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Sahin S, Gundogdu A, Nalbantoglu U, Kadioglu P, Karaca Z, Hacioglu A, Urhan ME, Unluhizarci K, Demir AN, Hora M, Durcan E, Elbüken G, Dokmetas HS, Zuhur SS, Kelestimur F. Acromegaly is associated with a distinct oral and gut microbiota. Pituitary 2022; 25:520-530. [PMID: 35467272 DOI: 10.1007/s11102-022-01223-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Our aim was to investigate the changes in the composition of oral and gut microbiota in patients with newly diagnosed acromegaly and their relationship with IGF-1 levels. METHODS Oral and fecal samples were collected from patients with newly diagnosed acromegaly without comorbidities and from healthy controls. The composition of the microbiota was analyzed. The general characteristics, oral and stool samples of the patients and healthy control subjects were compared. The changes in microbiota composition in both habitats, their correlations and associations with IGF-1 were statistically observed using machine learning models. RESULTS Fifteen patients with newly diagnosed acromegaly without comorbidities and 15 healthy controls were included in the study. There was good agreement between fecal and oral microbiota in patients with acromegaly (p = 0.03). Oral microbiota diversity was significantly increased in patients with acromegaly (p < 0.01). In the fecal microbiota, the Firmicutes/Bacteroidetes ratio was lower in patients with acromegaly than in healthy controls (p = 0.011). Application of the transfer learned model to the pattern of microbiota allowed us to identify the patients with acromegaly with perfect accuracy. CONCLUSIONS Patients with acromegaly have their own oral and gut microbiota even if they do not have acromegaly-related complications. Moreover, the excess IGF-1 levels could be correctly predicted based on the pattern of the microbiome.
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Affiliation(s)
- Serdar Sahin
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Aycan Gundogdu
- Department of Microbiology and Clinical Microbiology, School of Medicine, Erciyes University, Kayseri, Turkey
- Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey
| | - Ufuk Nalbantoglu
- Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey
- Department of Computer Engineering, Erciyes University, Kayseri, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Aysa Hacioglu
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Muhammed Emre Urhan
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ahmet Numan Demir
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Hora
- Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey
| | - Emre Durcan
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Gülsah Elbüken
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Namik Kemal University, Tekirdaǧ, Turkey
| | - Hatice Sebile Dokmetas
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sayid Shafi Zuhur
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Namik Kemal University, Tekirdaǧ, Turkey
| | - Fahrettin Kelestimur
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Yeditepe University, Istanbul, Turkey.
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Jensen EA, Young JA, Kuhn J, Onusko M, Busken J, List EO, Kopchick JJ, Berryman DE. Growth hormone alters gross anatomy and morphology of the small and large intestines in age- and sex-dependent manners. Pituitary 2022; 25:116-130. [PMID: 34373994 PMCID: PMC8905484 DOI: 10.1007/s11102-021-01179-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Growth hormone (GH) has an important role in intestinal barrier function, and abnormalities in GH action have been associated with intestinal complications. Yet, the impact of altered GH on intestinal gross anatomy and morphology remains unclear. METHODS This study investigated the influence of GH signaling on gross anatomy, morphology, and fibrosis by characterizing the small and large intestines in male and female bovine growth hormone transgenic (bGH) mice and GH receptor gene-disrupted (GHR-/-) mice at multiple timepoints. RESULTS The length, weight, and circumference of the small and large intestines were increased in bGH mice and decreased in GHR-/- mice across all ages. Colon circumference was significantly increased in bGH mice in a sex-dependent manner while significantly decreased in male GHR-/- mice. Villus height, crypt depth, and muscle thickness of the small intestine were generally increased in bGH mice and decreased in GHR-/- mice compared to controls with age- and sex-dependent exceptions. Colonic crypt depth and muscle thickness in bGH and GHR-/- mice were significantly altered in an age- and sex-dependent manner. Fibrosis was increased in the small intestine of bGH males at 4 months of age, but no significant differences were seen between genotypes at other timepoints. CONCLUSION This study observed notable opposing findings in the intestinal phenotype between mouse lines with GH action positively associated with intestinal gross anatomy (i.e. length, weight, and circumference). Moreover, GH action appears to alter morphology of the small and large intestines in an age- and sex-dependent manner.
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Affiliation(s)
- Elizabeth A Jensen
- Translational Biomedical Sciences Program, Graduate College, Ohio University, Athens, OH, USA
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Jonathan A Young
- Edison Biotechnology Institute, Ohio University, Athens, OH, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Jaycie Kuhn
- Edison Biotechnology Institute, Ohio University, Athens, OH, USA
- College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Maria Onusko
- The Diabetes Institute, Ohio University, Parks Hall Suite 142, Athens, OH, USA
- College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Joshua Busken
- Edison Biotechnology Institute, Ohio University, Athens, OH, USA
| | - Edward O List
- Translational Biomedical Sciences Program, Graduate College, Ohio University, Athens, OH, USA
- Edison Biotechnology Institute, Ohio University, Athens, OH, USA
- The Diabetes Institute, Ohio University, Parks Hall Suite 142, Athens, OH, USA
| | - John J Kopchick
- Translational Biomedical Sciences Program, Graduate College, Ohio University, Athens, OH, USA
- Edison Biotechnology Institute, Ohio University, Athens, OH, USA
- The Diabetes Institute, Ohio University, Parks Hall Suite 142, Athens, OH, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Darlene E Berryman
- Translational Biomedical Sciences Program, Graduate College, Ohio University, Athens, OH, USA.
- Edison Biotechnology Institute, Ohio University, Athens, OH, USA.
- The Diabetes Institute, Ohio University, Parks Hall Suite 142, Athens, OH, USA.
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
- Office of Research and Grants, Heritage College of Osteopathic Medicine, Ohio University, Irvine Hall 220B, Athens, OH, 45701, USA.
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Lazebnik LB, Turkina SV, Golovanova EV, Ardatskaya MD, Ostroumova OD, Komissarenko IA, Korochanskaya NV, Kozlova IV, Uspensky YP, Fominykh YA, Levchenko SV, Loranskaya ID, Tkachenko EI, Sitkin SI, Bakulin IG, Bakulina NV, Shemerovsky KA. Constipation in adults. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2020:10-33. [DOI: 10.31146/1682-8658-ecg-175-3-10-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- L. B. Lazebnik
- Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
| | | | - E. V. Golovanova
- Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
| | - M. D. Ardatskaya
- Medical Center of the Presidential Administration of the Russian Federation
| | - O. D. Ostroumova
- Russian Clinical and Research Center of Gerontology (RCRCG) of Pirogov Russian National Research Medical University; All-Russia public organization “Russian Association of Gerontologists and Geriatrics”
| | - I. A. Komissarenko
- Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
| | | | - I. V. Kozlova
- “Saratov State Medical University n. a. V. I. Razumovsky”
| | | | | | - S. V. Levchenko
- Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
| | | | | | - S. I. Sitkin
- “North-West State Medical University n. a. I. I. Mechnikov”
| | - I. G. Bakulin
- “North-West State Medical University n. a. I. I. Mechnikov”
| | - N. V. Bakulina
- “North-West State Medical University n. a. I. I. Mechnikov”
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Inayet N, Hayat J, Bano G, Poullis A. Gastrointestinal symptoms in acromegaly: A case control study. World J Gastrointest Pharmacol Ther 2020; 11:17-24. [PMID: 32550042 PMCID: PMC7288728 DOI: 10.4292/wjgpt.v11.i2.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/19/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone, which leads to excess secretion of Insulin like growth factor 1 from the liver, causing abnormal soft tissue growth. There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms. Data was collected from patients with a confirmed diagnosis of acromegaly to evaluate the intensity, variety and impact of abdominal symptoms in comparison with a control group who were healthy participants recruited from the local fracture clinic.
AIM To evaluate the frequency type and burden of abdominal symptoms in acromegaly in comparison with a control group.
METHODS Medical documentation of patients with a diagnosis of acromegaly treated in one tertiary medical centre between 2010 and 2017 has been analysed. Data was collected from patients with confirmed acromegaly, using the Short Form Health Survey (SF36) and Rome IV Diagnostic questionnaire for Functional Gastrointestinal Disorders in Adults (R4DQ) and compared to a sex- and age-matched control group, to assess the burden of abdominal symptoms. Microsoft Excel and IBM SPSS v 25 were used for data analysis.
RESULTS Fifty patients with acromegaly (24 male and 26 females; age range 23-64 years, mean 43) and 200 controls (96 male and 104 females; age range 18-84, mean 42.4) were recruited. 92% (46 out of 50) of patients with acromegaly reported abdominal symptoms and 78% (39 out of 50) had at least one functional gastrointestinal disorder according to the Rome IV diagnostic criteria, compared to 16% of controls (OR > 1, P < 0.0001). The most commonly reported symptom was constipation (69% acromegaly vs 21% of controls OR > 1, P < 0.0001, 95%CI: 4.4–15.8). 34 out of 50 (68%) respondents met the criteria for functional constipation according to Rome IV. Upper gastrointestinal disorders were also more prevalent in the acromegaly group. There was no statistically significant difference in the prevalence of biliary and anorectal symptoms between the two groups. Patients in acromegaly group scored lower on the mean scores of the eight parameters of SF36 Quality of Life questionnaire (mean scores 60.04 vs 71.23, 95%CI: -13.6829 to -8.6971, OR > 1, P < 0.001) as compared to the control group.
CONCLUSION Upper and lower functional gastrointestinal tract disorders (defined by Rome IV diagnostic criteria) are significantly more prevalent in patients with acromegaly compared with healthy age and sex matched controls in our study. Functional constipation is the most commonly reported problem. Poorer quality of life may in part be attributable to the increased prevalence of abdominal symptoms.
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Affiliation(s)
- Nashiz Inayet
- Department of Gastroenterology, St Georges Hospital and St Georges, University of London, London SW17 0QT, United Kingdom
| | - Jamal Hayat
- Department of Gastroenterology, St Georges Hospital and St Georges, University of London, London SW17 0QT, United Kingdom
| | - Gul Bano
- Department of Endocrinology, St Georges Hospital and St Georges, University of London, London SW17 0QT, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St Georges Hospital and St Georges, University of London, London SW17 0QT, United Kingdom
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Abstract
Acromegaly results in a significantly increased morbidity and mortality due to cardiovascular and respiratory complications, as well as malignancies arising mainly from the colon. Furthermore, an increased lifetime risk of malignant transformation of pre-malignant colonic lesions relates to a worse overall prognosis from colorectal cancer, which is currently considered a major disease-related complication. In this review we provide some insight into colonic changes in this condition, summarize current knowledge and evidence on the use of colonoscopic screening in patients with acromegaly, and suggest a recommended screening protocol.
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Affiliation(s)
- Dorota Dworakowska
- Department of Hypertension and Diabetes, Medical University of Gdansk, Gdansk, Poland
- Guys Richard Dimbleby Department of Cancer Research, King's College London, London, United Kingdom
- Endocard LTD, London, United Kingdom
- *Correspondence: Dorota Dworakowska
| | - Ashley B. Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
- Barts and the London School of Medicine, Centre for Endocrinology, William Harvey Institute, London, United Kingdom
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Parolin M, Dassie F, Russo L, Mazzocut S, Ferrata M, De Carlo E, Mioni R, Fallo F, Vettor R, Martini C, Maffei P. Guidelines versus real life practice: the case of colonoscopy in acromegaly. Pituitary 2018; 21:16-24. [PMID: 28936751 DOI: 10.1007/s11102-017-0841-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study is to investigate guideline application and colonoscopy findings in real-life practice in acromegaly. METHODS We conducted a retrospective observational non-interventional and cross-sectional analysis on 146 patients with acromegaly (ACRO) referred to our clinic. We evaluated colonoscopy data, focusing on the correlation between colonoscopy findings and hormonal/metabolic values. RESULTS The total number of colonoscopies performed in ACRO patients increased from 6 in the period 1990-1994 to 57 in the period 2010-2014. Colonoscopy procedures were performed according to guidelines in 25% of ACRO patients at diagnosis, 51% at follow-up and 11% globally (both at diagnosis and follow-up). Among the 146 ACRO patients, 68% were subjected to at least one colonoscopy and in 32% of the cases a polyp was detected during the procedure. The presence of polyps was significantly associated with mean levels of growth hormone (GH), insulin-like growth factor 1 (IGF-1), fasting glucose and insulin levels (p < 0.05). Polyps were detected in 48% of untreated patients and in 26% of patients under treatment for acromegaly (p = 0.04). The general risk of polyps and adenomatous polyps in ACRO patients was higher compared to the control population of Veneto Region, Italy (odds ratio 1.33 and 1.16, respectively). No cancerous polyps were detected in our analysis. CONCLUSION In real-life practice, adherence to ACRO colonoscopy clinical guidelines was lower than expected. Among patients who underwent colonoscopy, the prevalence of colon polyps was higher for ACRO patients, suggesting the need for new strategies to ensure adherence to colonoscopy guidelines.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy.
| | - F Dassie
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - L Russo
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - S Mazzocut
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - M Ferrata
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - E De Carlo
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - R Mioni
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - F Fallo
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - R Vettor
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - C Martini
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - P Maffei
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
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7
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Abstract
INTRODUCTION In acromegaly the long-term exposure to high growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels may result in specific complications in different human organs, including the thyroid gland and the colon. MATERIALS AND METHODS We will review here the evidence available regarding the characteristic thyroid and colon complications in acromegaly. RESULTS This review summarizes the published data observing noncancerous structural abnormalities (thyroid nodules, colonic polyps) and thyroid and colon cancer in patients diagnosed with acromegaly. CONCLUSION Thyroid micro-carcinomas are probably over-diagnosed among acromegalic patients. In regard to colon cancer, there is no sufficient data to suggest that colon cancer risk is higher in acromegaly compared to the general population.
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Affiliation(s)
- Amit Tirosh
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 49100, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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8
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Caglar E, Hatipoglu E, Atasoy D, Niyazoglu M, Çağlar AS, Tuncer M, Dobrucali A, Kadioglu P. LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED? ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:60-64. [PMID: 31149149 DOI: 10.4183/aeb.2017.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. Methods Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. Results Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). Conclusion Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.
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Affiliation(s)
- E Caglar
- Kayseri Education and Research Hospital, Gastroenterology and Hepatology, Kayseri, Istanbul, Turkey
| | - E Hatipoglu
- Istanbul University, Cerrahpasa Medical School, Endocrinology and Metabolism, Istanbul, Turkey
| | - D Atasoy
- Acıbadem University, School of Medicine, Atakent Hospital, General Surgery, Istanbul, Turkey
| | - M Niyazoglu
- Istanbul University, Cerrahpasa Medical School, Endocrinology and Metabolism, Istanbul, Turkey
| | - A S Çağlar
- Endocrinology and Metabolism, Erciyes University, Medical School, Kayseri, Istanbul, Turkey
| | - M Tuncer
- Istanbul University, Cerrahpasa Medical School, Gastroenterology and Hepatology, Istanbul, Turkey
| | - A Dobrucali
- Istanbul University, Cerrahpasa Medical School, Gastroenterology and Hepatology, Istanbul, Turkey
| | - P Kadioglu
- Istanbul University, Cerrahpasa Medical School, Endocrinology and Metabolism, Istanbul, Turkey
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Abstract
Ultimately, almost all patients who are appropriately treated for pituitary tumours enter a chronic phase with control or cure of hormonal excess, adequate treatment of pituitary insufficiency and relief of mass effects. This phase is associated with improvement of initial signs and symptoms, but also with the persistent consequences of the initial disease and associated treatments. Pituitary insufficiency is a common denominator in many of these patients, and is associated with a reduction in quality of life, despite adequate endocrine substitution. Hypothalamic dysfunction can be present in patients previously treated for visual impairments caused by large suprasellar adenomas, or craniopharyngiomas. In addition to hypopituitarism, these patients can have multisystem morbidities caused by altered hypothalamic function, including weight gain and disturbed regulation of sleep-wake cycles. Mortality can also be affected. Patients cured of Cushing disease or acromegaly have chronic multisystem morbidities (in the case of Cushing disease, also affecting mortality) caused by irreversible effects of the previous excesses of cortisol in Cushing disease and growth hormone and insulin-like growth factor 1 in acromegaly. In addition to early diagnosis and treatment of pituitary tumours, research should focus on the amenability of these chronic post-treatment syndromes to therapeutic intervention, to improve quality of life and clinical outcomes.
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Affiliation(s)
- Johannes A Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, Netherlands
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10
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Wassenaar MJE, Cazemier M, Biermasz NR, Pereira AM, Roelfsema F, Smit JWA, Hommes DW, Felt-Bersma RJF, Romijn JA. Acromegaly is associated with an increased prevalence of colonic diverticula: a case-control study. J Clin Endocrinol Metab 2010; 95:2073-9. [PMID: 20215398 DOI: 10.1210/jc.2009-1714] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In acromegaly, overproduction of GH and IGF-I causes abnormal extracellular matrix regulation. We hypothesized that this may predispose to the development of colonic diverticula. Because the relation between acromegaly and colonic diverticula is unknown, the study aim was to assess the prevalence of colonic diverticula in patients with cured acromegaly. DESIGN This was a case-control study. METHODS We screened reports of colonoscopies performed for the purpose of screening for polyps in 107 patients with cured or biochemically controlled acromegaly and in 214 age- and sex-matched controls for the presence of diverticula, dolichocolon, and polyps. In patients, the findings were related to GH/IGF-I concentrations at the time of diagnosis of acromegaly and to the duration of GH/IGF-I excess. RESULTS In acromegaly, colonic diverticula were present in 37% of patients, dolichocolon in 34%, and adenomatous polyps in 34%, which was increased compared with controls (odds ratio 3.6, 95% confidence interval 1.4, 5.7; 12.4, 95% confidence interval 6.8, 18.0; 4.1, 95% confidence interval 1.9, 6.4, respectively). The presence of colonic diverticula was associated with both GH and IGF-I concentrations at the time of diagnosis of acromegaly, when adjusted for the duration of active disease. The presence of dolichocolon and adenomatous polyps was associated with higher IGF-I concentrations at diagnosis. CONCLUSIONS Acromegaly is associated with an increased prevalence of colonic diverticula. In addition to the known irreversible effect of GH excess on collagen of joints and cardiac valves, this observation indicates an irreversible effect of GH and/or IGF-I on the collagen in the colon.
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Affiliation(s)
- M J E Wassenaar
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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11
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Wassenaar MJE, Biermasz NR, Pereira AM, van der Klaauw AA, Smit JWA, Roelfsema F, van der Straaten T, Cazemier M, Hommes DW, Kroon HM, Kloppenburg M, Guchelaar HJ, Romijn JA. The exon-3 deleted growth hormone receptor polymorphism predisposes to long-term complications of acromegaly. J Clin Endocrinol Metab 2009; 94:4671-8. [PMID: 19864451 DOI: 10.1210/jc.2009-1172] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the impact of the genomic deletion of exon 3 of the GH receptor (d3GHR) on long-term clinical outcome of acromegaly in a well-characterized cohort of patients with long-term remission of acromegaly. DESIGN We conducted a cross-sectional study. METHODS The presence of the d3GHR polymorphism was assessed in 86 acromegalic patients with long-term disease control and related to anthropometric parameters, cardiovascular risk factors, osteoarthritis, bone mineral density, colonic polyps and diverticulae, and dolichocolon. RESULTS Fifty-one patients had two wild-type alleles (59%), whereas 29 patients (34%) had one allele and six patients (7%) had two alleles encoding for the d3GHR isoform. Carriers of the d3GHR isoform showed increased prevalence of osteoarthritis, especially of the hip [adjusted odds ratio (OR), 5.2; 95% confidence interval (CI), 3.2-7.1], of adenomatous polyps (adjusted OR, 4.1; 95% CI, 2.4-5.6), and dolichocolon (adjusted OR, 3.2; 95% CI, 1.8-4.6). Anthropometric parameters, cardiovascular risk factors, bone mineral density, and (non)vertebral fractures were not significantly different between patients with and without the d3GHR allele. CONCLUSION In patients with long-term cured acromegaly, the d3GHR polymorphism is associated with an increased prevalence of irreversible comorbidities such as osteoarthritis, dolichocolon, and adenomatous colonic polyps, but not with other comorbidities such as cardiovascular risk factors.
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Affiliation(s)
- M J E Wassenaar
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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12
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Ramos O, Boguszewski CL, Teixeira S, De Bem R, Parolim B, Prolla JC. Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study. ARQUIVOS DE GASTROENTEROLOGIA 2009; 46:90-6. [PMID: 19578607 DOI: 10.1590/s0004-28032009000200003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 03/19/2009] [Indexed: 01/11/2023]
Abstract
CONTEXT Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. OBJECTIVE To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. METHODS A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. RESULTS In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I ('per patient'), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II ('per polyp'), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography identified 7 of the 9 polyps >10 mm described by conventional colonoscopy and only 6 of the 10 small polyps identified at conventional colonoscopy were detected by computed tomographic colonography. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. CONCLUSION The authors present the first reports of computed tomographic colonography in the screening of colorectal polyps in acromegalic patients. In this study, computed tomographic colonography was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, computed tomographic colonography presented good sensitivity, specificity and accuracy for the identification of acromegalic patients with polyps of any size and better results in the diagnosis of large polyps, when they were compared to small polypoid lesions.
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Affiliation(s)
- Odery Ramos
- Department of Gastroenterology, Faculdade de Medicina, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Resmini E, Tagliafico A, Bacigalupo L, Giordano G, Melani E, Rebora A, Minuto F, Rollandi GA, Ferone D. Computed tomography colonography in acromegaly. J Clin Endocrinol Metab 2009; 94:218-22. [PMID: 18957501 DOI: 10.1210/jc.2008-1479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM Acromegalic patients have an increased risk for the development of colorectal cancer. For this reason, since 1996, screening colonoscopy has been recommended in all patients with acromegaly. The aim of our study was to assess the feasibility and to evaluate the results of computed tomography (CT)-colonography in acromegaly. PATIENTS AND METHODS We examined 23 acromegalic patients with no history of colorectal cancer (11 females and 12 males; age range 18-79 yr; disease duration range 1-15 yr) with CT-colonography. Twenty of them underwent traditional colonoscopy after the CT-colonography. RESULTS CT-colonography examination results were adequate in 17 of 23 cases (73%). CT-colonography found 12 polyps in eight patients, 95% confirmed by traditional colonoscopy. One polyp was a sigmoid cancer, and the diagnosis was confirmed at surgery. There were no polyps found by traditional colonoscopy that CT-colonography was not able to identify. The lesions were located in right colon (two), transversum (three), left colon (five), and sigmoid colon (two). Patient acceptance of the technique was good in 65%, medium in 20%, and poor in 15%. CONCLUSION For the first time we have demonstrated that CT-colonography has the potential ability to replace traditional colonoscopy in acromegalic patients. CT-colonography could be used as a screening modality for colon cancer in acromegaly.
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Affiliation(s)
- Eugenia Resmini
- Department of Endocrine and Medical Sciences, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
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Abstract
Acromegaly is an endocrine disorder characterized by sustained hypersecretion of growth hormone (GH) with concomitant elevation of insulin-like growth factor I (IGF-I) associated with premature mortality from cardiopulmonary diseases and certain malignancies. In particular, there is a two-fold increased risk of developing colorectal cancer. Possible mechanisms underlying this association include elevated levels of circulating GH and IGF-I, but several other plausible processes may be relevant. In a parallel literature, there has been debate whether GH replacement therapy is associated with increased cancer risk in three scenarios: (1) tumour recurrence in children with previously treated cancer; (2) second neoplasms (SNs) in survivors of childhood cancer treated with GH; and (3) de-novo cancer in non-cancer patients treated with GH. The general evidence suggests no increased risk in scenario 1. Through a maze of complex study designs, there is inconclusive evidence of a very modest increase in cancer risk in treated GH-deficiency patients in scenarios 2 and 3, but it is likely that the cumulative risk equates to that of the general population. This emphasizes the need for patient selection balanced against the known morbidity of untreated GH deficiency.
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Affiliation(s)
- Andrew G Renehan
- School of Cancer and Imaging Sciences, University of Manchester, Manchester, UK.
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Abstract
Acromegaly is characterised by excessive levels of circulating growth hormone and its tissue mediator, insulin-like growth factor (IGF)-I. Prior to effective treatment and lowering of growth hormone and IGF-I, the majority of patients with the disease died by the age of 60 years, largely due to diabetes mellitus, cardiovascular and cerebrovascular diseases. More recently, it has become apparent that patients with acromegaly may also have an increased prevalence of colorectal adenomas and cancer. This may be due to elevated IGF-I, which is implicated in the development of sporadic colorectal cancer, and environmental factors, such as the bile acid deoxycholic acid, the levels of which are also increased in acromegaly. There is some evidence to suggest that breast and prostatic malignancies might also be increased in acromegaly. However, these associations have been based mostly on small epidemiological surveys and circumstantial evidence. Large-scale epidemiological studies are required to clarify this issue.
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Affiliation(s)
- Paul J Jenkins
- Department of Endocrinology, St. Bartholomew's Hospital, London, UK.
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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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