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Zhang C, Cui T, Cai R, Wangpaichitr M, Mirsaeidi M, Schally AV, Jackson RM. Growth Hormone-Releasing Hormone in Lung Physiology and Pulmonary Disease. Cells 2020; 9:E2331. [PMID: 33096674 PMCID: PMC7589146 DOI: 10.3390/cells9102331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 01/11/2023] Open
Abstract
Growth hormone-releasing hormone (GHRH) is secreted primarily from the hypothalamus, but other tissues, including the lungs, produce it locally. GHRH stimulates the release and secretion of growth hormone (GH) by the pituitary and regulates the production of GH and hepatic insulin-like growth factor-1 (IGF-1). Pituitary-type GHRH-receptors (GHRH-R) are expressed in human lungs, indicating that GHRH or GH could participate in lung development, growth, and repair. GHRH-R antagonists (i.e., synthetic peptides), which we have tested in various models, exert growth-inhibitory effects in lung cancer cells in vitro and in vivo in addition to having anti-inflammatory, anti-oxidative, and pro-apoptotic effects. One antagonist of the GHRH-R used in recent studies reviewed here, MIA-602, lessens both inflammation and fibrosis in a mouse model of bleomycin lung injury. GHRH and its peptide agonists regulate the proliferation of fibroblasts through the modulation of extracellular signal-regulated kinase (ERK) and Akt pathways. In addition to downregulating GH and IGF-1, GHRH-R antagonist MIA-602 inhibits signaling pathways relevant to inflammation, including p21-activated kinase 1-signal transducer and activator of transcription 3/nuclear factor-kappa B (PAK1-STAT3/NF-κB and ERK). MIA-602 induces fibroblast apoptosis in a dose-dependent manner, which is an effect that is likely important in antifibrotic actions. Taken together, the novel data reviewed here show that GHRH is an important peptide that participates in lung homeostasis, inflammation, wound healing, and cancer; and GHRH-R antagonists may have therapeutic potential in lung diseases.
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Affiliation(s)
- Chongxu Zhang
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
| | - Tengjiao Cui
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
| | - Renzhi Cai
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
| | - Medhi Wangpaichitr
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
| | - Mehdi Mirsaeidi
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | - Andrew V. Schally
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33101, USA
- Department of Pathology and Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | - Robert M. Jackson
- Research Service, Miami VAHS, Miami, FL 33125, USA; (C.Z.); (T.C.); (R.C.); (M.W.); (M.M.); (A.V.S.)
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33101, USA
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Langlois F, Suarez GM, Fleseriu M. Updates in rare and not-so-rare complications of acromegaly: focus on respiratory function and quality of life in acromegaly. F1000Res 2020; 9. [PMID: 32765836 PMCID: PMC7391012 DOI: 10.12688/f1000research.22683.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Acromegaly is a complex disease with excessive growth hormone and insulin-like growth factor 1 (IGF-1) causing multisystem effects, particularly cardiovascular, respiratory, and metabolic. Psychological concerns and poor quality of life (QoL) are also major disease consequences. This review is intended for clinicians and focuses on the latest developments related to respiratory and QoL effects of long-term growth hormone excess. Along with biochemical disease control, patient treatment satisfaction and outcomes have become major treatment objectives; current knowledge and tools to evaluate and manage this aspect of the disease are described. Sleep apnea syndrome and other derangements of lung function and apparatus, from pathophysiology to treatment, and evaluation tools and determinants of QoL in patients with acromegaly are discussed.
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Affiliation(s)
- Fabienne Langlois
- Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Gabriela M Suarez
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, CH8N, Portland, OR, 97239, USA
| | - Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, CH8N, Portland, OR, 97239, USA
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Zhang C, Cai R, Lazerson A, Delcroix G, Wangpaichitr M, Mirsaeidi M, Griswold AJ, Schally AV, Jackson RM. Growth Hormone-Releasing Hormone Receptor Antagonist Modulates Lung Inflammation and Fibrosis due to Bleomycin. Lung 2019; 197:541-549. [PMID: 31392398 PMCID: PMC6778540 DOI: 10.1007/s00408-019-00257-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Growth hormone-releasing hormone (GHRH) is a 44-amino acid peptide that regulates growth hormone (GH) secretion. We hypothesized that a GHRH receptor (GHRH-R) antagonist, MIA-602, would inhibit bleomycin-induced lung inflammation and/or fibrosis in C57Bl/6J mice. METHODS We tested whether MIA-602 (5 μg or vehicle given subcutaneously [SC] on days 1-21) would decrease lung inflammation (at day 14) and/or fibrosis (at day 28) in mice treated with intraperitoneal (IP) bleomycin (0.8 units on days 1, 3, 7, 10, 14, and 21). Bleomycin resulted in inflammation and fibrosis around airways and vessels evident histologically at days 14 and 28. RESULTS Inflammation (histopathologic scores assessed blindly) was visibly less evident in mice treated with MIA-602 for 14 days. After 28 days, lung hydroxyproline (HP) content increased significantly in mice treated with vehicle; in contrast, lung HP did not increase significantly compared to naïve controls in mice treated with GHRH-R antagonist. GHRH-R antagonist increased basal and maximal oxygen consumption of cultured lung fibroblasts. Multiple genes related to chemotaxis, IL-1, chemokines, regulation of inflammation, and extracellular signal-regulated kinases (ERK) were upregulated in lungs of mice treated with bleomycin and MIA-602. MIA-602 also prominently suppressed multiple genes related to the cellular immune response including those for T-cell differentiation, receptor signaling, activation, and cytokine production. CONCLUSIONS MIA-602 reduced lung inflammation and fibrosis due to bleomycin. Multiple genes related to immune response and T-cell functions were downregulated, supporting the view that MIA-602 can modulate the cellular immune response to bleomycin lung injury.
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Affiliation(s)
| | - Renzhi Cai
- Research Service, Miami VAHS, Miami, FL, 33125, USA
| | - Aaron Lazerson
- Department of Comparative Pathology, University of Miami, Miami, FL, 33101, USA
| | | | | | - Mehdi Mirsaeidi
- Research Service, Miami VAHS, Miami, FL, 33125, USA
- Department of Medicine, University of Miami, Miami, FL, 33101, USA
| | - Anthony J Griswold
- Dr. John T. MacDonald Foundation Department of Human Genetics, University of Miami, Miami, FL, 33101, USA
| | - Andrew V Schally
- Research Service, Miami VAHS, Miami, FL, 33125, USA
- Department of Medicine, University of Miami, Miami, FL, 33101, USA
- Department of Pathology and Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33101, USA
| | - Robert M Jackson
- Research Service, Miami VAHS, Miami, FL, 33125, USA.
- Department of Medicine, University of Miami, Miami, FL, 33101, USA.
- Research Service, Miami VAHS, 1201 NW 16th Street, Miami, FL, 33125, USA.
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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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García-Álvarez M, Climent V. Sleep apnea and cardiovascular complications of the acromegaly. Response to the medical treatment. MINERVA ENDOCRINOL 2019; 44:159-168. [DOI: 10.23736/s0391-1977.18.02930-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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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Störmann S, Gutt B, Roemmler-Zehrer J, Bidlingmaier M, Huber RM, Schopohl J, Angstwurm MW. Assessment of lung function in a large cohort of patients with acromegaly. Eur J Endocrinol 2017; 177:15-23. [PMID: 28432267 DOI: 10.1530/eje-16-1080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acromegaly is associated with increased mortality due to respiratory disease. To date, lung function in patients with acromegaly has only been assessed in small studies, with contradicting results. We assessed lung function parameters in a large cohort of patients with acromegaly. DESIGN Lung function of acromegaly patients was prospectively assessed using spirometry, blood gas analysis and body plethysmography. Biochemical indicators of acromegaly were assessed through measurement of growth hormone and IGF-I levels. This study was performed at the endocrinology outpatient clinic of a tertiary referral center in Germany. METHODS We prospectively tested lung function of 109 acromegaly patients (53 male, 56 female; aged 24-82 years; 80 with active acromegaly) without severe acute or chronic pulmonary disease. We compared lung volume, air flow, airway resistance and blood gases to normative data. RESULTS Acromegaly patients had greater lung volumes (maximal vital capacity, intra-thoracic gas volume and residual volume: P < 0.001, total lung capacity: P = 0.006) and showed signs of small airway obstruction (reduced maximum expiratory flow when 75% of the forced vital capacity (FVC) has been exhaled: P < 0.001, lesser peak expiratory flow: P = 0.01). There was no significant difference between active and inactive acromegaly. Female patients had significantly altered lung function in terms of subclinical airway obstruction. CONCLUSIONS In our cross-sectional analysis of lung function in 109 patients with acromegaly, lung volumes were increased compared to healthy controls. Additionally, female patients showed signs of subclinical airway obstruction. There was no difference between patients with active acromegaly compared with patients biochemically in remission.
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Affiliation(s)
- Sylvère Störmann
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München und Lungentumorzentrum München, Germany
| | - Bodo Gutt
- Asklepios Klinik BirkenwerderAbteilung für Diabetologie, Birkenwerder, Germany
| | - Josefine Roemmler-Zehrer
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München und Lungentumorzentrum München, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München und Lungentumorzentrum München, Germany
| | - Rudolf M Huber
- Sektion Pneumologie Innenstadt und Thorakale OnkologieMedizinische Klinik und Poliklinik V, Klinikum der Universität München und Lungentumorzentrum München, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München und Lungentumorzentrum München, Germany
| | - Matthias W Angstwurm
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München und Lungentumorzentrum München, Germany
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Camilo GB, Carvalho ARS, Guimarães ARM, Kasuki L, Gadelha MR, Mogami R, de Melo PL, Lopes AJ. Computed tomography airway lumen volumetry in patients with acromegaly: Association with growth hormone levels and lung function. J Med Imaging Radiat Oncol 2017; 61:591-599. [PMID: 28217888 DOI: 10.1111/1754-9485.12598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/23/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The segmentation and skeletonisation of images via computed tomography (CT) airway lumen volumetry provide a new perspective regarding the incorporation of this technique in medical practice. Our aim was to quantify morphological changes in the large airways of patients with acromegaly through CT and, secondarily, to correlate these findings with hormone levels and pulmonary function testing (PFT) parameters. METHODS This was a cross-sectional study in which 28 non-smoker patients with acromegaly and 15 control subjects underwent CT analysis of airway lumen volumetry with subsequent image segmentation and skeletonisation. Moreover, all participants were subjected to PFT. RESULTS Compared with the controls, patients with acromegaly presented higher diameters in the trachea, right main bronchus and left main bronchus. The patients with acromegaly also showed a higher tracheal sinuosity index (the deviation of a line from the shortest path, calculated by dividing total length by shortest possible path) than the controls [1.06 (1.02-1.09) vs. 1.03 (1.02-1.04), P = 0.04], and tracheal stenosis was observed in 25% of these individuals. The tracheal area was correlated with the levels of growth hormone (rs = 0.45, P = 0.02) and insulin-like growth factor type I (rs = 0.38, P = 0.04). The ratio between the forced expiratory flow and forced inspiratory flow at 50% of the forced vital capacity was correlated with the tracheal area (rs = 0.36, P = 0.02) and Δ tracheal diameters (rs = 0.58, P < 0.0001). CONCLUSION Patients with acromegaly exhibit tracheobronchomegaly and tracheal sinuosity/stenosis. Moreover, there are associations between the results of CT airway lumen volumetry, hormone levels and functional parameters of large airway obstruction.
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Affiliation(s)
- Gustavo Bittencourt Camilo
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Faculty of Medical and Health Sciences of Juiz de Fora (SUPREMA), Teresinha de Jesus Hospital and Maternity, Juiz de Fora, Brazil
| | - Alysson Roncally Silva Carvalho
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan Ranieri Medeiros Guimarães
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Roberto Gadelha
- Neuroendocrinology Research Center/Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Mogami
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratory of Pulmonary Function, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pivonello R, Auriemma RS, Grasso LFS, Pivonello C, Simeoli C, Patalano R, Galdiero M, Colao A. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary 2017; 20:46-62. [PMID: 28224405 DOI: 10.1007/s11102-017-0797-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Ludovica F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Mariano Galdiero
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
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Chien CH, Lee MJ, Liou HC, Liou HH, Fu WM. Growth hormone is increased in the lungs and enhances experimental lung metastasis of melanoma in DJ-1 KO mice. BMC Cancer 2016; 16:871. [PMID: 27825319 PMCID: PMC5101681 DOI: 10.1186/s12885-016-2898-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/30/2016] [Indexed: 12/21/2022] Open
Abstract
Background Growth hormone (GH) mainly serves an endocrine function to regulate somatic growth, but also serves an autocrine function in lung growth and pulmonary function. Several recent studies have demonstrated the role of autocrine GH in tumor progression in some organs. However, it is not clear whether excessive secretion of GH in the lungs is related to pulmonary nodule formation. Methods Firstly, the lung tissues dissected from mice were used for Western blotting and PCR measurement. Secondly, the cultured cells were used for examining effects of GH on B16F10 murine melanoma cells. Thirdly, male C57BL/6 mice were intravenously injected with B16F10 cells and then subcutaneously injected with recombinant GH twice per week for three weeks. Finally, stably transfected pool of B16F10 cells with knockdown of growth hormone receptor (GHR) was used to be injected into mice. Results We found that expression of GH was elevated in the lungs of DJ-1 knockout (KO) mice. We also examined the effects of GH on the growth of cultured melanoma cells. The results showed that GH increased proliferation, colony formation, and invasive capacity of B16F10 cells. In addition, GH also increased the expression of matrix metalloproteinases (MMPs) in B16F10 cells. Administration of GH in vivo enhanced lung nodule formation in C57/B6 mice. Increased lung nodule formation in DJ-1 KO mice following intravenous injection of melanoma cells was inhibited by GHR knockdown in B16F10 cells. Conclusions These results indicate that up-regulation of GH in the lungs of DJ-1 KO mice may enhance the malignancy of B16F10 cells and nodule formation in pulmonary metastasis of melanoma. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2898-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chia-Hung Chien
- Institute of Clinical Medicine, National Cheng Kung University, No. 138, Shengli Road, Tainan, 704, Taiwan.,Pharmacological Institute, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 10051, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, No. 367, Shengli Road, Tainan, 704, Taiwan
| | - Ming-Jen Lee
- Department of Neurology, National Taiwan University Hospital, No. 7, Chung-shan South Road, Taipei, 10016, Taiwan
| | - Houng-Chi Liou
- Pharmacological Institute, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 10051, Taiwan
| | - Horng-Huei Liou
- Department of Neurology, National Taiwan University Hospital, No. 7, Chung-shan South Road, Taipei, 10016, Taiwan.,Pharmacological Institute, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 10051, Taiwan
| | - Wen-Mei Fu
- Institute of Clinical Medicine, National Cheng Kung University, No. 138, Shengli Road, Tainan, 704, Taiwan. .,Pharmacological Institute, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 10051, Taiwan. .,Department of Pharmacology, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 10051, Taiwan.
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11
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LENCU CODRUŢA, ALEXESCU TEODORA, PETRULEA MIRELA, LENCU MONICA. Respiratory manifestations in endocrine diseases. CLUJUL MEDICAL (1957) 2016; 89:459-463. [PMID: 27857512 PMCID: PMC5111483 DOI: 10.15386/cjmed-671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 03/22/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
Abstract
The control mechanisms of respiration as a vital function are complex: voluntary - cortical, and involuntary - metabolic, neural, emotional and endocrine. Hormones and hypothalamic neuropeptides (that act as neurotrasmitters and neuromodulators in the central nervous system) play a role in the regulation of respiration and in bronchopulmonary morphology. This article presents respiratory manifestations in adult endocrine diseases that evolve with hormone deficit or hypersecretion. In hyperthyroidism, patients develop ventilation disorders, obstructive and central sleep apnea, and pleural collection. The respiratory abnormalities in hyperthyroidism as a result of the hypermetabolic action of thyroid hormones are hyperventilation, myopathy and cardiovascular involvement; recent studies have reported pulmonary arterial hypertension in Graves' disease, as a result of the association of several mechanisms. Thyroid hypertrophy can induce through compression of the upper airways dyspnea, stridor, wheezing and cough. The respiratory disorders in acromegaly are ventilatory dysfunction and sleep apnea, which contribute to an unfavorable evolution of the disease. Respiratory changes in parathyroid, adrenal and reproductive system diseases have been described. Respiratory disorders should be recognized, investigated and monitored by medical practitioners of various specialties (family physicians, internists, endocrinologists, pneumologists, cardiologists). They are frequently severe, causing an unfavorable evolution of the associated endocrine and respiratory disease.
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Affiliation(s)
- CODRUŢA LENCU
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - TEODORA ALEXESCU
- 4th Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - MIRELA PETRULEA
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - MONICA LENCU
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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Zimmerman L. Pulmonary Complications of Endocrine Diseases. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152263 DOI: 10.1016/b978-1-4557-3383-5.00095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Roelfsema F, van den Berg G. Diagnosis, treatment and clinical perspectives of acromegaly. Expert Rev Endocrinol Metab 2015; 10:619-644. [PMID: 30289037 DOI: 10.1586/17446651.2015.1096770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acromegaly is an insidious disease of the pituitary caused by a growth hormone-secreting adenoma. Generally, the diagnosis is made rather late in the course of the disease. Currently, acromegaly can be cured in about half of the patients with the disease by expert surgery. The remainder of non-surgically cured patients often can be effectively treated with somatostatin analogs; either with the new generation of dopaminergic drugs or with Pegvisomant, a GH-receptor blocking agent. However, at the time of diagnosis many patients suffer from serious comorbidities, including hypertension, heart disease, arthrosis, sleep apnea and diabetes mellitus. Recent reports have shown that mortality risk can be normalized. Nevertheless, all efforts should be undertaken to treat comorbidities. New strategies for surgery and medical treatment are discussed.
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Affiliation(s)
- Ferdinand Roelfsema
- a Department of Endocrinology and Metabolism , Leiden University Medical Center , Leiden , The Netherlands
| | - Gerrit van den Berg
- b Department of Endocrinology and Metabolic Diseases, University Medical Center of Groningen , University of Groningen , Groningen , The Netherlands
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14
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Rodrigues MP, Naves LA, Viegas CA, Melo-Silva CA, de Paula WD, Cabral MT, Araújo RR, Casulari LA. Prevalence of lung structure abnormalities in patients with acromegaly and their relationship with gas exchange: cross-sectional analytical study with a control group. SAO PAULO MED J 2015; 133:394-400. [PMID: 26648427 PMCID: PMC10871800 DOI: 10.1590/1516-3180.2013.7640012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 03/23/2014] [Accepted: 03/26/2014] [Indexed: 01/15/2023] Open
Abstract
CONTEXT AND OBJECTIVE Different functional respiratory alterations have been described in acromegaly, but their relationship with pulmonary tissue abnormalities is unknown. The objective of this study was to observe possible changes in lung structure and explain their relationship with gas exchange abnormalities. DESIGN AND SETTING Cross-sectional analytical study with a control group, conducted at a university hospital. METHODS The study included 36 patients with acromegaly and 24 controls who were all assessed through high-resolution computed tomography of the thorax (CT). Arterial blood gas, effort oximetry and serum growth hormone (GH) and insulin-like growth factor I (IGF-1) were also assessed in the patients with acromegaly. RESULTS The abnormalities found in the CT scan were not statistically different between the acromegaly and control groups: mild cylindrical bronchiectasis (P = 0.59), linear opacity (P = 0.29), nodular opacity (P = 0.28), increased attenuation (frosted glass; P = 0.48) and decreased attenuation (emphysema; P = 0.32). Radiographic abnormalities were not associated with serum GH and IGF-1. Hypoxemia was present in seven patients; however, in six of them, the hypoxemia could be explained by underlying clinical conditions other than acromegaly: chronic obstructive pulmonary disease in two, obesity in two, bronchial infection in one and asthma in one. CONCLUSION No changes in lung structure were detected through thorax tomography in comparison with the control subjects. The functional respiratory alterations found were largely explained by alternative diagnoses or had subclinical manifestations, without any plausible relationship with lung structural factors.
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Affiliation(s)
- Marcelo Palmeira Rodrigues
- MD, MSc, PhD. Adjunct Professor of Pneumology, School of Medicine, Universidade de Brasília (UnB), Brasília, Brazil
| | - Luciana Ansaneli Naves
- MD, MSc, PhD. Adjunct Professor of Endocrinology, School of Medicine, Universidade de Brasília (UnB), Brasília, Brazil
| | - Carlos Alberto Viegas
- MD, MSc, PhD. Adjunct Professor of Pneumology, School of Medicine, Universidade de Brasília (UnB), Brasília, Brazil
| | - Cesar Augusto Melo-Silva
- MSc, PhD. Physiotherapist, Department of Pneumology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Wagner Diniz de Paula
- MD. Physician, Department of Radiology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Márcia Teixeira Cabral
- MD. Physician, Department of Radiology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Renata Rodrigues Araújo
- MD. Physician, Department of Pneumology, Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Luiz Augusto Casulari
- MD, MSc, PhD. Physician, Department of Endocrinology, Hospital Universitário de Brasília (HUB), Universidade de Brasília (UnB), Brasília, Brazil
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15
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Camilo GB, Carvalho ARS, Machado DC, Mogami R, Melo PL, Lopes AJ. CT pulmonary densitovolumetry in patients with acromegaly: a comparison between active disease and controlled disease. Br J Radiol 2015; 88:20150315. [PMID: 26246281 DOI: 10.1259/bjr.20150315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Our purpose was to compare the findings of CT pulmonary densitovolumetry and pulmonary function in patients with active acromegaly and controlled acromegaly and, secondarily, to correlate these findings. METHODS 11 patients with active acromegaly, 18 patients with controlled acromegaly and 17 control subjects, all non-smokers, underwent quantification of lung volume using multidetector CT (Q-MDCT) and pulmonary function tests. RESULTS Patients with active acromegaly had larger total lung mass (TLM) values than the controls and larger amounts of non-aerated compartments than the other two groups. Patients with active acromegaly also had larger amounts of poorly aerated compartments than the other two groups, a difference that was observed in both total lung volume (TLV) and TLM. TLV as measured by inspiratory Q-MDCT correlated significantly with total lung capacity, whereas TLV measured using expiratory Q-MDCT correlated significantly with functional residual capacity. CONCLUSION Patients with active acromegaly have more lung mass and larger amounts of non-aerated and poorly aerated compartments. There is a relationship between the findings of CT pulmonary densitovolumetry and pulmonary function test parameters. ADVANCES IN KNOWLEDGE Although the nature of our results demands further investigation, our data suggest that both CT pulmonary densitovolumetry and pulmonary function tests can be used as useful tools for patients with acromegaly by assisting in the prediction of disease activity.
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Affiliation(s)
- Gustavo B Camilo
- 1 Post-graduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,2 Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,3 State Institute of Brain Paulo Niemeyer, Rio de Janeiro, Brazil.,4 Faculty of Medical and Health Sciences of Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Alysson R S Carvalho
- 5 Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,6 Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dequitier C Machado
- 1 Post-graduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,2 Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Mogami
- 1 Post-graduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,2 Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro L Melo
- 7 Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,8 Post-graduate Program in Clinical and Experimental Physiopathology (FISCLINEX), School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo J Lopes
- 1 Post-graduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,9 Laboratory of Pulmonary Function, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Camilo GB, Carvalho ARS, Machado DC, Mogami R, Kasuki L, Gadelha MR, Melo PL, Lopes AJ. Correlations between forced oscillation technique parameters and pulmonary densitovolumetry values in patients with acromegaly. ACTA ACUST UNITED AC 2015; 48:877-85. [PMID: 26445330 PMCID: PMC4617113 DOI: 10.1590/1414-431x20154786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/29/2015] [Indexed: 01/17/2023]
Abstract
The aims of this study were to evaluate the forced oscillation technique (FOT) and
pulmonary densitovolumetry in acromegalic patients and to examine the correlations
between these findings. In this cross-sectional study, 29 non-smoking acromegalic
patients and 17 paired controls were subjected to the FOT and quantification of lung
volume using multidetector computed tomography (Q-MDCT). Compared with the controls,
the acromegalic patients had a higher value for resonance frequency [15.3 (10.9-19.7)
vs 11.4 (9.05-17.6) Hz, P=0.023] and a lower value for mean
reactance [0.32 (0.21-0.64) vs 0.49 (0.34-0.96) cm
H2O/L/s2, P=0.005]. In inspiratory Q-MDCT, the acromegalic
patients had higher percentages of total lung volume (TLV) for nonaerated and poorly
aerated areas [0.42% (0.30-0.51%) vs 0.25% (0.20-0.32%), P=0.039 and
3.25% (2.48-3.46%) vs 1.70% (1.45-2.15%), P=0.001, respectively].
Furthermore, the acromegalic patients had higher values for total lung mass in both
inspiratory and expiratory Q-MDCT [821 (635-923) vs 696 (599-769) g,
P=0.021 and 844 (650-945) vs 637 (536-736) g, P=0.009,
respectively]. In inspiratory Q-MDCT, TLV showed significant correlations with all
FOT parameters. The TLV of hyperaerated areas showed significant correlations with
intercept resistance (rs=−0.602, P<0.001) and mean resistance
(rs=−0.580, P<0.001). These data showed that acromegalic patients
have increased amounts of lung tissue as well as nonaerated and poorly aerated areas.
Functionally, there was a loss of homogeneity of the respiratory system. Moreover,
there were correlations between the structural and functional findings of the
respiratory system, consistent with the pathophysiology of the disease.
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Affiliation(s)
- G B Camilo
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - A R S Carvalho
- Laboratório de Fisiologia da Respiração, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - D C Machado
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - R Mogami
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - L Kasuki
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, BR
| | - M R Gadelha
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, BR
| | - P L Melo
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - A J Lopes
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
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17
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Camilo GB, Guimarães FS, Silva DPG, Mogami R, Kasuki L, Gadelha MR, Melo PL, Lopes AJ. Pulmonary function testing and chest tomography in patients with acromegaly. Multidiscip Respir Med 2013; 8:70. [PMID: 24219873 PMCID: PMC3831601 DOI: 10.1186/2049-6958-8-70] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/04/2013] [Indexed: 12/26/2022] Open
Abstract
Background Despite the gradual improvement in treatment procedures and cure rates of acromegaly, a steady increase in the mortality rate due to respiratory disease has been documented in recent decades. In this study, our objectives were to describe the abnormalities in lung structure and function that occur in acromegalic patients and to correlate these changes with hormonal levels. Methods This cross-sectional study included 20 acromegalic patients and 20 age-and height-matched control subjects, all non-smokers. All subjects underwent spirometry, whole body plethysmography, carbon monoxide diffusing capacity, and respiratory muscle strength. Acromegalic patients also performed high-resolution computed tomography (HRCT). Results Most patients were female (65%), with a mean age of 52.5 ± 13 years. Acromegalic patients showed lower values of maximum expiratory pressure (55.9 ± 17.1 vs. 103.7 ± 19.2%; p < 0.001) and maximum inspiratory pressure (71.4 ± 27.8 vs. 85.3 ± 24.1%; p = 0.005) compared to control subjects. The values of forced vital capacity (107.1 ± 15.9 vs. 98.9 ± 21.4%; p = 0.028), total lung capacity – TLC (107.3 ± 12.9 vs. 93.7 ± 7.60%; p = 0.002), residual volume (114.1 ± 22.7 vs. 90.0 ± 14.6%; p < 0.001), and airways’ resistance (3.82 vs. 2.31 cmH2O/L/s; p = 0.039) were greater in acromegalic patients than in control subjects. The difference between the TLC measured by plethysmography and the VA (alveolar volume) measured during the DLCO maneuver was higher in acromegalic patients than in control subjects (0.69 ± 0.46 vs. 0.19 ± 0.61 L; p = 0.021). The main findings in HRCT in acromegalic patients were air trapping, airway calcification and bronchiectasis, which were observed in 60%, 40% and 35% of cases, respectively. There was no significant correlation between the levels of growth hormone and insulin-like growth factor I, the lung function and the air trapping. Conclusions Acromegalic patients show changes consistent with the involvement of the small airways and ventilation inhomogeneity, both in terms of lung function and structure. However, air trapping cannot be explained either by hormone levels or changes in lung function.
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Affiliation(s)
| | | | | | | | | | | | | | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030, Brazil.
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18
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Torres I, Allona M, Martínez M, Lores V, Rojo B, García-Río F. Diferencias en función de la gravedad de la atenuación pulmonar en varones con EPOC. Arch Bronconeumol 2010; 46:56-63. [DOI: 10.1016/j.arbres.2009.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 09/07/2009] [Accepted: 09/14/2009] [Indexed: 11/29/2022]
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Abstract
Acromegaly is caused by growth hormone hypersecretion, mostly from a pituitary adenoma, driving insulin-like growth factor 1 overproduction. Manifestations include skeletal and soft tissue growth and deformities; and cardiac, respiratory, neuromuscular, endocrine, and metabolic complications. Increased morbidity and mortality require early and tight disease control. Surgery is the treatment of choice for microadenomas and well-defined intrasellar macroadenomas. Complete resection of large and invasive macroadenomas rarely is achieved; hence, their low rate of disease remission. Pharmacologic treatments, including long-acting somatostatin analogs, dopamine agonists, and growth hormone receptor antagonists, have assumed more importance in achieving biochemical and symptomatic disease control.
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Affiliation(s)
- Anat Ben-Shlomo
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
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García-Río F, Villamor A, Gómez-Mendieta A, Lores V, Rojo B, Ramírez T, Villamor J. The progressive effects of ageing on chemosensitivity in healthy subjects. Respir Med 2007; 101:2192-8. [PMID: 17643972 DOI: 10.1016/j.rmed.2007.04.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 02/26/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare the central inspiratory drive (P(0.1)) response to hypoxia and hypercapnia between different age groups of elderly, nonsmoker, healthy subjects and young healthy controls. A random sample, proportionally stratified by age (65-69, 70-74, 75-79 and 80-84 yrs) from a sample of nonsmoker elderly subjects representative of a general population and 47 healthy subjects aged 20-40 were selected. Arterial blood gas, lung volumes, diffusing capacity, maximal respiratory pressure and oxygen uptake measurements were performed. Breathing pattern and mouth occlusion pressure, as well as P(0.1) responses to hyperoxic progressive hypercapnia and isocapnic progressive hypoxia were evaluated. The elderly subjects had lower P0.1 responses to hypoxia (0.017+/-0.006 vs. 0.031+/-0.008 kPa/%, P<0.001) and hypercapnia (0.042+/-0.018 vs. 0.051+/-0.030 kPa/mmHg, P=0.047) than the young healthy controls. Hypoxic sensitivity gradually decreased as age increased to 70-74 and remained unchanged from 75 years of age onward. CO(2) threshold was lower in the elderly groups than in young healthy controls. Lung volumes, inspiratory muscle strength and baseline metabolic rate were the principal determinants of hypoxic sensitivity. In summary, during old age, a progressive decline in hypoxic sensitivity and a decrease in the CO(2) threshold are experienced. These alterations remain stable from the age of 75 onward.
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Affiliation(s)
- Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, Alfredo Marqueríe 11, 28034-Madrid, Spain.
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Beyea JA, Olson DM, Harvey S. Growth hormone (GH) action in the developing lung: Changes in lung proteins after adenoviral GH overexpression. Dev Dyn 2005; 234:404-12. [PMID: 16127721 DOI: 10.1002/dvdy.20538] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Growth hormone (GH) recently has been shown to be expressed in the neonatal rat lung during alveolarization. The possible functional importance of lung GH in lung function, therefore, has been assessed by determining changes in GH-responsive proteins in the developing rat lung after the overexpression of the GH gene in this tissue. GH overexpression was achieved using an adenovirus that expressed the mouse GH gene. This adenovirus was effective in inducing mouse GH expression in cultured rat lung L2 epithelial cells. It was also shown to be strongly expressed in the alveoli of 14-day-old rat pup lungs 10 days after it was administered by intratracheal injection, during a period of rapid lung development. Expression of the transgene in these pups was accompanied by changes in lung protein concentrations determined by two-dimensional gel electrophoresis and mass spectrometry. The lung concentrations of specific enzymes (nucleotide diphosphate kinase B, Cu/Zn superoxide dismutase, glutathione-S-transferase, and aldehyde reductase-1) were increased by the adenoviral expression of mouse GH, as were the concentrations of beta subunit G-protein calponin 2, beta-5 tubulin, retinoblastoma binding protein 4, and fetuin A. In contrast, the lung concentrations of haptoglobin and major acute phase alpha-1 protein were reduced by adenoviral expression of mouse GH. Although most of these proteins have not previously been identified as GH-responsive proteins, these results demonstrate actions of GH in the rat lung and support the possibility that GH acts as an autocrine/paracrine during early lung development.
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Affiliation(s)
- Jason A Beyea
- Department of Physiology and Perinatal Research Centre, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Mortality is increased in individuals with acromegaly unless serum growth hormone (GH) levels are below 2 microg/l and serum insulin-like growth factor (IGF)-I levels are normal following treatment. These combined criteria have been used to define remission of the disorder in this review. Transsphenoidal surgery achieves remission targets in an average of 55% of patients. For those not in remission following surgery, options include repeat surgery or use of adjuvant therapy. Fractionated external beam pituitary radiotherapy achieves 10-year remission rates of 47% but leaves patients exposed to excess GH until remission occurs. Stereotactic radiotherapy and gamma knife radiosurgery achieve remission rates of 40% over 3 years, and dopamine agonists produce remission in about 20% of patients. Somatostatin analogues induce remission in 59% of patients within the first year of treatment. The GH receptor antagonist pegvisomant leads to remission in 90% of patients, using IGF-I levels for assessment. Optimal treatment for a patient with acromegaly thus depends on the likely efficacy of treatment, cost, surgical skill, severity of side effects, tolerability, control of tumour growth, and improvement in complications related to tumour mass. A primary surgical approach, followed by medical therapy for those not in remission, remains the preferred option in most centres.
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Affiliation(s)
- Ian M Holdaway
- Department of Endocrinology, Auckland Hospital, Auckland, New Zealand.
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24
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Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004; 25:102-52. [PMID: 14769829 DOI: 10.1210/er.2002-0022] [Citation(s) in RCA: 804] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases, although currently neoplastic complications have been questioned as a relevant cause of increased risk of death. Biventricular hypertrophy, occurring independently of hypertension and metabolic complications, is the most frequent cardiac complication. Diastolic and systolic dysfunction develops along with disease duration; and other cardiac disorders, such as arrhythmias, valve disease, hypertension, atherosclerosis, and endothelial dysfunction, are also common in acromegaly. Control of acromegaly by surgery or pharmacotherapy, especially somatostatin analogs, improves cardiovascular morbidity. Respiratory disorders, sleep apnea, and ventilatory dysfunction are also important contributors in increasing mortality and are advantageously benefitted by controlling GH and IGF-I hypersecretion. An increased risk of colonic polyps, which more frequently recur in patients not controlled after treatment, has been reported by several independent investigations, although malignancies in other organs have also been described, but less convincingly than at the gastrointestinal level. Finally, the most important cause of morbidity and functional disability of the disease is arthropathy, which can be reversed at an initial stage, but not if the disease is left untreated for several years.
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Affiliation(s)
- Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, 80131 Naples, Italy.
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Tobin MJ. Sleep-disordered breathing, control of breathing, respiratory muscles, and pulmonary function testing in AJRCCM 2001. Am J Respir Crit Care Med 2002; 165:584-97. [PMID: 11874806 DOI: 10.1164/ajrccm.165.5.2201061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Route 11N, Hines, Illinois 60141, USA.
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