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Walbrodt S, Wrede KH, Chmielewski WX, Dinger TF, Schüβler M, Deuschl C, Chihi M, Gull HH, Jabbarli R, Oppong MD, Lenkeit A, Uerschels AK, Gembruch O, Kreitschmann-Andermahr I, Scheffler B, Sure U, Ahmadipour Y. The influence of radiological tumor growth pattern on sino‑nasal health in pituitary adenomas. Oncol Lett 2024; 27:125. [PMID: 38333639 PMCID: PMC10851331 DOI: 10.3892/ol.2024.14258] [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: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 02/10/2024] Open
Abstract
Pituitary adenomas are one of the most common mass lesions of the brain and are associated with a reduced quality of life. While transnasal and transsphenoidal endoscopic approaches are considered to deliver similar recovery rates for sino-nasal health (SNH), the impact of radiological tumor growth patterns on SNH has not been evaluated. In the present study, the influence of radiological tumor growth on SNH was examined before and after endoscopic transsphenoidal tumor resection. Patient data were prospectively collected between August 1, 2016 and August 31, 2022. The Knosp and Hardy classifications were used to dichotomize pituitary adenoma lesions into low- and high-graded lesions. SNH was assessed shortly before surgery and at follow-up examinations 3-6 months after operation using the Sino-Nasal Outcome Test for Neurosurgery (SNOT-NC) questionnaire. Fully completed SNOT-NC questionnaires were collected before and after surgery from a total of 101 patients. Independent t-tests showed significantly higher rates of deterioration after surgery in patients with Knosp low-graded lesions compared with those with high-graded tumors for the SNOT-NC total score P=0.048, nasal discomfort P=0.034, sleep problems P=0.024 and visual impairment P=0.042. Pre- and post-operative comparisons for the Knosp low-graded tumor cohort showed an increase of nasal discomfort (P=0.004), while the Knosp high-graded tumor cohort reported decreased visual impairment (P=0.016) after surgery. Assessing the Hardy classification, increased nasal discomfort was reported in patients with high-graded infrasellar tumors after surgery (P=0.046). Growth characteristics of pituitary adenomas based on Knosp and Hardy classifications may influence SNH. Patients with less invasive lesions were revealed to be more prone to experiencing a decrease in SNH, which went beyond the assumed deterioration of 1-3 months. These findings indicate the importance of detailed information regarding SNH as part of every pre-operative patient briefing.
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Affiliation(s)
- Sebastian Walbrodt
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Witold X. Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Maximilian Schüβler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Hanah Hadice Gull
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
- German Cancer Research Center-Division Translational Neurooncology at The West German Cancer Center, University Hospital Essen, D‑45147 Essen, Germany
- West German Cancer Center, University Hospital Essen, D-45147 Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Annika Lenkeit
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Anne-Kathrin Uerschels
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Björn Scheffler
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
- German Cancer Research Center-Division Translational Neurooncology at The West German Cancer Center, University Hospital Essen, D‑45147 Essen, Germany
- West German Cancer Center, University Hospital Essen, D-45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, D‑45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D‑45147 Essen, Germany
- German Cancer Research Center-Division Translational Neurooncology at The West German Cancer Center, University Hospital Essen, D‑45147 Essen, Germany
- West German Cancer Center, University Hospital Essen, D-45147 Essen, Germany
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Jurek A, Krzesiński P, Wierzbowski R, Uziębło-Życzkowska B, Witek P, Zieliński G, Kazimierczak A, Banak M, Gielerak G. The Heart's Function as a Pump Assessed via Impedance Cardiography and the Autonomic System Balance in Patients with Early-Stage Acromegaly. J Clin Med 2024; 13:395. [PMID: 38256528 PMCID: PMC10816868 DOI: 10.3390/jcm13020395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Acromegaly is a rare, chronic disease that involves structural and functional abnormalities of the cardiovascular system. Acromegaly likely affects interactions between the cardiovascular system and the autonomic nervous system (ANS). Therefore, assessing the relationship between sympathetic-parasympathetic balance by analyzing heart rate variability (HRV) and the hemodynamic profile via impedance cardiography (ICG) may be useful in learning the exact nature of interactions between the ANS and the cardiovascular system. The purpose of this study was to assess a possible association between HRV and ICG-based parameters of cardiac function in patients newly diagnosed with acromegaly. METHODS This observational cohort study was conducted on 33 patients (18 men, mean age of 47 years) newly diagnosed with acromegaly and no significant comorbidities. A correlation analysis (Spearman's rank coefficient R) of the parameters assessed via ICG and the HRV assessed via 24 h ambulatory electrocardiography was performed. ICG assessments included the following parameters: stroke volume index (SI), cardiac index (CI), acceleration index (ACI), velocity index (VI), and Heather index (HI). The analysis of HRV included both time-domain parameters (pNN50, SDNN, SDSD, rMSSD) and frequency-domain parameters (total power (TP) and its individual frequency bands: low-frequency (LF day/night), high-frequency (HF day/night), and the LF/HF ratio (day/night)). RESULTS Frequency-domain HRV analysis showed the following correlations: (1) lower nighttime LF values with higher ACI (R = -0.38; p = 0.027) and HI (R = -0.46; p = 0.007) values; (2) higher nighttime HF values with higher ACI (R = 0.39; p = 0.027) and HI (R = 0.43; p = 0.014) values; (3) lower nighttime LF/HF values with higher ACI (R = -0.36; p = 0.037) and HI (R = -0.42; p = 0.014) values; (4) higher nighttime TP values with higher SI values (R = 0.35; p = 0.049). Time-domain parameters of HRV showed a significant correlation only between the nighttime values of SDSD and SI (R = 0.35; p = 0.049) and between the daytime and nighttime values of SDNN and HR (R = -0.50; p = 0.003 and R = -0.35; p = 0.046). In multivariate regression, only ACI was revealed to be independently related to HRV. CONCLUSIONS In patients newly diagnosed with acromegaly, the relationship between the sympathetic-parasympathetic balance assessed via HRV and the hemodynamic profile assessed via ICG was revealed. Better function of the left ventricle was associated with a parasympathetic shift in the autonomic balance.
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Affiliation(s)
- Agnieszka Jurek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
| | - Paweł Krzesiński
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
| | - Robert Wierzbowski
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology, and Diabetology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland;
| | - Anna Kazimierczak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
| | - Małgorzata Banak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine–National Research Institute, 04-141 Warsaw, Poland; (P.K.)
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Wolf P, Maione L, Kamenický P, Chanson P. Acromegalic Cardiomyopathy: An Entity on its own? The Effects of GH and IGF-I Excess and Treatment on Cardiovascular Risk Factors. Arch Med Res 2023; 54:102921. [PMID: 38040526 DOI: 10.1016/j.arcmed.2023.102921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
Acromegaly is a chronic disease resulting from constantly elevated concentrations of growth hormone (GH) and insulin-like growth factor I (IGF-I). If not adequately treated, GH and IGF-I excess is associated with various cardiovascular risk factors. These symptoms mainly include hypertension and impaired glucose metabolism, which can be observed in approximately one-third of patients. Other comorbidities are dyslipidemia and the presence of obstructive sleep apnea syndrome. However, even in the absence of conventional cardiovascular risk factors, myocardial hypertrophy can occur, which reflects the impact of GH and IGF-I excess itself on the myocardium and is defined as acromegalic cardiomyopathy. Whereas previous echocardiography-based studies reported a high prevalence of cardiomyopathy, this prevalence is much lower in cardiac magnetic resonance imaging-based studies. Myocardial hypertrophy in acromegaly is due to a homogeneous increase in the intracellular myocardial mass and extracellular myocardial matrix and improves following successful treatment through intracellular changes. Intramyocardial water retention or ectopic lipid accumulation might not be of relevant concern. Successful treatment significantly improves myocardial morphology, as well as cardiovascular risk factors. In addition to GH/IGF-I-lowering therapy, the diagnosis and treatment of cardiovascular complications is crucial for the successful management of acromegaly.
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Affiliation(s)
- Peter Wolf
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, Assistance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin-Bicêtre, France; Physiologie et Physiopathologie Endocriniennes, INSERM, Le Kremlin-Bicêtre, France; Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Luigi Maione
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, Assistance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin-Bicêtre, France; Physiologie et Physiopathologie Endocriniennes, INSERM, Le Kremlin-Bicêtre, France
| | - Peter Kamenický
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, Assistance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin-Bicêtre, France; Physiologie et Physiopathologie Endocriniennes, INSERM, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, Assistance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin-Bicêtre, France; Physiologie et Physiopathologie Endocriniennes, INSERM, Le Kremlin-Bicêtre, France.
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Statello R, Rossi S, Pisani F, Bonzini M, Andreoli R, Martini A, Puligheddu M, Cocco P, Miragoli M. Nocturnal Heart Rate Variability Might Help in Predicting Severe Obstructive Sleep-Disordered Breathing. BIOLOGY 2023; 12:biology12040533. [PMID: 37106734 PMCID: PMC10135696 DOI: 10.3390/biology12040533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Obstructive sleep apnea (OSA) can have long-term cardiovascular and metabolic effects. The identification of OSA-related impairments would provide diagnostic and prognostic value. Heart rate variability (HRV) as a measure of cardiac autonomic regulation is a promising candidate marker of OSA and OSA-related conditions. We took advantage of the Physionet Apnea-ECG database for two purposes. First, we performed time- and frequency-domain analysis of nocturnal HRV on each recording of this database to evaluate the cardiac autonomic regulation in patients with nighttime sleep breathing disorders. Second, we conducted a logistic regression analysis (backward stepwise) to identify the HRV indices able to predict the apnea–hypopnea index (AHI) categories (i.e., “Severe OSA”, AHI ≥ 30; “Moderate-Mild OSA”, 5 ≥ AHI < 30; and “Normal”, AHI < 5). Compared to the “Normal”, the “Severe OSA” group showed lower high-frequency power in normalized units (HFnu) and higher low-frequency power in normalized units (LFnu). The standard deviation of normal R–R intervals (SDNN) and the root mean square of successive R–R interval differences (RMSSD) were independently associated with sleep-disordered breathing. Our findings suggest altered cardiac autonomic regulation with a reduced parasympathetic component in OSA patients and suggest a role of nighttime HRV in the characterization and identification of sleep breathing disorders.
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Akset M, Poppe KG, Kleynen P, Bold I, Bruyneel M. Endocrine disorders in obstructive sleep apnoea syndrome: A bidirectional relationship. Clin Endocrinol (Oxf) 2023; 98:3-13. [PMID: 35182448 DOI: 10.1111/cen.14685] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/21/2021] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common disorder characterized by recurrent episodes of apnoea or hypopnea due to total or partial pharyngeal collapse and temporary upper airway obstruction during sleep. The prevalence of OSA is increasing and currently affects about 30% of men and 13% of women in Europe. Intermittent hypoxia, oxidative stress, systemic inflammation, and sleep fragmentation resulting from OSA can provoke subsequent cardiometabolic disorders. The relationships between endocrine disorders and OSA are complex and bidirectional. Indeed, several endocrine disorders are risk factors for OSA. Compared with the general population, the prevalence of OSA is increased in patients with obesity, hypothyroidism, acromegaly, Cushing syndrome, and type 1 and 2 diabetes. In some cases, treatment of the underlying endocrine disorder can improve, and occasionally cure, OSA. On the other hand, OSA can also induce endocrine disorders, particularly glucose metabolism abnormalities. Whether continuous positive airway pressure (CPAP) treatment for OSA can improve these endocrine disturbances remains unclear due to the presence of several confounding factors. In this review, we discuss the current state-of-the-art based on the review of the current medical literature for key articles focusing on the bidirectional relationship between endocrine disorders and OSA and the effects of treatment. Screening of OSA in endocrine patients is also discussed, as it remains a subject of debate.
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Affiliation(s)
- Maud Akset
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kris Gustave Poppe
- Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Kleynen
- Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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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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Zhang X, Ma J, Li L, Gan L, He H, Shao E, Guo X, Zhu H, You H, Zhong Y, Xing B. Elevated IGF-1 and GH Levels Are Correlated With a Thicker Iris and Wider Anterior Chamber Angle in Treatment-Naïve Acromegaly Patients. Invest Ophthalmol Vis Sci 2022; 63:27. [PMID: 36306142 PMCID: PMC9624272 DOI: 10.1167/iovs.63.11.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the difference in anterior segment biometrics derived from anterior segment optical coherence tomography (AS-OCT) between treatment-naïve acromegaly patients and normal controls and evaluate the correlations between above biometrics and insulin-like growth factor 1 (IGF-1) and growth hormone (GH) levels. Methods Sixty eyes of 30 acromegaly patients and 60 eyes of 30 normal controls were included in this case-control study. Central corneal thickness, pupil diameter, iris thickness (IT), iris curvature (IC), anterior chamber depth (ACD), anterior chamber width, lens vault (LV), angle open distance (AOD) 500, AOD750, and trabecular iris space area (TISA) 500 and TISA750 were measured by AS-OCT. General linear regression models were constructed to evaluate the independent endocrine factors affecting iris morphology and anterior chamber angle (ACA) width. Results The acromegaly patients had an evenly thicker iris (P < 0.001), a smaller IC (P < 0.05), a smaller LV (P = 0.040) and significantly larger AOD500, AOD750, TISA500 and TISA750 (P < 0.001). There was a positive correlation between the serum GH level and ACD in the acromegaly patients (P = 0.031). Linear regression models showed the lower LV and smaller IC were independent influencing factors of the increase in the AOD500, AOD750, and TISA750 and nasal TISA500. Serum IGF-1 was an independent factor for the increase in pupil diameter (β = 0.002, P = 0.031) and both the average nasal (β = 6.781*10−5, P = 0.049) and temporal (β = 7.736*10−5, P = 0.045) IT values and for the decrease in temporal IC (β < 0.001, P = 0.037). GH was an independent factor for the increase in temporal AOD750 (β = 0.001, P = 0.030) and temporal TISA750 (β = 0.002, P = 0.016). Conclusions Patients with acromegaly have a thicker IT, smaller IC, and lower LV with a wider ACA than normal controls. Serum GH is independently correlated with the temporal ACA width, whereas serum IGF-1 is independently correlated with IT, pupil diameter, and IC.
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Affiliation(s)
- Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lüe Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linyang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Enhua Shao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Alteration in choroidal microvasculature determined by optical coherence tomography angiography in patients with acromegaly. Photodiagnosis Photodyn Ther 2021; 36:102590. [PMID: 34673271 DOI: 10.1016/j.pdpdt.2021.102590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022]
Abstract
AIM We aimed to investigate the retinal layers and macular capillary structure using optical coherence tomography angiography (OCTA) with acromegaly patients and determine the relationship between OCTA parameters and disease duration, Growth hormone (GH) and Insuline growth factor (IGF - 1) levels. PATIENTS AND METHOD Twenty-two patients with acromegaly who were followed up in the endocrinology outpatient clinic of Sisli Hamidiye Etfal Health Training and Research Hospital, were recruited into the study. Healthy control group was consisted of 22 age and gender matched subjects. Complete opthalmological examination including best visual acuity (BCVA), axial lenght, intraocular pressure (IOP) measurement, anterior segment and fundus examination, central corneal thickness with pachymetry and OCTA measurement were performed in the patients and healthy control group. Foveal avascular zone (FAZ), foveal vascular density (FVD), parafoveal vascular density (PFVD), choroidal flow (CF), foveal thickness (FT) and choroidal thickness (CT) were compared beetwen groups. Correlation between disease duration, GH and IGF-1 levels and OCTA parameters were evaluated. RESULTS There was no statistically significant difference between the groups in terms of BCVA, axial length, IOP, FT, FAZ, FD and PFVD. Choroidal thickness and CF was significantly high in the patients group compared to healthy controls (respectively, p = 0.003, p = 0.022). The mean follow-up period in patients with acromegaly was 90±50.2 months. There was a significant correlation between GH and subfoveal choroidal thickness in the patient group (p < 0.001, r = 0.52), a significant correlation was determined between disease duration and corneal thickness (p = 0.01, r = 0.41). In addition, an inverse correlation was detected between the IGF-1 level and the FAZ domain (p = 0.022, r= -0.34). CONCLUSION In patients with acromegaly, choroidal vasculature seems to be more affected than the retinal vasculature.
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Sagan KP, Andrysiak-Mamos E, Tyburski E, Sagan LM, Syrenicz A. Quality of Life and Sleep in Patients with Pituitary Adenoma in Relation to Tumor Type and Compression of the Optic Chiasm. J Clin Med 2021; 10:jcm10091879. [PMID: 33926090 PMCID: PMC8123647 DOI: 10.3390/jcm10091879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the effect of transsphenoidal surgery on quality of life and sleep in patients with pituitary adenomas depending on tumor type and compression of the optic chiasm. Methods: In this prospective study, patients with pituitary adenomas who were scheduled for transsphenoidal surgery completed the Short Form 36 Questionnaire, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale preoperatively and 7.5 (±1.5) months after surgery. Patients were analyzed based on tumor type and compression of the optic chiasm. Results: Significant improvements with large effect sizes were seen for patients with Cushing’s disease in general health (Z = −2.37; p = 0.018), vitality (Z = −2.05; p = 0.041), and mental health (Z = −2.06; p = 0.040). A significant deterioration with large effect size occurred in physical functioning (Z = −2.02; p = 0.043) in patients with acromegaly. A significant improvement with medium effect size was seen in subjective sleep quality, (Z = −2.24; p = 0.025), sleep duration (Z = −2.11; p = 0.035), and habitual sleep efficiency (Z = −2.26; p = 0.024) after decompression of the optic chiasm. Multiple significant correlations were observed between sleep parameters and Short Form 36 subscales before and after treatment. Conclusions: Changes in quality of life during the follow-up period depend on tumor type. Circadian rhythm disturbances may resolve promptly after decompression of the optic chiasm. Quality of life in pituitary adenoma patients is associated with quality of sleep in many dimensions, thus implying that developing strategies to improve sleep quality could increase overall well-being and everyday functioning in pituitary adenoma patients.
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Affiliation(s)
- Karol Piotr Sagan
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.A.-M.); (A.S.)
- Correspondence: ; Tel.: +48-91-425-3540
| | - Elżbieta Andrysiak-Mamos
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.A.-M.); (A.S.)
| | - Ernest Tyburski
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Poznan, Poland;
| | - Leszek Michał Sagan
- Department of Neurosurgery, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.A.-M.); (A.S.)
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10
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Yang H, Tan H, Huang H, Li J. Advances in Research on the Cardiovascular Complications of Acromegaly. Front Oncol 2021; 11:640999. [PMID: 33869029 PMCID: PMC8050332 DOI: 10.3389/fonc.2021.640999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular-related complications are one of the most common complications in patients with acromegaly, and can lead to an increased risk of death. Hypertension and cardiomyopathy are the main cardiovascular complications. The characteristics of acromegalic cardiomyopathy are concentric biventricular hypertrophy and diastolic dysfunction. In addition, arrhythmia and heart valve disease are common cardiac complications in acromegaly. Although the underlying pathophysiology has not been fully elucidated, the spontaneous overproduction of GH and IGF-1, increasing age, prolonged duration of disease and the coexistence of other cardiovascular risk factors are crucial to cardiac complications in patients with acromegaly. Early diagnosis and appropriate treatment of acromegaly might be beneficial for the prevention of cardiomyopathy and premature death.
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Affiliation(s)
- Han Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.,Department of Endocrinology and Metabolism, Chongqing Sixth People's Hospital, Chongqing, China
| | - Huiwen Tan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianwei Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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11
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Parolin M, Dassie F, Vettor R, Steeds RP, Maffei P. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest 2021; 44:209-221. [PMID: 32632903 DOI: 10.1007/s40618-020-01343-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acromegaly is disease associated with a specific cardiomyopathy. Hitherto, it has been widely understood that acromegaly carries an increased risk of arrhythmia. PURPOSE In this review we show that evidences are limited to a small number of case-control studies that reported increased rates of premature ventricular beats (PVB) but no more significant arrhythmia. In contrast, there are several studies that have reported impaired preclinical markers of arrhythmia, including reduced heart rate variability, increased late potentials, QT interval dispersion, impaired heart rate recovery after physical exercise and left ventricular dysynchrony. Whilst these markers are associated with an adverse cardiovascular prognosis in the general population, they do not have a high independent positive predictive accuracy for arrhythmia. In acromegaly, case reports have described sudden cardiac death, ventricular tachyarrhythmia and advanced atrio-ventricular block that required implantation of a cardio-defibrillator or permanent pacemaker. Treatment with somatostatin analogues can reduce cardiac dysrhythmia in some cases by reducing heart rate, PVBs and QT interval. Pegvisomant reduces mean heart rate. Pasireotide is associated with QT prolongation. In the absence of good quality data on risk of arrhythmia in acromegaly, the majority of position statements and guidelines suggest routine 12-lead electrocardiography (ECG) and transthoracic echocardiography (TTE) in every patient at diagnosis and then follow up dependent on initial findings.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy.
| | - F Dassie
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R Vettor
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R P Steeds
- University Hospital Birmingham and University of Birmingham, Cardiology, Birmingham, West Midlands, UK
| | - P Maffei
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
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12
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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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13
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Zhou N, Ho JPTF, De Vries N, De Lange J. Obstructive sleep apnea caused by acromegaly: Case report. Cranio 2020; 40:451-453. [PMID: 32485132 DOI: 10.1080/08869634.2020.1776530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acromegaly is an uncommon syndrome caused by growth hormone-producing pituitary adenoma or pituitary gland hypertrophy. Acromegaly is known to be characterized by progressive somatic disfigurement and a wide range of systematic manifestations. This case study describes a rare case of severe obstructive sleep apnea (OSA) caused by acromegaly. CLINICAL PRESENTATION A female patient presented to the consultant clinic with the chief complaint of progressively worsening sleep and was diagnosed with severe OSA. Because of a peculiar facial appearance of the patient, acromegaly was suspected and confirmed by the findings of hormonal analysis and magnetic resonance imaging (MRI). After transsphenoidal resection of the pituitary adenoma, her OSA was almost cured, with residual AHI of 5.5. CONCLUSION This case highlights the importance of a comprehensive clinical examination of OSA patients. In every sleep-related breathing disorder case, sleep clinicians should be aware of alternate problems that could cause upper airway obstruction.
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Affiliation(s)
- Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.,Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Nico De Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Jan De Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
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14
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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: 180] [Impact Index Per Article: 45.0] [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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15
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Kamenický P, Maione L, Chanson P. Cardiovascular complications of acromegaly. ANNALES D'ENDOCRINOLOGIE 2020; 82:206-209. [PMID: 33168155 DOI: 10.1016/j.ando.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acromegaly is a chronic disease due to growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess. It is associated with various systemic complications including cardiovascular disease. Arterial hypertension occurs in about 20% to 30% of patients. Its pathogenesis is mainly related to the increase in plasma volume secondary to a sodium retaining actions of GH and IGF-1 in the kidney, but abnormalities in vessel architecture and reactivity participate. Left ventricular hypertrophy and diastolic dysfunctions were frequently reported in echo-based studies and are mostly mild and without clinical consequences. Recent cardiac MRI studies described a much lower frequency of myocardial hypertrophy than echo-based assessments. Progression to systolic dysfunction with congestive heart failure is nowadays very rare. Risk of coronary heart disease and of clinically significant arrythmias does not seem to be increased. Acromegaly-related cardiac valve abnormalities may be related to fibrotic changes and seem to persist after effective treatment of acromegaly. Advances in acromegaly treatment over the last decades significantly diminished the cardiovascular burden of the disease, with the cardiovascular disease anymore being the leading cause of death.
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Affiliation(s)
- Peter Kamenický
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse (HYPO), Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France.
| | - Luigi Maione
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse (HYPO), Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse (HYPO), Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France
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16
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Parolin M, Dassie F, Alessio L, Wennberg A, Rossato M, Vettor R, Maffei P, Pagano C. Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5624994. [PMID: 31722411 DOI: 10.1210/clinem/dgz116] [Citation(s) in RCA: 21] [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: 06/18/2019] [Accepted: 10/11/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. AIM To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. METHODS AND STUDY SELECTION A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. RESULTS OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = -0.16; 95% CI, -0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = -0.03; 95% CI, -0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = -0.36; 95% CI, -0.49 to -0.23; k = 10; P < 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. CONCLUSION Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.
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Affiliation(s)
- Matteo Parolin
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Francesca Dassie
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Luigi Alessio
- Department of Neurosciences, University of Padua, via Giustiniani 2, Padova, Italy
| | - Alexandra Wennberg
- Department of Neurosciences, University of Padua, via Giustiniani 2, Padova, Italy
| | - Marco Rossato
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Pietro Maffei
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Claudio Pagano
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
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17
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Wolters TLC, Roerink SHPP, Drenthen LCA, van Haren-Willems JHGM, Wagenmakers MAEM, Smit JWA, Hermus ARMM, Netea-Maier RT. The Course of Obstructive Sleep Apnea Syndrome in Patients With Acromegaly During Treatment. J Clin Endocrinol Metab 2020; 105:5587082. [PMID: 31612224 PMCID: PMC7705224 DOI: 10.1210/clinem/dgz050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is common in active acromegaly and negatively influences quality of life, morbidity, and mortality. This prospective study with 3 predetermined timepoints and a standardized treatment protocol investigates changes in sleep parameters during the first 2.5 years of acromegaly treatment. METHODS Before initiation of acromegaly treatment (medical pretreatment followed by surgery), polysomnography (PSG) was performed in 27 consecutive patients with treatment-naive acromegaly. PSG was repeated after 1 year (N = 24) and 2.5 years (N = 23), and anthropometric and biochemical parameters were obtained. RESULTS At baseline, 74.1% of the patients was diagnosed with OSAS. The respiratory disturbance index (RDI; P = 0.001), oxygen desaturation index (ODI; P = 0.001), lowest oxygen saturation (LSaO2; P = 0.007) and the Epworth Sleepiness Scale (ESS; P < 0.001) improved significantly during treatment, with the greatest improvement in the first year. After 2.5 years of treatment, all patients had controlled acromegaly. Of the 16 patients with repeated PSG and OSAS at baseline, 11 (68.8%) were cured of OSAS. Changes in RDI, ODI, LSaO2, and ESS correlated with insulin-like growth factor 1 levels. CONCLUSION OSAS has a high prevalence in active acromegaly. There is a substantial decrease in prevalence and severity of OSAS following acromegaly treatment, with the largest improvement during the first year. Most patients recover from OSAS following surgical or biochemical control of the acromegaly. Therefore, a PSG is advised after diagnosis of acromegaly. When OSAS is present, it should be treated and PSG should be repeated during acromegaly treatment.
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Affiliation(s)
- Thalijn L C Wolters
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Sean H P P Roerink
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Linda C A Drenthen
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | | | - Margaretha A E M Wagenmakers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands GD
| | - Johannes W A Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Adrianus R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
- Correspondence: Romana T. Netea-Maier, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands. E-mail:
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18
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Wennberg A, Lorusso R, Dassie F, Benavides-Varela S, Parolin M, De Carlo E, Fallo F, Mioni R, Vettor R, Semenza C, Maffei P. Sleep disorders and cognitive dysfunction in acromegaly. Endocrine 2019; 66:634-641. [PMID: 31473920 DOI: 10.1007/s12020-019-02061-1] [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] [Received: 06/27/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE In the general population, sleep disorders are associated with an increased risk of cognitive impairment. The prevalence of sleep disorders, such as sleep apnea, in acromegalic patients is higher than in the general population, and they may have additional risk of cognitive impairment due to acromegaly treatment and comorbidities. We aim to study the relationship between sleep disturbances and cognitive dysfunction in a group of acromegalic patients. METHODS We studied 67 consecutive acromegalic patients. We performed a neurocognitive assessment and patients completed the Acromegaly Quality of Life Questionnaire (AcroQoL), Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. RESULTS Of the 67 acromegaly patients in the study, 38.8% were male and median age at the neurological examination was 56 (IQR 48, 65). Approximately 6-10% of patients had impaired cognitive assessment, depending on the test. In linear regression models adjusted for age, sex, BMI, disease duration, and disease activity, poorer sleep quality was associated with lower global cognitive z-score (B = -0.03, 95% CI -0.06, -0.002). Daytime somnolence was associated with poorer physical AcroQoL sub-score (B = -0.04, 95% CI -0.08, -0.002). Sleep quality was associated with poorer overall AcroQoL (B = -0.03, 95% CI -0.05, -0.006), physical AcroQoL (B = -0.04, 95% CI -0.07, -0.005), psychological AcroQoL (B = -0.02, 95% CI -0.04, -0.001), and social AcroQoL (B = -0.02, 95% CI -0.04, -0.0009). CONCLUSIONS In acromegaly patients, we found robust evidence that poor sleep quality is associated with poorer quality of life, and some evidence that it is associated with poorer cognitive function.
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Affiliation(s)
- A Wennberg
- Department of Neuroscience, University of Padua, Padova, PD, Italy
| | - R Lorusso
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - F Dassie
- Department of Medicine, University of Padua, Padova, PD, Italy.
| | - S Benavides-Varela
- Department of Developmental Psychology and Socialisation, University of Padua, Padova, PD, Italy
- Department of General Psychology, University of Padua, Padova, PD, Italy
| | - M Parolin
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - E De Carlo
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - F Fallo
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - R Mioni
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - R Vettor
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - C Semenza
- Department of Neuroscience, University of Padua, Padova, PD, Italy
- IRCCS Ospedale San Camillo, Venezia, Italy
| | - P Maffei
- Department of Medicine, University of Padua, Padova, PD, Italy
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Heidarpour M, Shafie D, Aminorroaya A, Sarrafzadegan N, Farajzadegan Z, Nouri R, Najimi A, Dimopolou C, Stalla G. Effects of somatostatin analog treatment on cardiovascular parameters in patients with acromegaly: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:29. [PMID: 31143230 PMCID: PMC6521613 DOI: 10.4103/jrms.jrms_955_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022]
Abstract
Background: There is a belief that in patients with acromegaly, first-generation somatostatin analogs (SSAs) might improve cardiovascular (CV) structure and function. However, most published clinical trials involved only a few patients and their results are rather variable. We aimed to conduct a systematic review on available studies on the impact of these drugs on CV parameters. Materials and Methods: A literature search was conducted in MEDLINE (OVID), EMBase, Cochrane, and ISI Web of Science for citations published until April 30 2018 to identify studies on our objective that considered changes in CV parameters. For this search, we established a Boolean search strategy using keywords related to “acromegaly,” “Somatostatin analog,” and “cardiovascular diseases and parameters.” All study types except for case reports or conference abstracts were included. Twenty-four studies (n = 558) fulfilled the inclusion criteria and were selected for final analysis. Results: In 12 studies (n = 350), decrease in heart rate (HR) and in 4 studies (n = 128), decrease in blood pressure (BP) was significant. In 15 studies (n = 320), left ventricular mass index (LVMi) changes were significant. In 9 studies (n = 202), the early diastole to peak velocity flow in late diastole (E/A ratio) was evaluated, and in 5 of them (n = 141), the improvement was significant. Eighteen studies (n = 366) examined changes in left ventricular ejection fraction (LVEF), 5 of which (n = 171) reported that these changes were significant. Decrease of left ventricular end-diastolic diameter was reported in only 2 studies (n = 27). Conclusion: We found that first-generation SSAs have a beneficial effect on cardiac parameters such as HR and LVMi. For other parameters such as LVEF, BP, LV diameter, and E/A ratio, we were not able to draw a firm conclusion.
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Affiliation(s)
- Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community Medicine, Faculty Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasool Nouri
- Department of Medical Library and Information Sciences, Health Information Technology Research Center, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Najimi
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Christina Dimopolou
- Max-Planck-Institute of Psychiatry, Internal Medicine/Endocrinology and Clinical Chemistry, Munich, Germany
| | - Gunter Stalla
- Max-Planck-Institute of Psychiatry, Internal Medicine/Endocrinology and Clinical Chemistry, Munich, Germany
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20
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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: 185] [Impact Index Per Article: 37.0] [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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21
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Vouzouneraki K, Franklin KA, Forsgren M, Wärn M, Persson JT, Wik H, Dahlgren C, Nilsson AS, Alkebro C, Burman P, Erfurth EM, Wahlberg J, Åkerman AK, Høybye C, Ragnarsson O, Engström BE, Dahlqvist P. Temporal relationship of sleep apnea and acromegaly: a nationwide study. Endocrine 2018; 62:456-463. [PMID: 30066288 PMCID: PMC6208862 DOI: 10.1007/s12020-018-1694-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Patients with acromegaly have an increased risk of sleep apnea, but reported prevalence rates vary largely. Here we aimed to evaluate the sleep apnea prevalence in a large national cohort of patients with acromegaly, to examine possible risk factors, and to assess the proportion of patients diagnosed with sleep apnea prior to acromegaly diagnosis. METHODS Cross-sectional multicenter study of 259 Swedish patients with acromegaly. At patients' follow-up visits at the endocrine outpatient clinics of all seven university hospitals in Sweden, questionnaires were completed to assess previous sleep apnea diagnosis and treatment, cardiovascular diseases, smoking habits, anthropometric data, and S-IGF-1 levels. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale. Patients suspected to have undiagnosed sleep apnea were referred for sleep apnea investigations. RESULTS Of the 259 participants, 75 (29%) were diagnosed with sleep apnea before the study start. In 43 (57%) of these patients, sleep apnea had been diagnosed before the diagnosis of acromegaly. After clinical assessment and sleep studies, sleep apnea was diagnosed in an additional 20 patients, yielding a total sleep apnea prevalence of 37%. Higher sleep apnea risk was associated with higher BMI, waist circumference, and index finger circumference. Sleep apnea was more frequent among patients with S-IGF-1 levels in the highest quartile. CONCLUSION Sleep apnea is common among patients with acromegaly, and is often diagnosed prior to their acromegaly diagnosis. These results support early screening for sleep apnea in patients with acromegaly and awareness for acromegaly in patients with sleep apnea.
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Affiliation(s)
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Forsgren
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
| | - Maria Wärn
- Department of Molecular Medicine and Surgery, Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Tiberg Persson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Wik
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Dahlgren
- Department of Endocrinology, Department of Medical and Health Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ann-Sofie Nilsson
- Department of Clinical Sciences and Department of Endocrinology, University of Lund and Skåne University Hospital, Malmö - Lund, Sweden
| | - Caroline Alkebro
- Division of Diabetology and Endocrinology, Department of Medicine, Örebro University Hospital, Örebro, Sweden
| | - Pia Burman
- Department of Clinical Sciences and Department of Endocrinology, University of Lund and Skåne University Hospital, Malmö - Lund, Sweden
| | - Eva-Marie Erfurth
- Department of Clinical Sciences and Department of Endocrinology, University of Lund and Skåne University Hospital, Malmö - Lund, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology, Department of Medical and Health Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna-Karin Åkerman
- Division of Diabetology and Endocrinology, Department of Medicine, Örebro University Hospital, Örebro, Sweden
| | - Charlotte Høybye
- Department of Molecular Medicine and Surgery, Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Oskar Ragnarsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Britt Edén Engström
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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22
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Zhang X, Ma J, Wang Y, Li L, Gao L, Guo X, Xing B, Zhong Y. Elevated serum IGF-1 level enhances retinal and choroidal thickness in untreated acromegaly patients. Endocrine 2018; 59:634-642. [PMID: 29318448 DOI: 10.1007/s12020-017-1511-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/23/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE 1) To compare the retinal, choroidal, Haller's layer, and Sattler's/choriocapillaris thicknesses of untreated acromegaly patients without chiasm compression or diabetes mellitus and healthy controls. 2) To evaluate the correlations of retinal and choroidal thicknesses with serum growth hormone (GH) and insulin-like growth factor 1 (IGF) burden. METHODS This prospective, case-control study included 27 untreated acromegaly patients and 27 sex-matched and age-matched controls. Subfoveal choroidal, Haller's layer and Sattler's/choriocapillaris thicknesses were determined by enhanced-depth imaging optical coherence tomography (EDI-OCT). Foveal and macular retinal thicknesses were determined with SD-OCT. GH and IGF-1 burdens were defined as the product of disease duration and treatment-naïve serum GH and IGF-1 levels. RESULTS Compared with healthy controls, patients with acromegaly exhibited significantly increased foveal retinal (p = 0.003), subfoveal choroidal (p < 0.001), and Haller's layer (p < 0.001) thicknesses, with no differences in Sattler's/choriocapillaris layer thickness. Multiple point measurements in the posterior pole area showed equally increased nasal and temporal parts of the choroid. The retinal thickness maps of the two groups did not significantly differ. Correlation analysis indicated that choroidal thickness was significantly correlated with disease duration (p = 0.01), serum IGF-1 level (p = 0.03) and IGF-1 burden (p = 0.009). No significant correlations were detected between choroidal thickness and GH burden (p = 0.44). Retinal thickness was not significantly correlated with any factor. CONCLUSION The choroidal thickness of acromegaly patients was greater than that of healthy controls and was significantly correlated with disease duration, IGF-1 level and IGF-1 burden, indicating that excessive serum IGF-1 and its exposure time have a combined effect on choroidal thickness.
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Affiliation(s)
- Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhan Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lüe Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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23
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Sharma MD, Nguyen AV, Brown S, Robbins RJ. Cardiovascular Disease in Acromegaly. Methodist Debakey Cardiovasc J 2018; 13:64-67. [PMID: 28740584 DOI: 10.14797/mdcj-13-2-64] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In patients with acromegaly, chronic excess of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) leads to the development of acromegalic cardiomyopathy. Its main features are biventricular hypertrophy, diastolic dysfunction, and in later stages, systolic dysfunction and congestive heart failure. Surgical and/or pharmacological treatment of acromegaly and control of cardiovascular risk factors help reverse some of these pathophysiologic changes and decrease the high risk of cardiovascular complications.
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24
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Pazarlı AC, Köseoğlu Hİ, Kutlutürk F, Gökçe E. Association of Acromegaly and Central Sleep Apnea Syndrome. Turk Thorac J 2017; 20:157-159. [PMID: 30407161 DOI: 10.5152/turkthoracj.2017.17003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 07/21/2017] [Indexed: 01/05/2023]
Abstract
Acromegaly is usually characterized by the excessive secretion of growth hormone (GH) after the closure of epiphyseal plaques, resulting from functional pituitary adenomas. The most common manifestations of acromegaly are acral and soft tissue overgrowth, diabetes mellitus, hypertension, and heart and respiratory failure. In patients, obstruction of the upper airway may develop due to enlargement of the tongue and thickening of the tissues of the larynx; consequently, obstructive sleep apnea syndrome (OSAS) occurs commonly in acromegaly. Previous studies have shown an association between acromegaly and central sleep apnea syndrome (CSAS). Some of these described patients described showed that an elevation in the GH level may cause a defect in the respiratory drive. Most systemic diseases seen in acromegaly require effective treatment. We believe that it is necessary to perform effective treatments by examining respiratory disorders in sleep.
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Affiliation(s)
- Ahmet Cemal Pazarlı
- Department of Pulmonary Diseases, Gaziopsmanpaşa University School of Medicine, Tokat, Turkey
| | - Handan İnönü Köseoğlu
- Department of Pulmonary Diseases, Gaziopsmanpaşa University School of Medicine, Tokat, Turkey
| | - Faruk Kutlutürk
- Department of Internal Medicine, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Erkan Gökçe
- Department of Radiology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
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25
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Rochette C, Castinetti F, Brue T. [Acromegaly and Cushing's disease: Persistence of comorbidities after the control of hypersecretion]. ANNALES D'ENDOCRINOLOGIE 2017. [PMID: 28645354 DOI: 10.1016/s0003-4266(17)30074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acromegaly and Cushing's disease lead to common and distinct comorbidities. Currently available treatments lead to the control of hyper secretion in the majority of cases. However, the prevalence of the comorbidities does not always go back to the one of the normal population after remission. For instance, about 1/3 of acromegalic patients with diabetes and half of patients with Cushing's disease and diabetes will have normal blood glucose values after remission. In contrast, high blood pressure frequently recovers after remission in both diseases. In contrast, while patients with acromegaly improve their lipid profile, patients with Cushing's disease frequently remain hypertriglyceridemic. Many other comorbidities (cardiovascular disease, bone alterations, altered quality of life) may persist after the control of hyper secretion. The aim of this review is to focus on the outcome of patients with acromegaly and Cuhing's disease, and to suggest the optimal follow-up of such patients in a multidisciplinary approach. These points have been discussed during the 2016 European Congress of Endocrinology, notably by J.Romijn and E.Valassi.
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Affiliation(s)
- C Rochette
- Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13284 Marseille, France; Service d'endocrinologie-diabète-maladies métaboliques, Pôle ENDO, Centre de Référence Pathologies hypophysaires Rares, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France
| | - F Castinetti
- Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13284 Marseille, France; Service d'endocrinologie-diabète-maladies métaboliques, Pôle ENDO, Centre de Référence Pathologies hypophysaires Rares, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France; Faculté de Médecine Secteur Nord, CNRS UMR 7286 - CRN2M, Boulevard Pierre Dramard, 13015 Marseille, France
| | - T Brue
- Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13284 Marseille, France; Service d'endocrinologie-diabète-maladies métaboliques, Pôle ENDO, Centre de Référence Pathologies hypophysaires Rares, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France; Faculté de Médecine Secteur Nord, CNRS UMR 7286 - CRN2M, Boulevard Pierre Dramard, 13015 Marseille, France.
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26
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Miranda-Rius J, Brunet-LLobet L, Lahor-Soler E, de Dios-Miranda D, Giménez-Rubio JA. GH-secreting pituitary macroadenoma (acromegaly) associated with progressive dental malocclusion and refractory CPAP treatment. Head Face Med 2017; 13:7. [PMID: 28490347 PMCID: PMC5424328 DOI: 10.1186/s13005-017-0140-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/05/2017] [Indexed: 12/30/2022] Open
Abstract
Background A link between progressive dental malocclusion, the use of a continuous positive airway pressure mask and GH-secreting pituitary macroadenoma (acromegaly) has not been previously reported. The present clinicopathological analysis stresses that tooth malposition should not be seen exclusively as a local process. Case presentation A 62-year-old caucasian man with no relevant medical history reported difficulty chewing food and perceived voice alteration during his annual periodontal check-up. He also referred stiffness of the tongue, face, and submandibular area. The patient had been diagnosed with obstructive sleep apnea syndrome two years previously, since when he had worn a continuous positive airway pressure device during sleep. Exploration of the occlusion revealed significant changes: an atypical left lateral and anterior open bite with major buccoversion of teeth 33, 34, 35, 36. Inspection of the soft tissue revealed only macroglossia, although external palpation indicated a subcutaneous stiffness of the submandibular area. General analytical tests, including hormone profiles, and magnetic resonance imaging confirmed the diagnosis of acromegaly induced by a pituitary adenoma. Intrasellar tumor resection via transsphenoidal approach was performed. After surgery, the patient already noted a marked improvement of all symptoms associated with the acromegaly. Desaturation data also evolved favourably and the pulmonologist advised the patient to abandon the continuous positive airway pressure treatment. Conclusion Progressive dental malocclusion may be associated with a systemic disease and the use of a nasal mask with premaxillary support may distort the diagnosis of acromegaly.
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Affiliation(s)
- Jaume Miranda-Rius
- Department of Odontostomatology, Faculty of Medicine & Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Lluís Brunet-LLobet
- Division of Orthodontics and Paediatric Dentistry, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- Department of Odontostomatology, Faculty of Medicine & Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - David de Dios-Miranda
- Bachelor of Science, Health Sciences Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Anton Giménez-Rubio
- Chief of Oral and Maxillofacial Department, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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27
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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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Abstract
PURPOSE OF REVIEW Patients with pituitary diseases have decreased quality of life. Sleep disorders are prevalent among patients with pituitary diseases and contribute to decreased quality of life. RECENT FINDINGS Patients previously treated for compression of the optic chiasm by surgery, and in some cases postoperative radiotherapy, suffer from sleep disorders. These are characterized by decreased sleep quality, delayed onset of sleep, and daytime sleepiness. Circumstantial evidence suggests that this may be caused by hypothalamic dysfunction. A challenging speculation is that previous compression of the optic chiasm compromised the function of the retinohypothalamic tract. Through this tract the eyes convey information on day-night cycles to the hypothalamic nuclei. Patients with acromegaly, even despite biochemical control, suffer frequently from obstructive sleep apnea. Patients with Cushing's disease suffer from fragmented sleep, sleep apnea, and snoring. Prolactinomas do not seem to affect sleep characteristics. The association between appropriately substituted pituitary insufficiency and sleep disorders is less clear. The effects of recombinant human growth hormone on sleep characteristics in adults are inconsistent. SUMMARY Pituitary disorders are associated with different sleep disorders. Different studies point to irreversible changes in sleep-wake rhythmicity in patients treated previously for pituitary tumors with chiasm compression. VIDEO ABSTRACT.
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Affiliation(s)
- Johannes A Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Castellani C, Francia G, Dalle Carbonare L, Ferrari M, Viva E, Cerini R, Zaccarella A, Trevisiol L, Davi' MV. Morphological study of upper airways and long-term follow-up of obstructive sleep apnea syndrome in acromegalic patients. Endocrine 2016; 51:308-16. [PMID: 26093846 DOI: 10.1007/s12020-015-0659-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
Pathogenesis and long-term outcome of obstructive sleep apnea syndrome (OSAS) in acromegalic patients are still under debate. The aim of the study was to assess the prevalence and long-term follow-up of a series of acromegalic patients with OSAS and to investigate site, degree, and possible causes of upper airway obstruction by morphological study. Cross-sectional and longitudinal study was conducted in 58 acromegalic patients (33 active, 25 controlled) with polysomnography in all subjects, repeated in 25 patients with OSAS, and echocardiography. Morphological study including fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM), magnetic resonance imaging (MRI), with 3-dimensional (3D) elaboration was also performed. The prevalence of OSAS was 58.6 % in the whole series: 63.6 % in the active group and 52 % in the controlled one. Left ventricular hypertrophy was more prevalent in patients with OSAS. OSAS improved in 62.5 % of active patients after achieving hormonal control, whereas it persisted or got worse in 66.6 % of the controlled ones. The uvula and tongue base were the main site of obstruction assessed by FNMM. Uvula diameters obtained by MRI study correlated with the severity of upper airway collapse assessed by FNMM and tongue measure with apnea-hypopnea index (p = 0.044). A greater narrowing and a smaller total volume of upper airways were confirmed by 3D-MRI in patients with more severe OSAS. Uvula and tongue hypertrophy plays a relevant role in the pathogenesis and severity of OSAS. Intensive treatment of acromegaly needs to be promptly adopted in order to reverse it.
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Affiliation(s)
- Cinzia Castellani
- Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Giuseppe Francia
- Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Luca Dalle Carbonare
- Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Marcello Ferrari
- Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Elena Viva
- ENT Department, University of Verona, Verona, Italy
| | - Roberto Cerini
- Department of Radiology, University of Verona, Verona, Italy
| | | | - Lorenzo Trevisiol
- Department of Dentistry and Maxillo Facial Surgery, University of Verona, Verona, Italy
| | - Maria Vittoria Davi'
- Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy.
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Kuhn E, Maione L, Bouchachi A, Rozière M, Salenave S, Brailly-Tabard S, Young J, Kamenicky P, Assayag P, Chanson P. Long-term effects of pegvisomant on comorbidities in patients with acromegaly: a retrospective single-center study. Eur J Endocrinol 2015; 173:693-702. [PMID: 26429918 PMCID: PMC4592912 DOI: 10.1530/eje-15-0500] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT The effect of pegvisomant on IGF1 levels in patients with acromegaly is well documented, but little is known of its long-term impact on comorbidity. AIM The aim of this retrospective study was to evaluate the effects of long-term pegvisomant therapy on cardiorespiratory and metabolic comorbidity in patients with acromegaly. PATIENTS AND METHODS We analyzed the long-term (up to 10 years) effect of pegvisomant therapy given alone (n=19, 45%) or in addition to somatostatin analogues and/or cabergoline (n=23, 55%) on echocardiographic, polysomnographic and metabolic parameters in respectively 42, 12 and 26 patients with acromegaly followed in Bicêtre hospital. RESULTS At the first cardiac evaluation, 20±16 months after pegvisomant introduction, IGF1 levels normalized in 29 (69%) of the 42 patients. The left ventricular ejection fraction (LVEF) improved significantly in patients whose basal LVEF was ≤60% and decreased in those whose LVEF was >70%. The left ventricular mass index (LVMi) decreased from 123±25 to 101±21 g/m(2) (P<0.05) in the 17 patients with a basal LVMi higher than the median (91 g/m(2)), while it remained stable in the other patients. Pegvisomant reduced the apnoea-hypopnea index and cured obstructive sleep apnea (OSA) in four of the eight patients concerned. Long-term follow-up of 22 patients showed continuing improvements in cardiac parameters. The BMI and LDL cholesterol level increased minimally during pegvisomant therapy, and other lipid parameters were not modified. CONCLUSIONS Long-term pegvisomant therapy not only normalizes IGF1 in a large proportion of patients but also improves cardiac and respiratory comorbidity.
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Affiliation(s)
- Emmanuelle Kuhn
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Luigi Maione
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Amir Bouchachi
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Myriam Rozière
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Sylvie Salenave
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Sylvie Brailly-Tabard
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Jacques Young
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Peter Kamenicky
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Patrick Assayag
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94275 Le Kremlin Bicêtre, FranceService de CardiologieF-94275 Le Kremlin Bicêtre, FranceService de Génétique moléculairePharmacogénétique et Hormonologie, F-94275 Le Kremlin Bicêtre, FranceUniv Paris-SudUniversité Paris-Saclay, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, F-94276 Le Kremlin Bicêtre, FranceInstitut National de la Santé et de la Recherche Médicale (INSERM) U1185F-94276 Le Kremlin Bicêtre, France
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[Does sleep apnea disappear once acromegaly is adequately treated?]. Rev Mal Respir 2015; 33:405-8. [PMID: 26518256 DOI: 10.1016/j.rmr.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 05/30/2015] [Indexed: 11/21/2022]
Abstract
Acromegaly is a rare hormonal disease related to excessive growth hormone secretion. It can result in a range of complications, including cardiovascular, respiratory, metabolic, articular and neoplastic disorders. Among patients with the condition, obstructive sleep apnea syndrome occurs frequently and the effect of treatment is inconstant: improvement, statu quo or deterioration can be observed. We here report three clinical cases, which illustrate the unpredictable evolution of this condition.
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Comunello A, Dassie F, Martini C, De Carlo E, Mioni R, Battocchio M, Paoletta A, Fallo F, Vettor R, Maffei P. Heart rate variability is reduced in acromegaly patients and improved by treatment with somatostatin analogues. Pituitary 2015; 18:525-34. [PMID: 25261332 DOI: 10.1007/s11102-014-0605-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular complications, including arrhythmias and cardiac sudden death, are the most common causes of enhanced mortality in acromegaly. However, few data are available on cardiac autonomic functions and sympathovagal balance in acromegalic patients. OBJECTIVE The aim of this study was to investigate both the time and frequency domain parameters of Heart Rate Variability (HRV), in order to characterize the cardiac autonomic functions in patients affected by acromegaly. This study correlated anthropometric, metabolic, echocardiographic parameters and blood pressure with those relating to HRV, to identify the main factors responsible for the HRV related alterations possibly present. We also aimed to analyze the effects of the treatment with somatostatin analogues (SSAs) on HRV. MATERIALS AND METHODS This study enrolled 47 acromegalic patients (23 males, age 49.1 ± 13.5 years) and 37 (13 males) age matched (52.3 ± 13.3 years) healthy subjects. All participants underwent 12-lead 24 h ECG Holter recordings and a HRV analysis of the ECG tracings was performed. The parameters obtained from the time domain analysis of HRV included pNN50, SDNN, SDNN index, SDANN and RMSSD. The power spectral analysis of HRV was obtained by summing powers of the LF (low frequency) and the HF (high frequency) band. Sympathovagal balance was estimated by calculating the LF/HF ratio during 24 h and 15 min of clinostatism. The HRV of 28 acromegalic patients was studied before and after SSAs treatment. RESULTS Acromegalic patients showed significantly lower SDNN and SDANN compared to controls. Diabetic and non-diabetic acromegalic patients showed decreased SDNN and SDANN, when compared to healthy subjects. Diabetic acromegalic patients had a lower LF/HF ratio during 24 h when compared to non-diabetic acromegalic patients. Similar results were obtained analyzing patients affected by acromegaly and impaired glucose tolerance. SDNN and SDANN were lowered by hypertension in the acromegalic population, when compared to controls, and hypertensive acromegalic patients also displayed a decreased LF/HF ratio during 24 h when compared to normotensive acromegalic subjects. Patients with ventricular arrhythmias in Lown classes 3-5 showed a decreased SDANN compared to patients in Lown class 0-2. The treatment with SSAs was able to ameliorate all the time domain parameters of HRV, without altering the 24 h LF/HF ratio. CONCLUSION Cardiac autonomic functions and sympathovagal balance are altered in patients affected by acromegaly and could be ameliorated by SSAs therapy. HRV analysis allows an estimation of the autonomic sympathovagal balance and may be a useful clinical tool for the cardiac risk stratification in acromegalic patients.
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Affiliation(s)
- A Comunello
- DIMED, Padua University Hospital, Padua, Italy
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Ceccato F, Bernkopf E, Scaroni C. Sleep apnea syndrome in endocrine clinics. J Endocrinol Invest 2015; 38:827-34. [PMID: 26122486 DOI: 10.1007/s40618-015-0338-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/10/2015] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a chronic condition with a high prevalence (up to 7 % of the general population) characterized by frequent episodes of upper airway collapse while sleeping. Left untreated, OSAS can cause severe complications, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. This review aims to summarize the close links between OSAS, endocrinology, and metabolism. In patients with metabolic syndrome, OSAS is an independent risk factor for the onset of type 2 diabetes and a worsening glycemic control. The accumulation of adipose tissue in the neck and limited chest wall dynamics, hypoxia, and local micro-inflammation link visceral obesity closely with OSAS. There is now an abundance of convincing data indicating that promoting lifestyle changes, improving sleep hygiene, and adjusting diet can ameliorate both metabolic syndrome and OSAS, especially in obese patients. The incidence of OSAS in acromegaly is high, though GH treatments seem to be unrelated to the onset of apnea in GH-deficient individuals. Prospective studies have suggested an association between hypertension and OSAS because intermittent nocturnal hypoxia prompts an increase in sympathetic tone, endothelial dysfunction, and vascular inflammation: aldosterone excess may have a pathophysiological role, and some authors have reported that treating OSAS leads to a modest, but significant, reduction in blood pressure.
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Affiliation(s)
- F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy,
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Lerat J, Lacoste M, Prechoux JM, Aubry K, Nadalon S, Ly KH, Bessede JP. An uncommon case of dyspnea with unilateral laryngeal paralysis in acromegaly. Auris Nasus Larynx 2015; 43:105-7. [PMID: 26142980 DOI: 10.1016/j.anl.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022]
Abstract
A 61-year-old man with obstructive sleep apnea syndrome and normal BMI complained of dyspnea. Nasofibroscopy revealed a global and major oedema of the glottis and supraglottis and also a paralysis of the left vocal fold. CT-scan pointed out a spontaneous hyperdensity of the left arytenoid cartilage. A tracheostomy was performed. Clinical examination revealed large hands and macroglossy with high IGF1 rate. MRI confirmed a supracentimetric pituitary adenoma. To our knowledge, this is the first description of a case of acute respiratory distress due to unilateral larynx paralysis leading to acromegaly diagnosis. This is due to submucosal hypertrophy and vocal cord immobility.
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Affiliation(s)
- Justine Lerat
- Otorhinolaryngology, Head and Neck Surgery, Dupuytren Teaching Hospital, 2 Avenue Martin Luther King, 87100 Limoges cedex, France.
| | - Marie Lacoste
- Internal Medicine, Dupuytren Teaching Hospital, Limoges, France
| | - Jean-Marc Prechoux
- Otorhinolaryngology, Head and Neck Surgery, Dupuytren Teaching Hospital, 2 Avenue Martin Luther King, 87100 Limoges cedex, France
| | - Karine Aubry
- Otorhinolaryngology, Head and Neck Surgery, Dupuytren Teaching Hospital, 2 Avenue Martin Luther King, 87100 Limoges cedex, France
| | - Sylvie Nadalon
- Internal Medicine, Dupuytren Teaching Hospital, Limoges, France
| | - Kim Heang Ly
- Internal Medicine, Dupuytren Teaching Hospital, Limoges, France
| | - Jean-Pierre Bessede
- Otorhinolaryngology, Head and Neck Surgery, Dupuytren Teaching Hospital, 2 Avenue Martin Luther King, 87100 Limoges cedex, France
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Orosz A, Csajbók É, Czékus C, Gavallér H, Magony S, Valkusz Z, Várkonyi TT, Nemes A, Baczkó I, Forster T, Wittmann T, Papp JG, Varró A, Lengyel C. Increased Short-Term Beat-To-Beat Variability of QT Interval in Patients with Acromegaly. PLoS One 2015; 10:e0125639. [PMID: 25915951 PMCID: PMC4411033 DOI: 10.1371/journal.pone.0125639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular diseases, including ventricular arrhythmias are responsible for increased mortality in patients with acromegaly. Acromegaly may cause repolarization abnormalities such as QT prolongation and impairment of repolarization reserve enhancing liability to arrhythmia. The aim of this study was to determine the short-term beat-to-beat QT variability in patients with acromegaly. Thirty acromegalic patients (23 women and 7 men, mean age±SD: 55.7±10.4 years) were compared with age- and sex-matched volunteers (mean age 51.3±7.6 years). Cardiac repolarization parameters including frequency corrected QT interval, PQ and QRS intervals, duration of terminal part of T waves (Tpeak-Tend) and short-term variability of QT interval were evaluated. All acromegalic patients and controls underwent transthoracic echocardiographic examination. Autonomic function was assessed by means of five standard cardiovascular reflex tests. Comparison of the two groups revealed no significant differences in the conventional ECG parameters of repolarization (QT: 401.1±30.6 ms vs 389.3±16.5 ms, corrected QT interval: 430.1±18.6 ms vs 425.6±17.3 ms, QT dispersion: 38.2±13.2 ms vs 36.6±10.2 ms; acromegaly vs control, respectively). However, short-term beat-to-beat QT variability was significantly increased in acromegalic patients (4.23±1.03 ms vs 3.02±0.80, P<0.0001). There were significant differences between the two groups in the echocardiographic dimensions (left ventricular end diastolic diameter: 52.6±5.4 mm vs 48.0±3.9 mm, left ventricular end systolic diameter: 32.3±5.2 mm vs 29.1±4.4 mm, interventricular septum: 11.1±2.2 mm vs 8.8±0.7 mm, posterior wall of left ventricle: 10.8±1.4 mm vs 8.9±0.7 mm, P<0.05, respectively). Short-term beat-to-beat QT variability was elevated in patients with acromegaly in spite of unchanged conventional parameters of ventricular repolarization. This enhanced temporal QT variability may be an early indicator of increased liability to arrhythmia.
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Affiliation(s)
- Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Éva Csajbók
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Csilla Czékus
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Henriette Gavallér
- 2nd Department of Internal Medicine and Cardiology Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Sándor Magony
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Valkusz
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás T. Várkonyi
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2nd Department of Internal Medicine and Cardiology Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Internal Medicine and Cardiology Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Wittmann
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Csaba Lengyel
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
- * E-mail:
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