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Jaafar S, Cristofolini G, Morenghi E, Rinaudo L, Birtolo MF, Sala E, Ferrante E, Mungari R, Lavezzi E, Leonardi L, Ragucci P, Ulivieri FM, Balzarini L, Mantovani G, Lania AG, Mazziotti G. DXA-derived lumbar bone strain index corrected for kyphosis is associated with vertebral fractures and trabecular bone score in acromegaly. Endocrine 2024; 85:1319-1326. [PMID: 38809345 DOI: 10.1007/s12020-024-03863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE The bone strain index (BSI) is a marker of bone deformation based on a finite element analysis inferred from dual X-ray absorptiometry (DXA) scans, that has been proposed as a predictor of fractures in osteoporosis (i.e., higher BSI indicates a lower bone's resistance to loads with consequent higher risk of fractures). We aimed to investigate the association between lumbar BSI and vertebral fractures (VFs) in acromegaly. METHODS Twenty-three patients with acromegaly (13 males, mean age 58 years; three with active disease) were evaluated for morphometric VFs, trabecular bone score (TBS), bone mineral density (BMD) and BSI at lumbar spine, the latter being corrected for the kyphosis as measured by low-dose X-ray imaging system (EOS®-2D/3D). RESULTS Lumbar BSI was significantly higher in patients with VFs as compared to those without fractures (2.90 ± 1.46 vs. 1.78 ± 0.33, p = 0.041). BSI was inversely associated with TBS (rho -0.44; p = 0.034), without significant associations with BMD (p = 0.151), age (p = 0.500), BMI (p = 0.957), serum IGF-I (p = 0.889), duration of active disease (p = 0.434) and sex (p = 0.563). CONCLUSIONS Lumbar BSI corrected for kyphosis could be proposed as integrated parameter of spine arthropathy and osteopathy in acromegaly helping the clinicians in identifying patients with skeletal fragility possibly predisposed to VFs.
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Affiliation(s)
- Simona Jaafar
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giacomo Cristofolini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Maria Francesca Birtolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elisa Sala
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Emanuele Ferrante
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Roberta Mungari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Elisabetta Lavezzi
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lorenzo Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pasquala Ragucci
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fabio M Ulivieri
- Bone Metabolic Unit, Casa di Cura la Madonnina Milan, Milan, Italy
| | - Luca Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanna Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Andrea G Lania
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Cuny T. Craniofacial impact of acromegaly: when muscle ma-sse-tter. Pituitary 2024:10.1007/s11102-024-01436-6. [PMID: 39060818 DOI: 10.1007/s11102-024-01436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Thomas Cuny
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Centre d'investigations cliniques, Hôpital de la Conception, Aix-Marseille Université, INSERM, U1409, Institut Marseille Maladies Rares (MarMaRa), Marseille, 13005, France.
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3
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Freda PU. Impact of medical therapy for hormone-secreting Pituitary tumors on bone. Pituitary 2024:10.1007/s11102-024-01421-z. [PMID: 38967763 DOI: 10.1007/s11102-024-01421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Bone health is often impaired in patients with hormone-secreting pituitary tumors. Since medical therapy is central to their care, understanding how its use impacts on this is highly important. METHODS This review summarizes a systemmatic review of the literature on the effects of medical therapies for hormone-secreting pituitary tumors on bone. RESULTS In acromegaly, medical therapy lowers bone turnover marker (BTM) levels, consistent with correction of the high bone turnover of active disease, and overall, areal bone mineral density (aBMD) does not change or increases. Somatostatin-receptor ligand (SRL) and pegvisomant-treated acromegaly patients have persistently reduced volumetric BMD and microarchitectural abnormalities of the peripheral skeleton, deficits that are similar to those in surgically-treated patients. Fracture risk remains elevated in medically-treated acromegaly patients but in conjunction with biochemical control the risk is lessened. Treatment of prolactin-secreting tumors with dopamine agonists is associated with improvements in aBMD, but this does not always fully normalize despite effective medical treatment of the prolactinoma. In one cross-sectional study, prolactinoma patients had lower total volumetric BMD and impaired microarchitecture suggesting that bone microstructure does not fully normalize despite dopamine agonist therapy. Cross-sectional studies show a high rate of VF in patients with prolactin-secreting tumors that is lowered on cabergoline therapy, but still the fracture rate of men and postmenopausal women is higher than that of controls in some studies. Studies on the effects of modern-day medical therapy for Cushing's disease on bone are lacking. CONCLUSION More research is needed on the effectsof medical therapies for hormone secreting pituitary tumors on bone health.
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Affiliation(s)
- Pamela U Freda
- Department of Medicine, Vagelos College of Physicians & Surgeons Columbia University, 650 West 168th Street 10-1014, New York, NY, 10032, USA.
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Kaya Çelik E, Er S, Keseroğlu K, Öner F, Düğer H, Uçan B, Kızılgül M, Çetin Ş, Saylam G. Disrupted harmony of the skull skeleton: Middle ear resonance in acromegaly. Growth Horm IGF Res 2024; 76:101594. [PMID: 38833815 DOI: 10.1016/j.ghir.2024.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES This study aims to investigate whether the middle ear resonance frequency (RF) is affected in acromegaly, which causes growth in the skull bone. METHODS Thirty acromegaly patients and 38 volunteers were included in the study. Pure tone average scores and middle ear RF values of the groups that underwent pure tone audiometry, tympanometry, and multifrequency tympanometry tests were compared. RESULTS The pure tone mean was 14.95 ± 12.13 in acromegaly patients and 5.70 ± 8.52 in the control group (p:0.18). Sensorineural hearing loss(SNHL) was observed in 16.6% of the patients. The average middle ear RF was calculated as 815 ± 179.05 Hz in patients with acromegaly and 773 ± 127.15 in the control group. (p = 0.0001). CONCLUSION This study is the first to evaluate middle-ear RF in acromegaly patients. Acromegaly-induced changes in soft tissues and bone structures impact middle ear functions. In this patient group, we found an increase in middle ear RF without conductive-type hearing loss and a 16.6% rate of SNHL.
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Affiliation(s)
- Elif Kaya Çelik
- University of Tokat Gaziosmanpaşa, Department of Otolaryngology Head and Neck Surgery, Tokat, Turkey.
| | - Serap Er
- Ankara Etlik City Hospital, Department of Audiology, Ankara, Turkey
| | | | - Fatih Öner
- Kastomonu University, Faculty of Medicine, Department of Otolaryngology Head and Neck Surgery, Kastomonu, Turkey
| | - Hakan Düğer
- Kilis Profesör Dr.Alaeddin Yavaşça State Hospital, Department of Endocrinology and Metabolism, Kilis, Turkey
| | - Bekir Uçan
- Ankara Etlik City Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Muhammed Kızılgül
- Ankara Etlik City Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Şirin Çetin
- University of Amasya, Faculty of Medicine, Department of Biostatistical, Amasya, Turkey
| | - Güleser Saylam
- Ankara Etlik City Hospital, Department of Otolaryngology Head and Neck Surgery, Ankara, Turkey
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Rosendal C, Arlien-Søborg MC, Nielsen EH, Andersen MS, Feltoft CL, Klose M, Andreassen M, Bruun NH, Jørgensen JOL, Dal J. Changes in acromegaly comorbidities, treatment, and outcome over three decades: a nationwide cohort study. Front Endocrinol (Lausanne) 2024; 15:1380436. [PMID: 38638137 PMCID: PMC11024468 DOI: 10.3389/fendo.2024.1380436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Objective To study the time-dependent changes in disease features of Danish patients with acromegaly, including treatment modalities, biochemical outcome, and comorbidities, with a particular focus on cancer and mortality. Methods Pertinent acromegaly-related variables were collected from 739 patients diagnosed since 1990. Data are presented across three decades (1990-1999, 2000-2009, and 2010-2021) based on the year of diagnosis or treatment initiation. Results Adenoma size and insulin-like growth factor I (IGF-I) levels at diagnosis did not differ significantly between study periods. The risk of being diagnosed with diabetes, heart disease, sleep apnea, joint disease, and osteoporosis increased from the 1990s to the later decades, while the mortality risk declined to nearly half. The risk of cancer did not significantly change. Treatment changed toward the use of more medical therapy, and fewer patients underwent repeat surgeries or pituitary irradiation. A statistically significant increase in the proportion of patients achieving IGF-I normalization within 3-5 years was observed over time (69%, 83%, and 88%). The proportion of patients with three or more deficient pituitary hormones decreased significantly over time. Conclusion Modern medical treatment regimens of acromegaly as well as increased awareness and improved diagnostics for its comorbidities have led to better disease control, fewer patients with severe hypopituitarism, and declining mortality in the Danish cohort of acromegaly patients. The risk of cancer did not increase over the study period.
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Affiliation(s)
- Christian Rosendal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | - Claus Larsen Feltoft
- Department of Medicine, Copenhagen University Hospital, Herlev, Denmark
- Department of Endocrinology, Gentofte Hospital, Herlev, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Andreassen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Henrik Bruun
- Research Data and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
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Eroğlu I, İremli BG, Erkoç A, Idilman IS, Yuce D, Calik-Kutukcu E, Akata D, Erbas T. Osteosarcopenia in acromegaly: reduced muscle quality and increased vertebral fat deposition. J Endocrinol Invest 2023; 46:2573-2582. [PMID: 37212954 DOI: 10.1007/s40618-023-02114-3] [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] [Received: 02/15/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Musculoskeletal disorders are among the most disabling comorbidities in patients with acromegaly. This study examined muscle and bone quality in patients with acromegaly. METHODS Thirty-three patients with acromegaly and nineteen age- and body mass index-matched healthy controls were included in the study. Body composition was determined using dual-energy X-ray absorptiometry. The participants underwent abdominal magnetic resonance imaging (MRI) for cross-sectional evaluation of muscle area and vertebral MRI proton density fat fraction (MRI-PDFF). Muscular strength was measured using hand grip strength (HGS). Skeletal muscle quality (SMQ) was classified as weak, low, or normal, according to HGS/ASM (appendicular skeletal muscle mass) ratio. RESULTS Groups had similar lean tissues, total body fat ratios, and total abdominal muscle areas. Acromegalic patients had lower pelvic BMD (p = 0.012) and higher vertebral MRI-PDFF (p = 0.014), while total and spine bone mineral densities (BMD) were similar between the groups. The SMQ score rate was normal only 57.5% in the acromegaly group, and 94.7% of the controls had a normal SMQ score (p = 0.01). Subgroup analysis showed that patients with active acromegaly (AA) had higher lean tissue and lower body fat ratios than controlled acromegaly (CA) and control groups. Vertebral MRI-PDFF was higher in the CA group than that in the AA and control groups (p = 0.022 and p = 0.001, respectively). The proportion of participants with normal SMQ was lower in the AA and CA groups than that in the control group (p = 0.012 and p = 0.013, respectively). CONCLUSION Acromegalic patients had reduced SMQ and pelvic BMD, but greater vertebral MRI-PDFF. Although lean tissue increases in AA, this does not affect SMQ. Therefore, increased vertebral MRI-PDFF in controlled acromegalic patients may be due to ectopic adiposity.
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Affiliation(s)
- I Eroğlu
- Department of Internal Medicine, School of Medicine, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey.
| | - B G İremli
- Department of Internal Medicine, School of Medicine, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey
- Department of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Ankara, Turkey
| | - A Erkoç
- Department of Cardiorespiratory Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - I S Idilman
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - D Yuce
- Department of Preventive Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - E Calik-Kutukcu
- Department of Cardiorespiratory Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - D Akata
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - T Erbas
- Department of Internal Medicine, School of Medicine, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey
- Department of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Ankara, Turkey
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Freda PU. Differences between bone health parameters in adults with acromegaly and growth hormone deficiency: A systematic review. Best Pract Res Clin Endocrinol Metab 2023; 37:101824. [PMID: 37798201 PMCID: PMC10843107 DOI: 10.1016/j.beem.2023.101824] [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] [Indexed: 10/07/2023]
Abstract
Preserving bone health is an important goal of care of patients with acromegaly and growth hormone deficiency (GHD). Both disorders are associated with compromised bone health and an increased risk of fracture. However, parameters of bone health that are routinely used to predict fractures in other populations, such as aBMD measured by DXA, are unreliable for this in acromegaly and GHD. Additional methodologies need to be employed to assess bone health in these patients. This review summarizes available data on the effects of acromegaly and GHD on parameters of bone health such as aBMD, volumetric bone mineral density (vBMD) and microarchitecture assessed by HRpQCT and other techniques, trabecular bone score (TBS) and fracture assessment. More research is needed to identify reliable predictors of fracture risk and to determine how best to screen for and treat those patients at risk so that bone health is optimized in these patients.
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Affiliation(s)
- Pamela U Freda
- Vagelos College of Physicians and Surgeons, Columbia University, New York.
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Wydra A, Stelmachowska-Banaś M, Czajka-Oraniec I. Skeletal complications in acromegaly. Reumatologia 2023; 61:248-255. [PMID: 37745143 PMCID: PMC10515128 DOI: 10.5114/reum/169918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Hypersecretion of growth hormone (GH) is rare and typically results from a pituitary functional tumor - somatotropinoma. It leads to excessive linear bone growth and manifests as gigantism if occurring in childhood and adolescence, before the closure of epiphyses or as a acromegaly in adulthood. The excess of GH impacts bone metabolism directly as well as indirectly through increased insulin-like growth factor 1 (IGF-1). In acromegaly as a consequence of overproduction of GH and IFG-1 and the influence of these hormones on bone osteoblasts, bone metabolism, growth and density increase. However, bone turnover is accelerated causing impaired bone microstructure and strength, which may lead to increased risk of vertebral fractures irrespective of normal bone mineral density. Apart from the changes in bone architecture, acromegaly also results in a degenerative joint disease of a different nature than primary osteoarthritis. Moreover, acromegaly leads to cardiovascular, metabolic and respiratory complications, and thus significantly impairs the quality of life. In this review, authors summarize the pathophysiology, diagnosis, and treatment of bone and joint disease in acromegaly.
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Affiliation(s)
- Arnika Wydra
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Maria Stelmachowska-Banaś
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Izabella Czajka-Oraniec
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
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Peng S, Liu Q, Teng Y, Huang B, Liu Z, Li M, Liang J, Zhang Y, Wang M. A worldwide bibliometric analysis of acromegaly in the past two decades: 1999-2022. Front Neurosci 2023; 17:1187820. [PMID: 37476831 PMCID: PMC10354554 DOI: 10.3389/fnins.2023.1187820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Objectives To conduct a bibliometric analysis to quantify and identify the current status and trends of acromegaly research in the past two decades. Materials and methods Articles related to acromegaly that were published from 1999 to 2022 were retrieved through the Web of Science core collection (WoSCC) database. Then, they were imported into VOSviewer and CiteSpace to conduct a visualization analysis of authors, countries, institutions, citation numbers, cocitations, keywords, and references. Results A total of 3,909 articles were identified in the study. Among them, the United States made the largest contribution to the field. Moreover, Colao A. was the most prolific author, and the University of Naples Federico II was the institution with the most publications. In addition, the Journal of Clinical Endocrinology and Metabolism was the core journal in the field. High-frequency keywords mainly included "acromegaly," "GH (Growth Hormone)," "IGH-I (Insulin-Like Growth Factor I)," "pituitary adenomas," and "octreotide." Conclusion Studies related to acromegaly have shown stable stepwise growth over the past two decades. Interestingly, the research focus after 2016 gradually shifted from the etiology, mechanism, medications for treatment, and complications to improving prognosis and quality of life of patients with acromegaly. The current findings may provide guidance for further research in the field of acromegaly.
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Affiliation(s)
- Shuqin Peng
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Teng
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Biling Huang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ze Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingliu Li
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jieyu Liang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Wang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Poudel SB, Ruff RR, Yildirim G, Dixit M, Michot B, Gibbs JL, Ortiz SD, Kopchick JJ, Kirsch T, Yakar S. Excess Growth Hormone Triggers Inflammation-Associated Arthropathy, Subchondral Bone Loss, and Arthralgia. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:829-842. [PMID: 36870529 PMCID: PMC10284029 DOI: 10.1016/j.ajpath.2023.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/29/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
Growth hormone (GH) is a key mediator of skeletal growth. In humans, excess GH secretion due to pituitary adenoma, seen in patients with acromegaly, results in severe arthropathies. This study investigated the effects of long-term excess GH on the knee joint tissues. One year-old wild-type (WT) and bovine GH (bGH) transgenic mice were used as a model for excess GH. bGH mice showed increased sensitivity to mechanical and thermal stimuli, compared with WT mice. Micro-computed tomography analyses of the distal femur subchondral bone revealed significant reductions in trabecular thickness and significantly reduced bone mineral density of the tibial subchondral bone-plate associated with increased osteoclast activity in both male and female bGH compared with WT mice. bGH mice showed severe loss of matrix from the articular cartilage, osteophytosis, synovitis, and ectopic chondrogenesis. Articular cartilage loss in the bGH mice was associated with elevated markers of inflammation and chondrocyte hypertrophy. Finally, hyperplasia of synovial cells was associated with increased expression of Ki-67 and diminished p53 levels in the synovium of bGH mice. Unlike the low-grade inflammation seen in primary osteoarthritis, arthropathy caused by excess GH affects all joint tissues and triggers severe inflammatory response. Data from this study suggest that treatment of acromegalic arthropathy should involve inhibition of ectopic chondrogenesis and chondrocyte hypertrophy.
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Affiliation(s)
- Sher B Poudel
- Department of Molecular Pathobiology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York
| | - Ryan R Ruff
- Department of Epidemiology and Health Promotion, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York
| | - Gozde Yildirim
- Department of Molecular Pathobiology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York
| | - Manisha Dixit
- Department of Molecular Pathobiology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York
| | - Benoit Michot
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Jennifer L Gibbs
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Silvana D Ortiz
- Department of Biomedical Sciences, Edison Biotechnology Institute, Ohio University, Athens, Ohio
| | - John J Kopchick
- Department of Biomedical Sciences, Edison Biotechnology Institute, Ohio University, Athens, Ohio
| | - Thorsten Kirsch
- Department of Orthopaedic Surgery, New York University Grossman School of Medicine, New York, New York; Department of Biomedical Engineering, New York University Tandon School of Engineering, New York, New York
| | - Shoshana Yakar
- Department of Molecular Pathobiology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York.
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11
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Sorohan MC, Poiana C. Vertebral Fractures in Acromegaly: A Systematic Review. J Clin Med 2022; 12:jcm12010164. [PMID: 36614962 PMCID: PMC9821150 DOI: 10.3390/jcm12010164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Acromegaly is characterized by a very particular alteration of bone microarchitecture, leading to increased vertebral fragility. However, due to inconsistent and insufficient evidence, no guidelines are available for the evaluation of this osteopathy. METHODS We performed a literature review of studies published between 1968 and January 2022 on the PubMed and SCOPUS databases using the terms "acromegaly" and "vertebral fractures". Twenty-four studies were found eligible for inclusion, published between June 2005 and November 2021. Included studies evaluated acromegaly patients, who were assessed for the presence of vertebral fractures. We excluded case reports, reviews, meta-analyses, letters to the editor, articles not written in English, and research performed on the same set of patients without significant differences in study design. Risk of bias was avoided by following the ROBIS risk of bias recommendations. We executed rigorous data collection, and the results are depicted as a narrative overview, but also, as statistical synthesis. Limitations of the evidence presented in the study include study heterogeneity, small sample sizes, and a small number of prospective studies with short follow-up. FINDINGS Data regarding vertebral fractures (VFs) in acromegaly and their influencing factors are variable. Twenty-four studies were included, nine out of which had a prospective design. The smallest group of acromegaly patients had 18 subjects and the largest included 248 patients. Prevalence ranges between 6.5% and 87.1%, although most studies agree that it is significantly higher than in controls. VFs also have a higher incidence (between 5.6% and 42%) and are more frequently multiple (between 46.15% and 71%). Evidence shows that disease activity and active disease duration are influencing factors for the prevalence and incidence of VFs. Nonetheless, hypogonadism does not seem to influence the frequency of VFs. While reports are conflicting regarding the use of bone mineral density in acromegaly, evidence seems to be slightly in favor of it not being associated with VFs. However, trabecular bone score is significantly lower in fractured patients, although no prospective studies are available. INTERPRETATION Vertebral fractures evaluation should be performed with regularity in all acromegalic patients, especially in the presence of active disease. Disease activity is an important determinant of vertebral fracture incidence and prevalence, although hypogonadism is less so. To clarify the predictive value of both BMD and TBS for vertebral fractures, additional, larger, prospective studies are necessary.
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Affiliation(s)
- Madalina Cristina Sorohan
- CI Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Catalina Poiana
- CI Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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12
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Chiloiro S, Giampietro A, Gagliardi I, Bondanelli M, Veleno M, Ambrosio MR, Zatelli MC, Pontecorvi A, Giustina A, De Marinis L, Bianchi A. Impact of the diagnostic delay of acromegaly on bone health: data from a real life and long term follow-up experience. Pituitary 2022; 25:831-841. [PMID: 35922724 PMCID: PMC9362053 DOI: 10.1007/s11102-022-01266-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Acromegaly is a chronic disease with systemic complications. Disease onset is insidious and consequently typically burdened by diagnostic delay. A longer diagnostic delay induces more frequently cardiovascular, respiratory, metabolic, neuropsychiatric and musculoskeletal comorbidities. No data are available on the effect of diagnostic delay on skeletal fragility. We aimed to evaluate the effect of diagnostic delay on the frequency of incident and prevalent of vertebral fractures (i-VFs and p-VFs) in a large cohort of acromegaly patients. PATIENTS AND METHODS A longitudinal, retrospective and multicenter study was conducted on 172 acromegaly patients. RESULTS Median diagnostic delay and duration of follow-up were respectively 10 years (IQR: 6) and 10 years (IQR: 8). P-VFs were observed in 18.6% and i-VFs occurred in 34.3% of patients. The median estimated diagnostic delay was longer in patients with i-VFs (median: 11 years, IQR: 3), in comparison to those without i-VFs (median: 8 years, IQR: 7; p = 0.02). Age at acromegaly diagnosis and at last follow-up were higher in patients with i-VFs, with respect to those without i-VFs. The age at acromegaly diagnosis was positively associated with the diagnostic delay (p < 0.001, r = 0.216). A longer history of active acromegaly was associated with a high frequency of i-VFs (p = 0.03). The logistic regression confirmed that patients with a diagnostic delay > 10 years had 1.5-folds increased risk of developing i-VFs (OR: 1.5; 95%CI: 1.1-2; p = 0.017). CONCLUSION Our data showed that the diagnostic delay in acromegaly has a significant impact on VF risk, further supporting the clinical relevance of an early acromegaly diagnosis.
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Affiliation(s)
- Sabrina Chiloiro
- Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Giampietro
- Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Irene Gagliardi
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marta Bondanelli
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Miriam Veleno
- Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alfredo Pontecorvi
- Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Laura De Marinis
- Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Bianchi
- Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Coopmans EC, Andela CD, Claessen KMJA, Biermasz NR. Evaluating the Impact of Acromegaly on Quality of Life. Endocrinol Metab Clin North Am 2022; 51:709-725. [PMID: 36244688 DOI: 10.1016/j.ecl.2022.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acromegaly has a substantial negative impact on quality of life (QoL). This review aims to discuss the impact of acromegaly on QoL from the clinical perspective as well as from the patient perspective. Furthermore, it aims to evaluate the use of patient-reported outcome measures (PROMs) in acromegaly and how PROMs aid decision-making. The recommendations presented in this review are based on recent clinical evidence on the impact of acromegaly on QoL combined with the authors' own clinical experience treating patients with acromegaly. We recommend that a patient-centered approach should be considered in treatment decisions, integrating conventional biochemical outcomes, tumor control, comorbidities, treatment complications, and PROMs, including QoL measures. This more integrated approach seems effective in treating comorbidities and improving patient-reported outcomes and is critical, as many patients do not achieve biochemical or tumor control and comorbidities, impairment in QoL may not remit even when full biochemical control is achieved.
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Affiliation(s)
- Eva C Coopmans
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands.
| | - Cornelie D Andela
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands; Basalt Rehabilitation Center, Vrederustlaan 180, 2543 SW Den Haag, the Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Center for Endocrine Tumors Leiden (CETL), Center for Pituitary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZB Leiden, the Netherlands.
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14
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Melmed S, Kaiser UB, Lopes MB, Bertherat J, Syro LV, Raverot G, Reincke M, Johannsson G, Beckers A, Fleseriu M, Giustina A, Wass JAH, Ho KKY. Clinical Biology of the Pituitary Adenoma. Endocr Rev 2022; 43:1003-1037. [PMID: 35395078 PMCID: PMC9695123 DOI: 10.1210/endrev/bnac010] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 02/06/2023]
Abstract
All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in 10% of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intrapituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one-thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas, and particularly their benign nature, stands in marked contrast to other tumors of the endocrine system, such as thyroid and neuroendocrine tumors.
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Affiliation(s)
| | - Ursula B Kaiser
- Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M Beatriz Lopes
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jerome Bertherat
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luis V Syro
- Hospital Pablo Tobon Uribe and Clinica Medellin - Grupo Quirónsalud, Medellin, Colombia
| | - Gerald Raverot
- Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Martin Reincke
- University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | - Gudmundur Johannsson
- Sahlgrenska University Hospital & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Andrea Giustina
- San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | | | - Ken K Y Ho
- The Garvan Institute of Medical Research and St. Vincents Hospital, Sydney, Australia
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15
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Dixit M, Louis LD, Basta-Pljakic J, Yildirim G, Poudel SB, Kumararaja F, List EO, Duran SO, Kopchick JJ, Ruff RR, Schaffler MB, Yakar S. Lifelong Excess in GH Elicits Sexually Dimorphic Effects on Skeletal Morphology and Bone Mechanical Properties. J Bone Miner Res 2022; 37:2201-2214. [PMID: 36069368 PMCID: PMC9712242 DOI: 10.1002/jbmr.4699] [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] [Received: 12/12/2021] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/09/2022]
Abstract
Excess in growth hormone (GH) levels, seen in patients with acromegaly, is associated with increases in fractures. This happens despite wider bones and independent of bone mineral density. We used the bovine GH (bGH) transgenic mice, which show constitutive excess in GH and insulin-like growth factor 1 (IGF-1) in serum and tissues, to study how lifelong increases in GH and IGF-1 affect skeletal integrity. Additionally, we crossed the acid labile subunit (ALS) null (ALSKO) to the bGH mice to reduce serum IGF-1 levels. Our findings indicate sexually dimorphic effects of GH on cortical and trabecular bone. Male bGH mice showed enlarged cortical diameters, but with marrow cavity expansion and thin cortices as well as increased vascular porosity that were associated with reductions in diaphyseal strength and stiffness. In contrast, female bGH mice presented with significantly smaller-diameter diaphysis, with greater cortical bone thickness and with a slightly reduced tissue elastic modulus (by microindentation), ultimately resulting in overall stronger, stiffer bones. We found increases in C-terminal telopeptide of type 1 collagen and procollagen type 1 N propeptide in serum, independent of circulating IGF-1 levels, indicating increased bone remodeling with excess GH. Sexual dimorphism in response to excess GH was also observed in the trabecular bone compartment, particularly at the femur distal metaphysis. Female bGH mice preserved their trabecular architecture during aging, whereas trabecular bone volume in male bGH mice significantly reduced and was associated with thinning of the trabeculae. We conclude that pathological excess in GH results in sexually dimorphic changes in bone architecture and gains in bone mass that affect whole-bone mechanical properties, as well as sex-specific differences in bone material properties. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Manisha Dixit
- David B. Kriser Dental Center, Department of Molecular Pathobiology New York University College of Dentistry New York, NY 10010-4086
| | - Leeann D Louis
- Department of Biomedical Engineering, City College of New York, 160 Convent Avenue, New York, NY, 10031, USA
| | - Jelena Basta-Pljakic
- Department of Biomedical Engineering, City College of New York, 160 Convent Avenue, New York, NY, 10031, USA
| | - Gozde Yildirim
- David B. Kriser Dental Center, Department of Molecular Pathobiology New York University College of Dentistry New York, NY 10010-4086
| | - Sher-Bahadur Poudel
- David B. Kriser Dental Center, Department of Molecular Pathobiology New York University College of Dentistry New York, NY 10010-4086
| | - Fancy Kumararaja
- David B. Kriser Dental Center, Department of Molecular Pathobiology New York University College of Dentistry New York, NY 10010-4086
| | - Edward O List
- Edison Biotechnology Institute, and Dept. of Biomedical Sciences, Ohio University, Athens, OH
| | - Silvana Ortiz Duran
- Edison Biotechnology Institute, and Dept. of Biomedical Sciences, Ohio University, Athens, OH
| | - John J Kopchick
- Edison Biotechnology Institute, and Dept. of Biomedical Sciences, Ohio University, Athens, OH
| | - Ryan R Ruff
- David B. Kriser Dental Center, Department of Epidemiology and Health Promotion, New York University College of Dentistry New York, NY 10010-4086
| | - Mitchell B Schaffler
- Department of Biomedical Engineering, City College of New York, 160 Convent Avenue, New York, NY, 10031, USA
| | - Shoshana Yakar
- David B. Kriser Dental Center, Department of Molecular Pathobiology New York University College of Dentistry New York, NY 10010-4086
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16
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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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17
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Frara S, Melin Uygur M, di Filippo L, Doga M, Losa M, Santoro S, Mortini P, Giustina A. High Prevalence of Vertebral Fractures Associated With Preoperative GH Levels in Patients With Recent Diagnosis of Acromegaly. J Clin Endocrinol Metab 2022; 107:e2843-e2850. [PMID: 35349698 DOI: 10.1210/clinem/dgac183] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 01/01/2023]
Abstract
CONTEXT Osteopathy and morphometric vertebral fractures (VFs) are emerging complications in acromegaly. However, the prediction of VFs in this clinical setting is still a matter of uncertainty, and it is debated whether they are an early event in the natural history of the disease. OBJECTIVE We aimed to evaluate the prevalence and determinants of morphometric VFs in patients with recently diagnosed acromegaly. METHODS We enrolled 92 patients (43 men/49 women) on admission to the neurosurgery unit before transsphenoidal surgery, and compared them with control individuals without secondary forms of osteoporosis and pituitary disorders. We performed a VF assessment on preoperative chest x-ray images and collected biochemical, demographic, and clinical data. RESULTS We detected a significantly higher prevalence of VFs (33.7%) in patients with acromegaly than in controls (P = .001). Among the patients with acromegaly and VFs, 12 (38.7%) showed multiple VFs, and 5 (16.1%) showed moderate/severe VFs. Patients with VFs had higher random serum growth hormone (GH) levels than those with no VFs (P = .03), but there was no difference in insulin-like growth factor-1 (IGF-1) (P = .07) and IGF-1/Upper Normal Limit ratio (P = .08). Free 3,5,3'-triiodothyronine was slightly lower in patients with acromegaly and VFs than in those without VFs (P = .05). In multiple logistic analysis, GH was independently associated with risk for VFs (P = .003). The preoperative serum GH cutoff value that predicted VFs was 12 ng/mL. CONCLUSION For the first time, high prevalence of radiological VFs is reported in patients with recent diagnosis of acromegaly. Therefore, we can hypothesize that VFs are an early phenomenon of acromegaly and related to GH levels. VF assessment should be included in the workup at the diagnosis of acromegaly.
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Affiliation(s)
- Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Meliha Melin Uygur
- Marmara University Pendik Training and Research Hospital, Department of Endocrinology and Metabolism Disease, 34800 Istanbul, Turkey
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Mauro Doga
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Marco Losa
- Department of Neurosurgery, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Simona Santoro
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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Schweizer JROL, Schilbach K, Haenelt M, Giannetti AV, Bizzi MF, Soares BS, Paulino E, Schopohl J, Störmann S, Ribeiro-Oliveira A, Bidlingmaier M. Soluble Alpha Klotho in Acromegaly: Comparison With Traditional Markers of Disease Activity. J Clin Endocrinol Metab 2021; 106:e2887-e2899. [PMID: 33864468 PMCID: PMC8277223 DOI: 10.1210/clinem/dgab257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Soluble alpha klotho (sαKL) has been linked to growth hormone (GH) action, but systematic evaluation and comparisons with traditional biomarkers in acromegaly are lacking. OBJECTIVE To evaluate the potential of sαKL to aid classification of disease activity. METHODS This retrospective study at 2 academic centers included acromegaly patients before surgery (A, n = 29); after surgery (controlled, discordant, or uncontrolled) without (B1, B2, B3, n = 28, 11, 8); or with somatostatin analogue treatment (C1, C2, C3, n = 17, 11, 5); nonfunctioning pituitary adenomas (n = 20); and healthy controls (n = 31). sαKL was measured by immunoassay and compared with traditional biomarkers (random and nadir GH, insulin-like growth factor I [IGF-I], IGF binding protein 3). Associations with disease activity were assessed. RESULTS sαKL was correlated to traditional biomarkers, particularly IGF-I (rs=0.80, P <0.0001). High concentrations before treatment (A, median, interquartile range: 4.04 × upper limit of normal [2.26-8.08]) dropped to normal after treatment in controlled and in most discordant patients. A cutoff of 1548 pg/mL for sαKL discriminated controlled (B1, C1) and uncontrolled (B3, C3) patients with 97.8% (88.4%-99.9%) sensitivity and 100% (77.1%-100%) specificity. sαKL was below the cutoff in 84% of the discordant subjects. In the remaining 16%, elevated sαKL and IGF-I persisted, despite normal random GH. Sex, age, body mass index, and markers of bone and calcium metabolism did not significantly affect sαKL concentrations. CONCLUSION Our data support sαKL as a biomarker to assess disease activity in acromegaly. sαKL exhibits close association with GH secretory status, large dynamic range, and robustness toward biological confounders. Its measurement could be helpful particularly when GH and IGF-I provide discrepant information.
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Affiliation(s)
- Júnia R O L Schweizer
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Katharina Schilbach
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Michael Haenelt
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | | | - Mariana F Bizzi
- Endocrine Laboratory–Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Beatriz S Soares
- Endocrine Laboratory–Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Eduardo Paulino
- Pathology Department–Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jochen Schopohl
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Sylvère Störmann
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | | | - Martin Bidlingmaier
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
- Correspondence: Martin Bidlingmaier, Endocrine Laboratory, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstrasse 1, 80336 Munich, Germany.
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Graber E, Reiter EO, Rogol AD. Human Growth and Growth Hormone: From Antiquity to the Recominant Age to the Future. Front Endocrinol (Lausanne) 2021; 12:709936. [PMID: 34290673 PMCID: PMC8287422 DOI: 10.3389/fendo.2021.709936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022] Open
Abstract
Since antiquity Man has been fascinated by the variations in human (and animal) growth. Stories and art abound about giants and little people. Modern genetics have solved some of etiologies at both extremes of growth. Serious study began with the pathophysiology of acromegaly followed by early attempts at treatment culminating in modern endoscopic surgery and multiple pharmacologic agents. Virtually at the same time experiments with the removal of the pituitary from laboratory animals noted the slowing or stopping of linear growth and then over a few decades the extraction and purification of a protein within the anterior pituitary that restored, partially or in full, the animal's growth. Human growth hormone was purified decades after those from large animals and it was noted that it was species specific, that is, only primate growth hormone was metabolically active in primates. That was quite unlike the beef and pork insulins which revolutionized the care of children with diabetes mellitus. A number of studies included mild enzymatic digestion of beef growth hormone to determine if those "cores" had biologic activity in primates and man. Tantalizing data showed minimal but variable metabolic efficacy leading to the "active core" hypothesis, for these smaller peptides would be amenable to peptide synthesis in the time before recombinant DNA. Recombinant DNA changed the landscape remarkably promising nearly unlimited quantities of metabolically active hormone. Eight indications for therapeutic use have been approved by the Food and Drug Administration and a large number of clinical trials have been undertaken in multiple other conditions for which short stature in childhood is a sign. The future predicts other clinical indications for growth hormone therapy (and perhaps other components of the GH?IGF-1 axis), longer-acting analogues and perhaps a more physiologic method of administration as virtually all methods at present are far from physiologic.
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Affiliation(s)
- Evan Graber
- DO Division of Pediatric Endocrinology, Nemours/Alfred I. Dupont Hospital for Children, Wilmington, DE, United States
| | - Edward O. Reiter
- Baystate Children’s Hospital, UMassMedical School-Baystate, Springfield, MA, United States
| | - Alan D. Rogol
- Pediatrics/Endocrinology, University of Virginia, Charlottesville, VA, United States
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Calatayud M, Pérez-Olivares Martín L, Librizzi MS, Lora Pablos D, González Méndez V, Aramendi Ramos M, Martínez Diaz-Guerra G, Hawkins F. Trabecular bone score and bone mineral density in patients with long-term controlled acromegaly. Clin Endocrinol (Oxf) 2021; 95:58-64. [PMID: 33559169 DOI: 10.1111/cen.14439] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Acromegaly is associated with increased vertebral fracture (VFs) risk not correlated to bone mineral density (BMD). Trabecular bone score (TBS), related to bone microarchitecture, provides information on bone strength. This cross-sectional study considered the usefulness of TBS and BMD to assess bone status in long-term controlled acromegalic patients. DESIGN, PATIENTS, MEASUREMENTS 26 acromegaly patients (14 female and 12 males) were included in the study. A further 117 subjects were recruited as controls (58 females and 57 males). BMD was measured using dual-energy X-ray absorptiometry (DXA), TBS was obtained applying Medimaps software 2.0. Biochemical parameters were determined by standardized techniques. RESULTS 73% of patients with acromegaly exhibited normal lumbar spine (LS) BMD. TBS was normal in 38% of acromegalic patients and partially degraded or degraded in 31% of patients, respectively. No differences were found in LS BMD between acromegalic patients and controls. TBS values were significantly lower in patients with acromegaly (1.27 ± 0.13 vs. 1.35 ± 0.17, p = .01). Postsurgical remission was associated with higher TBS values (1.35 ± 0.10 vs. 1.23 ± 0.13, p = .02) and pituitary radiotherapy treatment with lower TBS values (1.18 ± 0.12 vs. 1.31 ± 0.12, p = .004). On multivariate analysis, age, BMI and LS BMD were predictors of TBS changes in patients with acromegaly (p < .05). CONCLUSIONS Patients with long-term controlled acromegaly can exhibit deterioration of bone microstructure measured with TBS, despite BMD measurement not showing bone loss. Our study suggests that TBS is useful for monitoring the bone status changes in acromegalic patients.
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Affiliation(s)
- María Calatayud
- Endocrinology Service, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laura Pérez-Olivares Martín
- Endocrinology Service, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - María Soledad Librizzi
- Endocrinology Service, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - David Lora Pablos
- Epidemiology Unit, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Violeta González Méndez
- Radiology Service, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Mercedes Aramendi Ramos
- Biochemical Service, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Guillermo Martínez Diaz-Guerra
- Endocrinology Service, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Federico Hawkins
- Research Institute i+12, University Hospital 12 Octubre, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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21
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Duan L, Yang S, Wang LJ, Zhang Y, Li R, Yang H, Zhao Y, Du H, Zhai X, Gong F, Pan H, Zhu H, Xia W. The Negative Impacts of Acromegaly on Bone Microstructure Not Fully Reversible. Front Endocrinol (Lausanne) 2021; 12:738895. [PMID: 34603213 PMCID: PMC8479105 DOI: 10.3389/fendo.2021.738895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study aimed to evaluate the bone turnover markers and bone microarchitecture parameters derived from high-resolution peripheral quantitative computed tomography (HR-pQCT) in active and controlled acromegaly patients. METHODS This cross-sectional study involved 55 acromegaly patients from a tertiary hospital (23 males and 32 females, aged 45.0 ± 11.6 years). Firstly, growth hormone (GH), insulin-like growth factor-1 (IGF-1), and markers for bone turnover were assessed. Next, we derived peripheral bone microstructure parameters and volumetric bone mineral density (vBMD) through HR-pQCT. These parameters were compared between acromegaly patients and 110 healthy controls, as well as between 27 active and 28 controlled acromegaly patients. Moreover, the relationship between GH/IGF-1 and bone microstructure parameters was analyzed through multiple linear regression. RESULTS As compared with healthy controls, acromegaly patients exhibited elevated cortical vBMD, reduced trabecular vBMD, and increased trabecular inhomogeneity in the distal radius and tibia. While controlled acromegaly patients had slower bone turnover, they did not necessarily have better bone microstructure relative to active patients in intergroup comparison. Nevertheless, multiple regression indicated that higher IGF-1 was associated with lower tibial stiffness and failure load. Additionally, males with higher IGF-1 typically had larger trabecular separation, lower trabecular number, and larger cortical pores in the radius. Moreover, patients with elevated GH typically had more porous cortical bone in the radius and fewer trabeculae in the tibia. However, the compromised bone strength in active patients was partially compensated by increased bone thickness. Furthermore, no significant linkage was observed between elevated GH/IGF-1 and the most important HR-pQCT parameters such as trabecular volumetric bone density. CONCLUSION Acromegaly adversely affected bone quality, even in controlled patients. As the deterioration in bone microstructure due to prolonged GH/IGF-1 exposure was not fully reversible, clinicians should be aware of the bone fragility of acromegaly patients even after they had achieved biochemical remission.
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Affiliation(s)
- Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shengmin Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lin Jie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuxing Zhao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hanze Du
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Zhai
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Huijuan Zhu, ; Weibo Xia,
| | - Weibo Xia
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Huijuan Zhu, ; Weibo Xia,
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22
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Cellini M, Biamonte E, Mazza M, Trenti N, Ragucci P, Milani D, Ferrante E, Rossini Z, Lavezzi E, Sala E, Mantovani G, Arosio M, Fornari M, Balzarini L, Lania AG, Mazziotti G. Vertebral Fractures Associated with Spinal Sagittal Imbalance and Quality of Life in Acromegaly: A Radiographic Study with EOS 2D/3D Technology. Neuroendocrinology 2021; 111:775-785. [PMID: 32980840 DOI: 10.1159/000511811] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acromegaly is commonly complicated by arthropathy and skeletal fragility with high risk of vertebral fractures (VFs). OBJECTIVE This study aimed to assess whether VFs may be associated with sagittal spine deformities, arthropathy, impaired quality of life (QoL), pain, and disability. METHODS Thirty-eight patients with acromegaly (median age: 55 years, 20 males) and 38 matched control subjects were evaluated by a low-dose sagittal and coronal planes, X-ray imaging system (EOS®-2D/3D) for morphometric VFs, radiological signs of spine arthropathy, and spine deformities (Cobb thoracic index ≥40°, pelvic incidence minus lumbar lordosis ≥10°, pelvic tilt >20°, and sagittal vertical axis ≥4 cm) determining sagittal spine imbalance. Acromegalic patients were also evaluated by questionnaires for QoL (Acromegaly QoL Questionnaire [AcroQoL] and Short Form-36 [SF-36]) and pain and disability (Western Ontario and McMaster University [WOMAC]). RESULTS Acromegalic patients showed higher prevalence of thoracic hyperkyphosis (i.e., Cobb thoracic index ≥40°; p = 0.04) and pelvic tilt >20° (p = 0.02) than control subjects. VFs were found in 34.2% of acromegalic patients (p = 0.003 vs. control subjects), in relationship with higher prevalence of hyperkyphosis (p = 0.03), pelvic tilt >20° (p = 0.04), sagittal vertical axis ≥4 cm (p = 0.03), and moderate/severe subchondral degeneration (p = 0.01). Moreover, patients with VFs had lower AcroQoL general health (p = 0.007) and SF-36 general health (p = 0.002) scores and higher WOMAC pain (p = 0.003) and global (p = 0.009) scores than patients who did not fracture. CONCLUSIONS In acromegaly, VFs may be associated with spine deformities and sagittal imbalance, spine arthropathy, impaired QoL, and disability.
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Affiliation(s)
- Miriam Cellini
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Emilia Biamonte
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Massimiliano Mazza
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Nicoletta Trenti
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Pasquala Ragucci
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Davide Milani
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Elisabetta Lavezzi
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Elisa Sala
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Luca Balzarini
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Andrea G Lania
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy,
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,
| | - Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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23
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Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, Bolanowski M, Bonert V, Bronstein MD, Casanueva FF, Clemmons D, Colao A, Ferone D, Fleseriu M, Frara S, Gadelha MR, Ghigo E, Gurnell M, Heaney AP, Ho K, Ioachimescu A, Katznelson L, Kelestimur F, Kopchick J, Krsek M, Lamberts S, Losa M, Luger A, Maffei P, Marazuela M, Mazziotti G, Mercado M, Mortini P, Neggers S, Pereira AM, Petersenn S, Puig-Domingo M, Salvatori R, Shimon I, Strasburger C, Tsagarakis S, van der Lely AJ, Wass J, Zatelli MC, Melmed S. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab 2020; 105:5586717. [PMID: 31606735 DOI: 10.1210/clinem/dgz096] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013. PARTICIPANTS The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration. EVIDENCE This evidence-based consensus was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence following critical discussion of the current literature on the diagnosis and treatment of acromegaly comorbidities. CONSENSUS PROCESS Acromegaly Consensus Group participants conducted comprehensive literature searches for English-language papers on selected topics, reviewed brief presentations on each topic, and discussed current practice and recommendations in breakout groups. Consensus recommendations were developed based on all presentations and discussions. Members of the Scientific Committee graded the quality of the supporting evidence and the consensus recommendations using the GRADE system. CONCLUSIONS Evidence-based approach consensus recommendations address important clinical issues regarding multidisciplinary management of acromegaly-related cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders and their sequelae, as well as their effects on quality of life and mortality.
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Affiliation(s)
- Andrea Giustina
- Division of Endocrinology and Metabolism, San Raffaele University Hospital, Milan, Italy
| | - Ariel Barkan
- Division of Endocrinology, University of Michigan Health System, Ann Arbor, Michigan
| | - Albert Beckers
- Department of Endocrinology, University of Liège, Liège, Belgium
| | - Nienke Biermasz
- Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Beverly M K Biller
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cesar Boguszewski
- SEMPR, Endocrine Division, Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Vivien Bonert
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marcello D Bronstein
- Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil
| | - Felipe F Casanueva
- Division of Endocrinology, Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain
| | - David Clemmons
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Annamaria Colao
- Division of Endocrinologia, Universita' Federico II di Napoli, Naples, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Maria Fleseriu
- Departments of Medicine and Neurological Surgery, Pituitary Center, Oregon Health & Science University, Portland, Oregon
| | - Stefano Frara
- Division of Endocrinology and Metabolism, San Raffaele University Hospital, Milan, Italy
| | - Monica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ezio Ghigo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Mark Gurnell
- University of Cambridge & Addenbrooke's Hospital, Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, United Kingdom
| | - Anthony P Heaney
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ken Ho
- The Garvan Institute of Medical Research and St. Vincent's Hospital, Sydney, Australia
| | - Adriana Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, and Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Laurence Katznelson
- Departments of Medicine and Neurosurgery, Stanford University School of Medicine, Stanford, California
| | | | - John Kopchick
- Edison Biotechnology Institute and Department of Biomedical Sciences, Ohio University, Athens, Ohio
| | - Michal Krsek
- 2nd Department of Medicine, 3rd Faculty of Medicine of the Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Marco Losa
- Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy
| | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Pietro Maffei
- Department of Medicine, Padua University Hospital, Padua, Italy
| | - Monica Marazuela
- Department of Medicine, CIBERER, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gherardo Mazziotti
- Endocrinology Unit, Humanitas University and Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Moises Mercado
- Division of Medicine, National Autonomous University of Mexico, Experimental Endocrinology Unit, Centro Médico Nacional, Siglo XXI, IMSS, Mexico City, Mexico
| | - Pietro Mortini
- Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy
| | - Sebastian Neggers
- Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alberto M Pereira
- Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Manel Puig-Domingo
- Endocrinology Service, CIBER and CIBERES Germans Trias i Pujol Research Institute and Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes, and Metabolism and Pituitary Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ilan Shimon
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Christian Strasburger
- Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - A J van der Lely
- Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John Wass
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United Kingdom
| | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Cozzi R, Ambrosio MR, Attanasio R, Bozzao A, De Marinis L, De Menis E, Guastamacchia E, Lania A, Lasio G, Logoluso F, Maffei P, Poggi M, Toscano V, Zini M, Chanson P, Katznelson L. Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues. Endocr Metab Immune Disord Drug Targets 2020; 20:1133-1143. [PMID: 31985386 PMCID: PMC7579251 DOI: 10.2174/1871530320666200127103320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
Acromegaly is a rare disease. Improvements in lifespan in these patients have recently been reported due to transsphenoidal surgery (TSS), advances in medical therapy, and strict criteria for defining disease remission. This document reports the opinions of a group of Italian experts who have gathered together their prolonged clinical experience in the diagnostic and therapeutic challenges of acromegaly patients. Both GH and IGF-I (only IGF-I in those treated with Pegvisomant) are needed in the diagnosis and follow-up. Comorbidities (cardio-cerebrovascular disease, sleep apnea, metabolic derangement, neoplasms, and bone/joint disease) should be specifically addressed. Any newly diagnosed patient should be referred to a multidisciplinary team experienced in the treatment of pituitary adenomas.
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Affiliation(s)
- Renato Cozzi
- Address correspondence to this author at the Endocrinologia, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Tel: +39.347.5225490; E-mail:
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25
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Gu J, Xiang S, He M, Wang M, Gu Y, Li L, Yin Z. Quality of Life in Patients with Acromegaly before and after Transsphenoidal Surgical Resection. Int J Endocrinol 2020; 2020:5363849. [PMID: 32831834 PMCID: PMC7424368 DOI: 10.1155/2020/5363849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection. METHODS Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1. RESULTS 151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%-69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%-71.8%). Nadir GH levels (coefficient -0.08, p=0.047), T3 levels (coefficient 2.8, p=0.001), and testosterone levels (coefficient -0.20, p=0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months (p < 0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months (p < 0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group. CONCLUSION In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.
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Affiliation(s)
- Jing Gu
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shiyuan Xiang
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yanfang Gu
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Lingjuan Li
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhiwen Yin
- Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China
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26
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Fatti LM, Cangiano B, Vitale G, Persani L, Mantovani G, Sala E, Arosio M, Maffei P, Dassie F, Mormando M, Giampietro A, Tanda L, Masiello ER, Nazzari E, Ferone D, Corbetta S, Passeri E, Guaraldi F, Grottoli S, Cannavò S, Torre MLT, Soranna D, Zambon A, Cavagnini F, Scacchi M. Arthropathy in acromegaly: a questionnaire-based estimation of motor disability and its relation with quality of life and work productivity. Pituitary 2019; 22:552-560. [PMID: 31032537 DOI: 10.1007/s11102-019-00966-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Arthropathy is a common and disabling complication of acromegaly. Since in this condition radiological findings rarely correspond to functional impairment, we elected to quantify in a large cohort of acromegalic patients: the degree of motor disability compared with data from general population, the impact of joint involvement on quality of life and work productivity, and to look for associated factors. METHODS In 211 acromegalic patients, 131 with controlled disease and 80 with active disease, eight validated scales were used to evaluate the (i) prevalence and distribution of arthropathy, (ii) degree of motor disability and joint symptoms (VAS, AIMS symptoms and WOMAC), (iii) quality of life (AcroQoL and PASQ) and work capability (WPAI:GH) as consequences of joint complications. RESULTS Using the WOMAC questionnaire, for which population based normative values are available, a significantly higher prevalence and severity of motor disability was detected in acromegalics compared to the general population from literature. The results provided by the different questionnaires turned out to be highly concordant. All measures of motor disability correlated both with impaired quality of life and motor disability and were worse in females and in patients with higher BMI. CONCLUSIONS The questionnaires VAS, AIMS symptoms, and WOMAC (this latter both as a whole and with its functionality subscale), with their scores, proved to be the most adequate tools to evaluate motor disability and its consequences on both quality of life and work productivity in acromegaly. Female gender and higher BMI are associated with worse articular symptoms.
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Affiliation(s)
- L M Fatti
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - B Cangiano
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vitale
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Sala
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Maffei
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - F Dassie
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Mormando
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - A Giampietro
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - L Tanda
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E R Masiello
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - S Corbetta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - E Passeri
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - F Guaraldi
- Pituitary Unit, Department of Biomedical and Neuromotor Sciences, IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - S Grottoli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Cannavò
- Department of Human Pathology, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital of Messina, Messina, Italy
| | - M L T Torre
- Department of Human Pathology, University of Messina, Messina, Italy
| | - D Soranna
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - A Zambon
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - F Cavagnini
- Istituto Auxologico Italiano IRCCS, Center for Biomedical Research and Technology, Cusano Milanino, Milan, Italy
| | - M Scacchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, Ospedale S. Giuseppe, Strada Cadorna 90, 28824, Località Piancavallo, Oggebbio-Verbania, Italy.
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27
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Haliloglu O, Topsakal N, Camliguney F, Polat Korkmaz O, Sahin S, Cotuk B, Kadioglu P, Erkut O. Static and dynamic balances of patients with acromegaly and impact of exercise on balance. Pituitary 2019; 22:497-506. [PMID: 31368031 DOI: 10.1007/s11102-019-00979-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly. METHODS This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device. RESULTS The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior-posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left-right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward-backward and medial-lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A. CONCLUSIONS Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.
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Affiliation(s)
- Ozlem Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nuri Topsakal
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
| | - Filiz Camliguney
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
| | - Ozge Polat Korkmaz
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Birol Cotuk
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Oya Erkut
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
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Grijalva-Avila J, Villanueva-Fierro I, Lares-Asseff I, Chairez-Hernández I, Rivera-Sanchez G, Martínez-Estrada S, Martínez-Rivera I, Quiñones LA, Loera-Castañeda V. Milk intake and IGF-1 rs6214 polymorphism as protective factors to obesity. Int J Food Sci Nutr 2019; 71:388-393. [DOI: 10.1080/09637486.2019.1666805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | | | - Ismael Lares-Asseff
- Instituto Politécnico, Nacional-CIIDIR Unidad Durango, Durango, México
- Latin-American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Madrid, Spain
| | | | - Gildardo Rivera-Sanchez
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, Reynosa, México
| | | | | | - Luis A. Quiñones
- Latin-American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Madrid, Spain
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics (CQF), Department of Basic and Clinical Oncology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Loera-Castañeda
- Instituto Politécnico, Nacional-CIIDIR Unidad Durango, Durango, México
- Latin-American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Madrid, Spain
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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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Abstract
Pituitary diseases are rare conditions with severe chronic multiorgan and multisystemic morbidity requiring complex multidisciplinary treatment and usually life-long drug treatment. Most cases are caused by functioning or non-functioning pituitary adenoma. From the patient's perspective, the burden of disease is caused by the tumour itself and associated compression symptoms, interventions, hormone excess and deficiencies, systemic manifestations of these endocrine abnormalities and general psychosocial issues that can manifest in patients with a chronic condition. In this review, patient burden is classified according to classic endocrine syndromes, with burden at diagnosis and after long-term remission, and also within the framework of value-based health care and the conceptual model of wellbeing. The recently developed patient-reported outcome measurement tool that helps to evaluate burden of patients is also discussed.
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Affiliation(s)
- Nienke R Biermasz
- Leiden University Medical Center, Department of Medicine, Division of Endocrinology, Center of Endocrine Tumors Leiden, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
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31
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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: 197] [Impact Index Per Article: 39.4] [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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32
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Qin L, Guo X, Gao L, Wang Z, Feng C, Deng K, Lian W, Xing B. Preoperative and Postoperative Bone Mineral Density Change and Risk Factor Analysis in Patients with a GH-Secreting Pituitary Adenoma. Int J Endocrinol 2019; 2019:2102616. [PMID: 31781204 PMCID: PMC6875336 DOI: 10.1155/2019/2102616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/05/2019] [Accepted: 10/16/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study analysed changes in bone mineral density (BMD) at different sites in patients with acromegaly and postoperative BMD changes and explored risk factors associated with BMD. METHODS Clinical data of 39 patients with growth hormone- (GH-) secreting pituitary adenomas and 29 patients with nonfunctioning pituitary adenomas who were newly diagnosed in neurosurgery from January 2016 to December 2018 were retrospectively analysed, including measurements of preoperative and postoperative BMD, serum GH glucose inhibition, random GH and IGF-1, and other anterior pituitary hormones. RESULTS The average patient age and disease duration were 43.74 (33.41-54.07) years and 72.15 (22.82-121.48) months, respectively. Compared with patients with nonfunctioning adenomas, patients with GH-secreting pituitary adenomas had significantly higher BMDs at L1, L2, femoral neck, Ward triangle, trochanter, femoral shaft, and total hip sites (p < 0.05). The BMD Z score at L1 and femoral neck sites significantly increased (p < 0.05). Thirteen patients underwent re-examination of BMD 1 year postsurgery, and the BMD Z score was reduced to normal levels at L1, L2, L3, L4, L1-L4, and L2-L4 compared with preoperative levels (p < 0.05). Postoperative BMD Z scores in the femoral neck and total hip were significantly increased (p < 0.05). Disease duration was negatively correlated with the lumbar-spine BMD Z score. IGF-1 burden was negatively correlated with the BMD Z score at L1 and L1-L4. Multiple regression analysis showed that IGF-1 burden was a risk factor for a BMD Z score decrease at L1 and L1-L4. CONCLUSION BMD in patients with GH-secreting pituitary adenomas (compared with nonfunctional adenomas) increased at L1, L2, femoral neck, Ward triangle, trochanter, femoral shaft, and total hip sites. Lumbar-spine BMD Z score recovered to normal levels postsurgically when GH and IGF-1 levels were controlled. BMD Z score was negatively correlated with disease duration and IGF-1 burden in patients with GH-secreting pituitary adenomas, and IGF-1 burden was an independent risk factor for reduced lumbar-spine BMD Z score.
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Affiliation(s)
- Li'nan Qin
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Zihao Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Chenzhe Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing 100730, China
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing 100730, China
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34
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Mazziotti G, Frara S, Giustina A. Pituitary Diseases and Bone. Endocr Rev 2018; 39:440-488. [PMID: 29684108 DOI: 10.1210/er.2018-00005] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022]
Abstract
Neuroendocrinology of bone is a new area of research based on the evidence that pituitary hormones may directly modulate bone remodeling and metabolism. Skeletal fragility associated with high risk of fractures is a common complication of several pituitary diseases such as hypopituitarism, Cushing disease, acromegaly, and hyperprolactinemia. As in other forms of secondary osteoporosis, pituitary diseases generally affect bone quality more than bone quantity, and fractures may occur even in the presence of normal or low-normal bone mineral density as measured by dual-energy X-ray absorptiometry, making difficult the prediction of fractures in these clinical settings. Treatment of pituitary hormone excess and deficiency generally improves skeletal health, although some patients remain at high risk of fractures, and treatment with bone-active drugs may become mandatory. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary diseases.
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Affiliation(s)
| | - Stefano Frara
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Milan, Italy
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35
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Predictors of colonic pathologies in active acromegaly: single tertiary center experience. Wien Klin Wochenschr 2018; 130:511-516. [DOI: 10.1007/s00508-018-1367-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023]
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36
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Criterios para el diagnóstico y el control poscirugía de la acromegalia, y el cribado y el manejo de sus comorbilidades: recomendaciones de expertos. ENDOCRINOL DIAB NUTR 2018; 65:297-305. [DOI: 10.1016/j.endinu.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 12/29/2022]
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37
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Belaya Z, Grebennikova T, Melnichenko G, Nikitin A, Solodovnikov A, Brovkina O, Grigoriev A, Rozhinskaya L, Lutsenko A, Dedov I. Effects of active acromegaly on bone mRNA and microRNA expression patterns. Eur J Endocrinol 2018; 178:353-364. [PMID: 29374071 DOI: 10.1530/eje-17-0772] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/26/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the response of bone to chronic long-term growth hormone (GH) and insulin-like growth factor-1 (IGF1) excess by measuring the expression of selected mRNA and microRNA (miR) in bone tissue samples of patients with active acromegaly. DESIGN Case-control study. METHODS Bone tissue samples were obtained during transsphenoidal adenomectomy from the sphenoid bone (sella turcica) from 14 patients with clinically and biochemically confirmed acromegaly and 10 patients with clinically non-functioning pituitary adenoma (NFPA) matched by sex and age. Expression of genes involved in the regulation of bone remodeling was studied using quantitative polymerase chain reaction (qPCR). RESULTS Of the genes involved in osteoblast and osteoclast activity, only alkaline phosphatase (ALP) mRNA was 50% downregulated in patients with acromegaly. GH excess caused increased expression of the Wnt signaling antagonists (DKK1) and agonists (WNT10B) and changes in the levels of miR involved in mesenchymal stem cell commitment to chondrocytes (miR-199a-5p) or adipocytes (miR-27-5p, miR-125b-5p, miR-34a-5p, miR-188-3p) P < 0.05; q < 0.1. Relevant compensatory mechanisms were found through the changes in miR involved in osteoblastogenesis (miR-210-5p, miR-135a-5p, miR-211, miR-23a-3p, miR-204-5p), but the expression of TWIST1 was 50% downregulated and RUNX2 was unchanged. CONCLUSIONS Acromegaly had minimal effects on tested mRNAs specific to osteoblast or osteoclast function except for downregulated ALP expression. The expressions of miR known to be involved in mesenchymal stem cell commitment and downregulated TWIST1 expression suggest acromegaly has a negative effect on osteoblastogenesis.
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Affiliation(s)
- Zhanna Belaya
- The National Medical Research Centre for EndocrinologyMoscow, Russia
| | | | | | - Alexey Nikitin
- Federal Research and Clinical Center FMBA of RussiaMoscow, Russia
| | | | - Olga Brovkina
- Federal Research and Clinical Center FMBA of RussiaMoscow, Russia
| | - Andrey Grigoriev
- The National Medical Research Centre for EndocrinologyMoscow, Russia
| | | | | | - Ivan Dedov
- The National Medical Research Centre for EndocrinologyMoscow, Russia
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Claessen KMJA, Canete AN, de Bruin PW, Pereira AM, Kloppenburg M, Kroon HM, Biermasz NR. Acromegalic arthropathy in various stages of the disease: an MRI study. Eur J Endocrinol 2017; 176:779-790. [PMID: 28348071 DOI: 10.1530/eje-16-1073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI). METHODS Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active (n = 10) and controlled acromegaly (n = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison. RESULTS Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, P = 0.001) and bone marrow lesions (15% vs 80%, P = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage (P < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects (P < 0.01). CONCLUSIONS Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.
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Affiliation(s)
- K M J A Claessen
- Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden
| | | | | | - A M Pereira
- Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden
| | - M Kloppenburg
- Departments of RheumatologyLeiden University Medical CenterLeiden The Netherlands
| | | | - N R Biermasz
- Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden
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Giustina A, Arnaldi G, Bogazzi F, Cannavò S, Colao A, De Marinis L, De Menis E, Degli Uberti E, Giorgino F, Grottoli S, Lania AG, Maffei P, Pivonello R, Ghigo E. Pegvisomant in acromegaly: an update. J Endocrinol Invest 2017; 40:577-589. [PMID: 28176221 PMCID: PMC5443862 DOI: 10.1007/s40618-017-0614-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2007, we published an opinion document to review the role of pegvisomant (PEG) in the treatment of acromegaly. Since then, new evidence emerged on the biochemical and clinical effects of PEG and on its long-term efficacy and safety. AIM We here reviewed the emerging aspects of the use of PEG in clinical practice in the light of the most recent literature. RESULTS The clinical use of PEG is still suboptimal, considering that it remains the most powerful tool to control IGF-I in acromegaly allowing to obtain, with a pharmacological treatment, the most important clinical effects in terms of signs and symptoms, quality of life and comorbidities. The number of patients with acromegaly exposed to PEG worldwide has become quite elevated and the prolonged follow-up allows now to deal quite satisfactorily with many clinical issues including major safety issues, such as the concerns about possible tumour (re)growth under PEG. The positive or neutral impact of PEG on glucose metabolism has been highlighted, and the clinical experience, although limited, with sleep apnoea and pregnancy has been reviewed. Finally, the current concept of somatostatin receptor ligands (SRL) resistance has been addressed, in order to better define the acromegaly patients to whom the PEG option may be offered. CONCLUSIONS PEG increasingly appears to be an effective and safe medical option for many patients not controlled by SRL but its use still needs to be optimized.
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Affiliation(s)
- A Giustina
- Chair of Endocrinology, Vita-Salute San Raffaele University, Milano, Italy.
| | - G Arnaldi
- Clinic of Endocrinology and Metabolism Disease, Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - L De Marinis
- Pituitary Unit, Catholic University School of Medicine, Rome, Italy
| | - E De Menis
- Department of Internal Medicine, General Hospital, Montebelluna (TV), Italy
| | - E Degli Uberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S Grottoli
- Endocrinology, Diabetology and Metabolism, AOU Città della Salute e della Scienza of Turin, Turin, Italy
| | - A G Lania
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy
| | - P Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Azienda Ospedaliera Padova, Padova, Italy
| | - R Pivonello
- Department of Clinical and Surgery Medicine, Endocrinology and Metabolism, University of Naples, Naples, Italy
| | - E Ghigo
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
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40
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Appelman-Dijkstra NM, Biermasz NR. Understanding and predicting fracture risk in acromegaly. Endocrine 2017; 55:662-663. [PMID: 28155171 DOI: 10.1007/s12020-017-1238-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Natasha M Appelman-Dijkstra
- Leiden University Medical Center, Center for Endocrine Tumors Leiden, Leiden, The Netherlands
- Department of Internal Medicine: division Endocrinology, Center for Bone Quality Leiden, Leiden, The Netherlands
| | - Nienke R Biermasz
- Leiden University Medical Center, Center for Endocrine Tumors Leiden, Leiden, The Netherlands.
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41
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Abstract
Acromegalic osteopathy is an emerging complication of acromegaly characterized by increase in bone turnover, deterioration in bone microarchitecture and high risk of vertebral fractures. Vertebral fractures, as diagnosed by a radiological and morphometric approach, occur in about one-third of acromegaly patients in close relationship with duration of active disease. However, the prediction of vertebral fractures in this clinical setting is still a matter of uncertainty, since the pathogenesis of acromegalic osteopathy is multifactorial and fractures may occur even in presence of normal bone mineral density. In this narrative article, we summarize the pathophysiology and clinical aspects of acromegalic osteopathy.
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Affiliation(s)
- G Mazziotti
- Chair of Endocrinology, University of Brescia, Via Biseo, 17, 25123, Brescia, Italy
- Endocrinology Unit, ASST Carlo Poma of Mantua, Mantua, Italy
| | - F Maffezzoni
- Chair of Endocrinology, University of Brescia, Via Biseo, 17, 25123, Brescia, Italy
| | - S Frara
- Chair of Endocrinology, University of Brescia, Via Biseo, 17, 25123, Brescia, Italy
| | - A Giustina
- Chair of Endocrinology, University of Brescia, Via Biseo, 17, 25123, Brescia, Italy.
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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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43
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Neggers SJCMM, Muhammad A, van der Lely AJ. Pegvisomant Treatment in Acromegaly. Neuroendocrinology 2016; 103:59-65. [PMID: 25792221 DOI: 10.1159/000381644] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
Historically, medical treatment of acromegaly has mainly been used as an adjuvant therapy after surgery. In the last decades, an increased range of medical therapy options has been available. Somatostatin analogues have become the cornerstones of medical treatment in acromegaly and are even seen as a primary treatment in a selected group of acromegaly patients. The most recent medical treatment available for acromegaly patients is pegvisomant, a growth hormone receptor antagonist. To date, it is the most effective medical treatment, but it is costly. Pegvisomant is used as monotherapy and combined with somatostatin analogues. In this article, we review clinical studies and cohorts that have documented the efficacy of pegvisomant monotherapy and combined therapy and give a concise overview of associated side effects.
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Affiliation(s)
- Sebastian J C M M Neggers
- Section of Endocrinology, Department of Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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44
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Abstract
Available disease-specific questionnaires like the Acromegaly Quality of Life questionnaire have confirmed that quality of life (QoL) is impaired in acromegaly, especially in active disease. Successful therapy improves QoL, but it may not normalize completely even after endocrine cure; furthermore, there is not always a correlation between growth hormone (GH) and insulin-like growth factor 1 and subjective health perception of QoL. Appearance is the dimension most affected and has the highest impact on the patient's QoL. Worse QoL is associated with the presence of musculoskeletal pain, headache (if only medical therapy, not surgery, has been provided), having required treatment with radiotherapy, being older, of female gender, with a longer disease duration, coexisting diabetes mellitus, a higher BMI or becoming GH deficient after treatment for acromegaly.
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Affiliation(s)
- Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigacix00F3;n Biomx00E9;dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Barcelona, Spain
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45
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Schernthaner-Reiter MH, Trivellin G, Stratakis CA. MEN1, MEN4, and Carney Complex: Pathology and Molecular Genetics. Neuroendocrinology 2016; 103:18-31. [PMID: 25592387 PMCID: PMC4497946 DOI: 10.1159/000371819] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/31/2014] [Indexed: 12/17/2022]
Abstract
Pituitary adenomas are a common feature of a subset of endocrine neoplasia syndromes, which have otherwise highly variable disease manifestations. We provide here a review of the clinical features and human molecular genetics of multiple endocrine neoplasia (MEN) type 1 and 4 (MEN1 and MEN4, respectively) and Carney complex (CNC). MEN1, MEN4, and CNC are hereditary autosomal dominant syndromes that can present with pituitary adenomas. MEN1 is caused by inactivating mutations in the MEN1 gene, whose product menin is involved in multiple intracellular pathways contributing to transcriptional control and cell proliferation. MEN1 clinical features include primary hyperparathyroidism, pancreatic neuroendocrine tumours and prolactinomas as well as other pituitary adenomas. A subset of patients with pituitary adenomas and other MEN1 features have mutations in the CDKN1B gene; their disease has been called MEN4. Inactivating mutations in the type 1α regulatory subunit of protein kinase A (PKA; the PRKAR1A gene), that lead to dysregulation and activation of the PKA pathway, are the main genetic cause of CNC, which is clinically characterised by primary pigmented nodular adrenocortical disease, spotty skin pigmentation (lentigines), cardiac and other myxomas and acromegaly due to somatotropinomas or somatotrope hyperplasia.
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Affiliation(s)
- Marie Helene Schernthaner-Reiter
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md., USA
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46
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McCabe J, Ayuk J, Sherlock M. Treatment Factors That Influence Mortality in Acromegaly. Neuroendocrinology 2016; 103:66-74. [PMID: 25661647 DOI: 10.1159/000375163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/12/2015] [Indexed: 11/19/2022]
Abstract
Acromegaly is a rare condition characterized by excessive secretion of growth hormone (GH), which is almost always due to a pituitary adenoma. Acromegaly is associated with significant morbidity such as hypertension, type 2 diabetes, cardiomyopathy, obstructive sleep apnoea, malignancy and musculoskeletal abnormalities. Acromegaly has also been associated with increased mortality in several retrospective studies. This review will focus on the epidemiological data relating to mortality rates in acromegaly, the relationship between acromegaly and malignancy, the role of GH and insulin-like growth factor-I in assessing the risk of future mortality, and the impact of radiotherapy and hypopituitarism on mortality.
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Affiliation(s)
- John McCabe
- Department of Endocrinology, Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Ireland
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47
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The Modern Criteria for Medical Management of Acromegaly. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2016; 138:63-83. [DOI: 10.1016/bs.pmbts.2015.10.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Dal J, List EO, Jørgensen JOL, Berryman DE. Glucose and Fat Metabolism in Acromegaly: From Mice Models to Patient Care. Neuroendocrinology 2016; 103:96-105. [PMID: 25925240 DOI: 10.1159/000430819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/20/2015] [Indexed: 11/19/2022]
Abstract
Patients with active acromegaly are frequently insulin resistant, glucose intolerant, and at risk for developing overt type 2 diabetes. At the same time, these patients have a relatively lean phenotype associated with mobilization and oxidation of free fatty acids. These features are reversed by curative surgical removal of the growth hormone (GH)-producing adenoma. Mouse models of acromegaly share many of these characteristics, including a lean phenotype and proneness to type 2 diabetes. There are, however, also species differences with respect to oxidation rates of glucose and fat as well as the specific mechanisms underlying GH-induced insulin resistance. The impact of acromegaly treatment on insulin sensitivity and glucose tolerance depends on the treatment modality (e.g. somatostatin analogs also suppress insulin secretion, whereas the GH antagonist restores insulin sensitivity). The interplay between animal research and clinical studies has proven useful in the field of acromegaly and should be continued in order to understand the metabolic actions of GH.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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49
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Powlson AS, Gurnell M. Cardiovascular Disease and Sleep-Disordered Breathing in Acromegaly. Neuroendocrinology 2016; 103:75-85. [PMID: 26227953 DOI: 10.1159/000438903] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
Abstract
Treatment goals in acromegaly include symptom relief, tumour control and reversal of the excess morbidity and mortality associated with the disorder. Cardiovascular complications include concentric biventricular hypertrophy and cardiomyopathy, hypertension, valvular heart disease and arrhythmias, while metabolic disturbance (insulin resistance/diabetes mellitus, dyslipidaemia) further increases the risk of cardiovascular and cerebrovascular events. Sleep-disordered breathing (in the form of sleep apnoea) is also common in patients with acromegaly and may exacerbate cardiovascular dysfunction, in addition to contributing to impaired quality of life. Accordingly, and in keeping with evidence that cardiorespiratory complications in acromegaly are not automatically reversed/ameliorated simply through the attainment of 'safe' growth hormone and insulin-like growth factor 1 levels, recent guidelines have emphasised the need not only to achieve stringent biochemical control, but also to identify and independently treat these comorbidities. It is important, therefore, that patients with acromegaly are systematically screened at diagnosis, and periodically thereafter, for the common cardiovascular and respiratory manifestations and that biochemical targets do not become the only treatment goal.
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Affiliation(s)
- Andrew S Powlson
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
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50
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Chanson P. Medical Treatment of Acromegaly with Dopamine Agonists or Somatostatin Analogs. Neuroendocrinology 2016; 103:50-8. [PMID: 25677539 DOI: 10.1159/000377704] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/04/2015] [Indexed: 11/19/2022]
Abstract
Treatment of acromegaly aims to correct (or prevent) tumor compression of surrounding tissues by excising the disease-causing lesion and reduce growth hormone (GH) and IGF-1 levels to normal values. When surgery (the usual first-line treatment) fails to correct GH/IGF-1 hypersecretion, medical treatment with dopamine agonists (DAs; particularly cabergoline) or somatostatin analogs (SAs) can be used. The GH receptor antagonist pegvisomant is helpful in patients who are totally or partially resistant to SAs and can be given in association with both SAs and/or DAs. Thanks to this multistep therapeutic strategy, adequate hormonal disease control is achieved in most patients, giving them normal life expectancy. Comorbidities associated with acromegaly generally improve after treatment, but persistent sequelae may nonetheless impair quality of life.
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Affiliation(s)
- Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, and Inserm 1185, Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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