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Abstract
Acromegaly is characterized by Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) excess. Uncontrolled acromegaly is associated with a strongly increased risk of cardiovascular disease (CVD), and numerous cardiovascular risk factors remain present after remission. GH and IGF-1 have numerous effects on the immune and cardiovascular system. Since endothelial damage and systemic inflammation are strongly linked to the development of CVD, and have been suggested to be present in both controlled as uncontrolled acromegaly, they may explain the presence of both micro- and macrovascular dysfunction in these patients. In addition, these changes seem to be only partially reversible after remission, as illustrated by the often reported presence of endothelial dysfunction and microvascular damage in controlled acromegaly. Previous studies suggest that insulin resistance, oxidative stress, and endothelial dysfunction are involved in the development of CVD in acromegaly. Not surprisingly, these processes are associated with systemic inflammation and respond to GH/IGF-1 normalizing treatment.
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Affiliation(s)
- Thalijn L C Wolters
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Adrianus R M M Hermus
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Prencipe N, Scarati M, Manetta T, Berton AM, Parisi S, Bona C, Parasiliti-Caprino M, Ditto MC, Gasco V, Fusaro E, Grottoli S. Acromegaly and joint pain: is there something more? A cross-sectional study to evaluate rheumatic disorders in growth hormone secreting tumor patients. J Endocrinol Invest 2020; 43:1661-1667. [PMID: 32333332 DOI: 10.1007/s40618-020-01268-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present study was to evaluate the rheumatic profile in acromegalic patients to better characterize joint pain. METHODS The immunological pattern (rheumatoid factor; antinuclear antibodies-ANA, extractable nuclear antigens-ENA-Ab; anti-citrullinated protein antibodies; erythrocyte sedimentation rate) was evaluated in 20 acromegaly subjects (AS) and 20 control subjects (CS). Bilateral joint ultrasound of hands/wrists and nail capillaroscopy were also performed. RESULTS Articular pain was more frequent in AS than in CS (p = 0.027). No difference was detected in immunological parameters. ANA and ENA-Ab were positive in only 10% of AS and in 5% of CS, while no difference was found in anti-citrullinated protein antibodies. No difference was detected between rheumatoid factor positivity, but threefold higher IgG were detected in AS compared to CS. The erythrocyte sedimentation rate was significantly higher in AS than CS (p = 0.040), while in AS, there was a trend in increased Power Doppler (PWD) articular uptake. The capillaroscopic evaluation showed a significant difference in almost each parameter (presence and number of tortuous capillaries, capillary enlargements, and hemorrhages), showing a moderate-to-severe microangiopathy in AS. CONCLUSION The results of our study suggest that joint damage in acromegaly has not an autoimmune etiology. Increased erythrocyte sedimentation rate levels and PWD alteration in acromegalic population reflect a possible inflammatory nature, while the capillaroscopic findings suggest a moderate-to-severe microangiopathy that could help to identify patients with a greater macroangiopathic risk.
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Affiliation(s)
- N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - M Scarati
- SSD of Rheumatology, Medical Department, Mauriziano Hospital, Turin, Italy
| | - T Manetta
- Department of Public and Pediatric Health, AOU Health and Science City, Turin, Italy
| | - A M Berton
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Parisi
- SC of Rheumatology, Medical Department, AOU Health and Science City, Turin, Italy
| | - C Bona
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Parasiliti-Caprino
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M C Ditto
- SC of Rheumatology, Medical Department, AOU Health and Science City, Turin, Italy
| | - V Gasco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Fusaro
- SC of Rheumatology, Medical Department, AOU Health and Science City, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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Maffei P, Dassie F, Wennberg A, Parolin M, Vettor R. The Endothelium in Acromegaly. Front Endocrinol (Lausanne) 2019; 10:437. [PMID: 31396153 PMCID: PMC6667653 DOI: 10.3389/fendo.2019.00437] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Growth hormone (GH) and insulin like growth factor-1 (IGF-1) excess induce well-known deleterious effects on the cardiovascular system, especially after long-term exposition. Acromegaly, a condition of chronic GH and IGF-1 hypersecretion, is frequently associated to cardiovascular complications, although recent studies have shown a reduction in the prevalence of these comorbidities in well-controlled patients and a mortality risk similar to normal aging population. Many factors could contribute to the increased cardiovascular risk of acromegaly patients. Among these factors, the endothelium plays a key role in the pathogenesis of atherosclerotic plaques and could be considered an early marker of atherosclerosis and cardiovascular dysfunction. In this review we examined the relationship between GH/IGF-1 excess and the endothelium, from basic studies to clinical evidence. Many studies involving various arterial districts (microvascular arteries of retina, kidney and brain, and major vessels as carotid and aorta) showed that GH/IGF-1 excess promotes endothelial dysfunction via several different mechanisms. Increased endothelial proliferation, dysfunction of endothelial progenitor cells, increased oxidative stress, and compromised oxidative defenses are the main factors that are associated with endothelial dysfunction. In the general population, these alterations are associated with the development of atherosclerosis with an increased incidence of coronary artery disease and cerebrovascular complications. However, in acromegaly this is still a debated issue, despite the presence of many pro-atherogenic factors and comorbidities, such as hypertension, diabetes, sleep apnoea, and metabolic syndrome. Preclinical markers of atherosclerosis as arterial intima media thickness, pulse wave velocity and flow mediated dilation seem to be impaired in acromegaly and partly mediated by the endothelium dysfunction. In conclusion, the pathophysiology of endothelial dysfunction in the condition of GH and IGF-1 excess remains a crucial area of investigation to fully dissect the association of acromegaly with cardiovascular disease complications.
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Affiliation(s)
- Pietro Maffei
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
- *Correspondence: Pietro Maffei
| | - Francesca Dassie
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Alexandra Wennberg
- Clinica Neurologica, Department of Neurosciences (DNS), Padua University Hospital, Padua, Italy
| | - Matteo Parolin
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
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Parolin M, Dassie F, Martini C, Mioni R, Russo L, Fallo F, Rossato M, Vettor R, Maffei P, Pagano C. Preclinical markers of atherosclerosis in acromegaly: a systematic review and meta-analysis. Pituitary 2018; 21:653-662. [PMID: 30225826 DOI: 10.1007/s11102-018-0911-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Multiple studies investigated preclinical markers of peripheral vascular damage in acromegaly (ACRO) reporting discordant results. The aim of this study was to run a meta-analysis to examine whether intima media thickness (IMT), flow mediated dilation (FMD) and arterial pulse wave velocity (PWV) are affected in acromegalic patients and to assess the impact of effective treatment of growth hormone excess on these outcomes. STUDY SELECTION Twenty-seven studies comparing ACRO vs control (CON) populations and active (ACT) vs inactive (INACT) ACRO were included in the meta-analysis. DATA SYNTHESIS ACRO compared to CON have higher IMT (ES = 0.83, 95% C.I. 0.35-1.30), p = 0.001, impaired FMD (ES = - 1.59, 95% C.I. - 2.33 to - 0.85, p < 0.0001) and higher PWV (ES = 0.76 95% C.I. 0.37-1.16, p = 0.0001). When patients with ACT vs INACT disease were considered IMT was higher (ES = 0.43, 95% C.I. 0.02-0.84, p = 0.041) and FMD was impaired (ES = - 0.66, 95% C.I. - 1.28 to 0.04, p = 0.038) in ACT patients. Meta-regression analysis of studies comparing IMT in ACT vs INACT acromegalic patients showed a significant and inverse association between the effect size and the percent of hypertensive (p = 0.025) and diabetic (p = 0.041) patients. CONCLUSIONS IMT, FMD and arterial stiffness are impaired in acromegaly showing that these patients may be at increased risk of atherosclerosis. In patients with active disease these preclinical markers of atherosclerosis are worse compared to patients with inactive disease but the role of diabetes and hypertension is prevailing on growth hormone excess.
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Affiliation(s)
- Matteo Parolin
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesca Dassie
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Chiara Martini
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberto Mioni
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Lucia Russo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Marco Rossato
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberto Vettor
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Pietro Maffei
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
| | - Claudio Pagano
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
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Kanaka-Gantenbein C, Kogia C, Abdel-Naser MB, Chrousos GP. Skin manifestations of growth hormone-induced diseases. Rev Endocr Metab Disord 2016; 17:259-267. [PMID: 27571787 DOI: 10.1007/s11154-016-9378-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The human skin is a well-organized organ bearing different types of cells in a well-structured interference to each other including epidermal and follicular keratinocytes, sebocytes, melanocytes, dermal papilla cells and fibroblasts, endothelial cells, sweat gland cells as well as nerves. Several hormones act on different cell types of the skin, while it is also considered an endocrine organ secreting hormones that act at several sites of the organism. GH receptors are found in almost all cell types forming the skin, while IGF-1 receptors' expression is restricted to the epidermal keratinocytes. Both Growth Hormone (GH) excess, as in the case of Acromegaly in adults, or Gigantism in growing children, and GH deficiency states lead to skin manifestations. In case of GH excess the main dermatological findings are skin thickening, coarsening of facial features, acrochordons, puffy hands and feet, oily skin and hyperhidrosis, while GH deficiency, on the contrary, is characterized by thin, dry skin and disorder of normal sweating. Moreover, special disorders associated with GH excess may have specific characteristics, as is the case of café-au-lait spots in Neurofibromatosis, or big café-au-lait skin hyperpigmented regions with irregular margins, as is the case in McCune-Albright syndrome. Meticulous examination of the skin may therefore contribute to the final diagnosis in cases of GH-induced disorders.
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Affiliation(s)
- Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christina Kogia
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamed Badawy Abdel-Naser
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - George P Chrousos
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Boysan SN, Kantarci F, Celik O, Mihmanli I, Gazioglu N, Kadioglu P. Atherosclerotic Risk Factors and Premature Atherosclerosis in Acromegaly Before and After 48 Months of Octreotide-LAR Treatment. Angiology 2012; 63:522-7. [DOI: 10.1177/0003319711431879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied premature atherosclerosis with carotid Doppler ultrasonography in active acromegaly before and after treatment. Patients (n = 27) with active acromegaly and 12 age-, gender-, and body mass index-matched healthy individuals were included in the study. Carotid intima–media thickness was decreased significantly in the inactive group after treatment (median: 0.6 mm, interquartile range [IQR]: 0.55-0.80]) when compared with the active group (median: 0.9 mm [IQR: 0.75-1.15], P < .0001), but there was no significant difference between the inactive and control groups. There was a correlation between homeostasis model of assessment–insulin resistance ( P = .01, r = .41) and growth hormone (GH; P < .0001, r = .46). In conclusion, premature atherosclerosis was demonstrated in active acromegaly patients probably as a consequence of insulin resistance and direct vascular effects of GH and/or insulin-like growth factor 1.
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Affiliation(s)
- S. N. Boysan
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - F. Kantarci
- Department of Radiology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - O. Celik
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - I. Mihmanli
- Department of Radiology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - N. Gazioglu
- Department of Neurosurgery, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
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Silha JV, Krsek M, Hana V, Marek J, Weiss V, Jezkova J, Rosicka M, Jarkovska Z, Murphy LJ. The effects of growth hormone status on circulating levels of vascular growth factors. Clin Endocrinol (Oxf) 2005; 63:79-86. [PMID: 15963066 DOI: 10.1111/j.1365-2265.2005.02303.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vascular growth factors are important not only in angiogenesis but also for the maintenance of normal endothelial integrity and function. Elevated levels of vascular endothelial growth factor (VEGF), angiopoietin-2, hepatocyte growth factor (HGF), endostatin and angiogenin have been associated with endothelial dysfunction and atherosclerosis. Both acromegaly and growth hormone deficiency (GHD) are associated with endothelial dysfunction and changes in blood vessel morphology. AIM To investigate the effect of GH status on the circulating levels of angiogenic factors. DESIGN We measured the levels of six endothelial growth modulators, four angiogenic growth factors and two inhibitors of angiogenesis in 35 untreated acromegalics, 36 untreated GH-deficient subjects and 101 normal control subjects. Fifteen GH-deficient subjects were also studied before and 1 year after treatment with GH. RESULTS Mean angiogenin concentrations were increased in acromegaly and decreased in GH-deficient subjects compared to control subjects. Endostatin levels showed a similar pattern although the elevated levels in acromegalic subjects did not achieve statistical significance. Angiogenin and endostatin levels both correlated significantly with IGF-I levels (R = 0.61, P < 0.001 and R = 0.22, P < 0.01, respectively). The relationship between angiogenin and IGF-I levels remained significant even after correction for gender, age, body mass index (BMI) and insulin resistance. There were no significant differences in the levels of HGF, VEGF, VEGF-C or angiopoietin-2 between the three groups. VEGF-D levels were elevated in both acromegalic and GH-deficient male subjects. A similar pattern was apparent in female subjects. After GH treatment, a significant reduction in VEGF-D levels and a significant rise in endostatin levels were observed in GH-deficient subjects. A nonsignificant increase in angiogenin levels was also observed. CONCLUSION These data indicate that significant perturbations in the levels of vascular growth modulators are present in both acromegaly and GHD. While changes in endostatin and angiogenin levels appear to correlate with IGF-I levels, VEGF-D levels show similar perturbations in both acromegaly and GHD. Further studies are required to determine the relationship of the perturbations to endothelial dysfunction in these conditions.
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Affiliation(s)
- Josef V Silha
- Department of Physiology and Internal Medicine, University of Manitoba, Winnipeg, Canada
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