatment. INTERVENTIONS Transsphenoidal surgery, octreotide subcutaneous (OCT, 0.3-0.8 mg/day), octreotide-LAR i.m. (LAR, 20-30 mg/q28 days), lanreotide i.m. (LAN, 60-90 mg/q28 days), bromocriptine (BRC, 5 mg/day), cabergoline (CAB, 1-2 mg/week). RESULTS Concomitant hyperprolactinaemia was found in eight patients (61.5%). All girls presented with amenorrhoea, which was associated with galactorrhoea in two patients; all boys presented with symptoms of tumour mass compression such as visual disturbance or headache; two girls also had these symptoms. Height at diagnosis was above the 97th centile in four of five girls and in six of eight boys. None of the patients had altered lipid profile while homeostasis model assessment of insulin resistance (HOMA-IR; 2.8 +/- 0.9) and beta-cell function (HOMA-beta, 207.6 +/- 98.1%) were higher than predicted (1% and 100%, respectively). First-line treatment was surgery in two patients and somatostatin analogues associated with dopaminergic drugs in 11 patients. None of the patients operated on were cured while six of 11 patients receiving pharmacotherapy (6-24 months) were controlled. In these six, tumour volume was reduced by 51.0 +/- 25.2% (median 51.5%). As second-line treatment, all the 11 patients treated with somatostatin analogues underwent surgical removal of their tumours. Surgery was successful in four patients and second-line pharmacotherapy in six patients. One patient was lost at follow-up and two patients maintained active acromegaly despite different treatment schedules; both patients were then treated with radiotherapy. At the last follow-up, there was a significant decrease in insulin levels, HOMA-IR and HOMA-beta without any change in lipid profile. CONCLUSIONS The clinical presentation of GH-secreting adenomas in adolescent girls is associated with menstrual disturbances and in boys with symptoms of mass effects; tall stature is characteristic in both. First-line treatment with depot somatostatin analogues followed by surgery and then by a second course of somatostatin analogues was successful and safe in 11 of 13 patients.
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Affiliation(s)
- Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, Section of Endocrinology, Federico II University of Naples, Naples, Italy.
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Taboada GF, van Haute FR, Corrêa LL, Casini AF, Gadelha MR. Etiologic aspects and management of acromegaly. ACTA ACUST UNITED AC 2005; 49:626-40. [PMID: 16444346 DOI: 10.1590/s0004-27302005000500004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acromegaly is a systemic disease with various etiologies. It can occur as a sporadic or, more rarely, as a familial disease. Numerous complications such as endocrine, cardiovascular, respiratory, metabolic, osteoarticular and neoplastic disturbances occur and must be taken into account when establishing a therapeutic strategy. For this reason, the decision as to a treatment modality of acromegaly must be followed by a thorough evaluation of the patient and once the diagnosis of complications is settled, adequate treatment should be instituted. Follow up of the patients requires periodical re-assessment of complications’ status.
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Affiliation(s)
- Giselle F Taboada
- Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ
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Abstract
Over the last few years, growth hormone (GH) has become increasingly popular as doping within different sports. However, the precise mechanisms behind the ergogenic (performance enhancing) effects of GH in athletes are still being debated. Besides a well-documented stimulatory effect of GH on carbohydrate and fatty acid metabolism, and a possible anabolic effect on myofibrillar muscle protein, we suggest a role for GH as an anabolic agent in connective tissue in human skeletal muscle and tendon. Given the importance of the connective tissue for the function of skeletal muscle and tendon, a strengthening effect of GH on connective tissue could fit with the ergogenic effect of GH experienced by athletes. This review examines the endogenous secretion of GH and its mediators in relation to exercise. Furthermore, we consider the effect of endogenous GH and administered recombinant human GH (rhGH) on both myofibrillar and connective tissue protein synthesis, thus offering an alternative explanation for the ergogenic effect of GH. Finally, we suggest a possible therapeutic role for rhGH in clinical management of the frequently suffered injuries in the connective tissue.
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Affiliation(s)
- S Doessing
- Institute of Sports Medicine, Copenhagen, Bispebjerg Hospital, Copenhagen NV, Denmark.
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Colao A, Barkan AL, Scarpa R. Growth Hormone/Insulin-Like Growth Factor–I System and Connective Tissues: Basic Aspects and Clinical Implications. Rheum Dis Clin North Am 2005; 31:29-42, viii. [PMID: 15639054 DOI: 10.1016/j.rdc.2004.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews basic and clinical aspects of the effects of growth hormone and insulin-like growth factor-I on the connective tissues.
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Affiliation(s)
- Annamaria Colao
- Unit of Neuroendocrinology, Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples, Via S. Pancini C, Naples 80131, Italy.
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Cook DM, Ezzat S, Katznelson L, Kleinberg DL, Laws ER, Nippoldt TB, Swearingen B, Vance ML. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly. Endocr Pract 2004; 10:213-25. [PMID: 15382339 DOI: 10.4158/ep.10.3.213] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The treatment of patients with persistently active acromegaly has been facilitated over the past decade by the advent of highly specific and selective pharmacological agents. Somatostatin analogs, derived from the native inhibitory hormone somatostatin, are available in extended-duration preparations and are effective in reducing serum levels of growth hormone (GH) and insulin-like growth factor-I (IGF-I) as well as in improving the adverse clinical effects of acromegaly. Cabergoline, an agonist with a specificity for the dopamine D-2 receptor, has been shown to suppress IGF-I levels and induce tumor shrinkage in 35 and 50% of patients, respectively. The GH receptor antagonists compete with naturally occurring GH for binding with the GH receptor. As such, pegvisomant normalizes circulating IGF-I levels in 80 to 90% of patients with acromegaly. This last line of therapy should be considered for use in patients in whom surgery and medical therapy with somatostatin and/or dopamine agonists are either ineffective or poorly tolerated.
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Affiliation(s)
- Shereen Ezzat
- Division of Endocrinology and Metabolism, University of Toronto, Ontario, Canada.
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Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004; 25:102-52. [PMID: 14769829 DOI: 10.1210/er.2002-0022] [Citation(s) in RCA: 790] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases, although currently neoplastic complications have been questioned as a relevant cause of increased risk of death. Biventricular hypertrophy, occurring independently of hypertension and metabolic complications, is the most frequent cardiac complication. Diastolic and systolic dysfunction develops along with disease duration; and other cardiac disorders, such as arrhythmias, valve disease, hypertension, atherosclerosis, and endothelial dysfunction, are also common in acromegaly. Control of acromegaly by surgery or pharmacotherapy, especially somatostatin analogs, improves cardiovascular morbidity. Respiratory disorders, sleep apnea, and ventilatory dysfunction are also important contributors in increasing mortality and are advantageously benefitted by controlling GH and IGF-I hypersecretion. An increased risk of colonic polyps, which more frequently recur in patients not controlled after treatment, has been reported by several independent investigations, although malignancies in other organs have also been described, but less convincingly than at the gastrointestinal level. Finally, the most important cause of morbidity and functional disability of the disease is arthropathy, which can be reversed at an initial stage, but not if the disease is left untreated for several years.
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Affiliation(s)
- Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, 80131 Naples, Italy.
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Vitale G, Pivonello R, Ferone D, De Martino MC, Auriemma RS, Caraglia M, Abbruzzese A, Lombardi G, Colao A. The role of somatostatin receptors in the medical treatment of acromegaly. Dig Liver Dis 2004; 36 Suppl 1:S55-9. [PMID: 15077912 DOI: 10.1016/j.dld.2003.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Somatostatin is a hypothalamic inhibitor of pituitary growth hormone secretion and cell proliferation, binding to five distinct receptor subtypes (sstr1-5). Since native somatostatin has a short half-life, somatostatin analogues with a longer half-life have been developed for therapeutic purposes. Octreotide and lanreotide are currently available for treatment of acromegaly, binding with high-affinity sstr2 and sstr5. Octreotide, the first somatostatin analogue used in the medical therapy of acromegaly, was initially given subcutaneously at doses of 100-500 microg three times daily. The introduction of new depot formulations, such as octreotide long-acting release, slow-release lanreotide and lanreotide-autogel, improved patients compliance of long-term therapy, overcoming the inconvenience of multiple daily administration. The treatment with somatostatin analogues induces biochemical control and tumour shrinkage in about 50-70% and 30-60% of patients with acromegaly, respectively. However, the efficacy of this therapy lies on an adequate expression of sstr2 and sstr5 on tumor cells. In the past, somatostatin receptor expression was tested in vivo by (111)In-diethylenetriaminepentaacetate-D-Phe-octreotide scintigraphy: this method has been abandoned since normal pituitary tissue can be visualised by (111)In-diethylenetriaminepentaacetate-D-Phe-octreotide scintigraphy. Currently, the somatostatin receptorial profile can be characterised by autoradiography, molecular biology techniques and immunohistochemistry on surgically removed tumor tissue. These methods may offer an individualised approach sparing patients from unnecessary treatment.
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Affiliation(s)
- G Vitale
- Department of Molecular and Clinical Endocrinology, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
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Attanasio R, Baldelli R, Pivonello R, Grottoli S, Bocca L, Gasco V, Giusti M, Tamburrano G, Colao A, Cozzi R. Lanreotide 60 mg, a new long-acting formulation: effectiveness in the chronic treatment of acromegaly. J Clin Endocrinol Metab 2003; 88:5258-65. [PMID: 14602759 DOI: 10.1210/jc.2003-030266] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Lanreotide (LAN) 60 mg (LAN60), a new long-acting formulation of LAN alleged to suppress GH/IGF-I hypersecretion for 28 d in acromegalic patients, was administered in a prospective open multicenter study to 92 patients with active acromegaly (61 women and 31 men, aged 20-79 yr). LAN60 was given as adjuvant treatment (AT) in 62 patients; the other 30 patients [primary treatment (PT)] were de novo (n = 20) or previously treated only by pharmacotherapy (n = 10). After wash-out from previous treatments, LAN60 was started im every 28 d for 3 injections; the dose was then individually tailored, aiming at lowering GH to less than 2.5 micro g/liter and IGF-I to the normal range. After a median follow-up of 24 months (range, 6-48 months), IGF-I normalized in 65% of patients, decreasing from 199 +/- 8% (expressed as a percentage of the upper limit of normal range; mean +/- SE) to 87 +/- 4% (P < 0.0001). GH fell to less than 2.5 microg/liter in 63% of patients and to less than 1 microg/liter in 25%, decreasing from 20 +/- 3 to 3 +/- 0.4 microg/liter (P < 0.0001). A progressive increase in the rate of IGF-I normalization was observed (from 49% at 1 yr to 77% at 3 yr). The rate of GH/IGF-I normalization was 72% at 36 months by Kaplan-Meier analysis. No tachyphylaxis was observed throughout the study. Shortening the interval between injections to 21 d improved GH/IGF-I suppression. PT and AT patients achieved similar final GH/IGF-I levels and rates of normalization. Tumor shrank in 39% of assessable patients and in 50% of PT. Plasma glucose levels did not change, and high density lipoprotein cholesterol increased (by 19.3 +/- 5.1%; P = 0.0215). Gallstones appeared or worsened in 13% of patients. LAN60 is a new, very effective and long-lasting formulation for the treatment of acromegaly. The persistence of a powerful suppression of GH/IGF-I levels, the progressive increase in the rate of IGF-I normalization, and the similarity in the efficacy achieved in PT and AT patients point to a role for LAN60 in the primary treatment of acromegaly.
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Kocakoc E, Kiris A, Ozgocmen S. Acromegalic arthropathy of the hand with sesamoid involvement: a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2002; 7:153-4. [PMID: 12365058 DOI: 10.1142/s0218810402000947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2001] [Accepted: 09/10/2001] [Indexed: 11/18/2022]
Abstract
Acromegalic arthropathy may affect the hand joints with characteristic radiological changes. Sesamoid involvement in the hand may be presented with unusual changes. A case of a female patient with characteristic hand joint and sesamoid bone osteophytic changes related to acromegalic arthropathy is presented.
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Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Division of Rheumatology, Firat University Faculty of Medicine, Sursuru Mah, Seckin Sok, No: 7/10 Elazig, Turkey.
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Affiliation(s)
- A L Barkan
- The University of Michigan Health System, Ann Arbor, Michigan, USA.
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Cozzi R, Barausse M, Sberna M, Lodrini A, Franzini A, Lasio G, Attanasio R. Lanreotide 60 mg, a longer-acting somatostatin analog: tumor shrinkage and hormonal normalization in acromegaly. Pituitary 2000; 3:231-8. [PMID: 11788011 DOI: 10.1023/a:1012832230598] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Somatostatin analogues are nowadays the milestone in the medical treatment of acromegaly. We evaluated the effects of a new 60 mg longer-acting formulation of lanreotide (LAN60) on GH/IGF-I levels and tumor size. PATIENTS Twenty-one acromegalics entered a prospective monocentric open study. Eight were consecutive "de novo" patients (group I). Thirteen patients sensitive to SA (GH levels < 2.5 [mgr]g/l and/or IGF-I normalization on chronic LAN 30 mg (LAN30) treatment) were switched to LAN60 (group II). PROTOCOL LAN60 was administered IM for 6 cycles at 28 day intervals. In group I when GH/IGF-I remained pathological, the intervals were shortened to 21 days for the last three cycles. CONTROLS GH/IGF-I at the end of the 1st, 3rd and 6th cycle; MRI at the end of the study in all patients in group I bearing an adenoma. RESULTS Group I. GH (p = 0.00638, below 2.5 [mgr]g/l in two patients) and IGF-I (p = 0.0289, normalized in 5) significantly decreased. In one of two patients shortening the LAN60 schedule was more effective in suppressing GH/IGF-I. Group II. No change in GH and IGF-I levels was observed with the administration of LAN60, instead of LAN30. On LAN60 GH remained below 2.5 [mgr]g/l in 8/10 patients and IGF-I normal in 11/11 patients that had attained those values on LAN30. Tumor markedly shrank (23% to 64% vs basal), from 1400 (664-1680) mm3 to 520 (500-960) mm3 (median, interquartile, p = 0.0218) in all the 5 evaluable patients. CONCLUSION LAN60 is a very effective and longer-lasting formulation for the treatment of acromegaly. A closer administration schedule might achieve greater efficacy. Its effectiveness in shrinking tumor opens new perspectives in the therapy of acromegaly.
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Affiliation(s)
- R Cozzi
- Division of Endocrinology, Niguarda Hospital, Milan, Italy.
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Ferone D, Colao A, van der Lely AJ, Lamberts SW. Pharmacotherapy or surgery as primary treatment for acromegaly? Drugs Aging 2000; 17:81-92. [PMID: 10984197 DOI: 10.2165/00002512-200017020-00001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In recent years important progress has been made in the management of acromegaly due to the availability of effective and well tolerated drugs and to improved surgical techniques, resulting in a broader choice of therapeutic interventions. Although surgery in the hands of an experienced surgeon still represents the primary option for the majority of patients, the new formulations of somatostatin analogues and dopamine agonists have partially modified the primary therapeutic approach to this severe and disabling chronic disease. Therapy with somatostatin analogues has been shown to reduce morbidity and the mortality rate in patients with acromegaly, and currently in some patients this medical approach may be preferable to surgery. Although in selected patients individualised pharmacotherapy might represent the primary therapy, trans-sphenoidal surgery of microadenomas and noninvasive macroadenomas remains the primary option, since the remission rate is very high and the costs are relatively low in comparison with lifelong therapy with somatostatin analogues. However, the treatment schedule in acromegaly should consider criteria additional to tumour size and invasiveness, such as the age and the general clinical condition of the patient. Presurgical treatment with somatostatin analogues has been reported to reduce surgical complications and time of hospitalisation after the operation. Moreover, a multidisciplinary team of well trained specialists is needed in order to guarantee the most optimal quality of life and life expectancy for patients with acromegaly.
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Affiliation(s)
- D Ferone
- Department of Internal Medicine III, Erasmus University, Rotterdam, The Netherlands.
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