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Peng G, Li X, Zhou Y, Bai J, Hong P, Li W, Zhang Y, Zhang L, Liao Q, Liao M, Zhou L, Sun Z, Shen R, Zheng H, Long M. Clinical Characteristics and Associated Factors of Colonic Polyps in Acromegaly. Exp Clin Endocrinol Diabetes 2022; 130:714-722. [PMID: 36075228 DOI: 10.1055/a-1913-7900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the clinical characteristics and associated factors of colonic polyps in patients with acromegaly. METHODS Clinical characteristics and colonoscopy findings of 86 acromegaly patients who received treatment were retrospectively reviewed, and colonoscopy findings and the correlation with growth hormone (GH)-secreting pituitary adenoma (GHPA) volume and hormonal/metabolic levels were analyzed. RESULTS The prevalence of colonic polyps in acromegaly patients was 40.7% and increased significantly with advanced age, especially in those ≥50 years. Multiple polyps (62.8%) and colonic polyps in the left colon (54.2%) were detected more frequently. Compared to acromegaly patients without polyps, those with polyps displayed higher insulin-like growth factor-1 × upper limit of normal (IGF-1×ULN) levels (P=0.03). IGF-1 levels and GHPA volumes in patients with polyps showed increasing trends, although the differences were not significant. GH levels were higher in patients with polyps of diameter ≤5 mm than those with polyps of diameter >5 mm (P=0.031). The univariate and multivariate logistic regression analysis revealed that GHPA volumes (OR: 1.09, 95% CI: 1.01-1.20; P=0.039) and IGF-1×ULN Q2 levels (OR: 6.51, 95% CI: 1.20-44.60; P=0.038) were independent factors for predicting the risk of colonic polyp occurrence in acromegaly patients. A nomogram was prepared to evaluate the risk of colonic polyps in acromegaly patients. CONCLUSION The acromegalic patients are a population with a high prevalence of colonic polyps. GHPA volumes and IGF-1×ULN levels may be predictors of colonic polyp occurrence.
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Affiliation(s)
- Guiliang Peng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Xing Li
- Department of Endocrinology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuanyuan Zhou
- Department of Gastroenterology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Jianying Bai
- Department of Gastroenterology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Pian Hong
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Weixing Li
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Yuling Zhang
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Lei Zhang
- Department of Radiology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Qian Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Mingyu Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Ling Zhou
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Zheng Sun
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
| | - Rufei Shen
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Min Long
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
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Sahin S, Gundogdu A, Nalbantoglu U, Kadioglu P, Karaca Z, Hacioglu A, Urhan ME, Unluhizarci K, Demir AN, Hora M, Durcan E, Elbüken G, Dokmetas HS, Zuhur SS, Kelestimur F. Acromegaly is associated with a distinct oral and gut microbiota. Pituitary 2022; 25:520-530. [PMID: 35467272 DOI: 10.1007/s11102-022-01223-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Our aim was to investigate the changes in the composition of oral and gut microbiota in patients with newly diagnosed acromegaly and their relationship with IGF-1 levels. METHODS Oral and fecal samples were collected from patients with newly diagnosed acromegaly without comorbidities and from healthy controls. The composition of the microbiota was analyzed. The general characteristics, oral and stool samples of the patients and healthy control subjects were compared. The changes in microbiota composition in both habitats, their correlations and associations with IGF-1 were statistically observed using machine learning models. RESULTS Fifteen patients with newly diagnosed acromegaly without comorbidities and 15 healthy controls were included in the study. There was good agreement between fecal and oral microbiota in patients with acromegaly (p = 0.03). Oral microbiota diversity was significantly increased in patients with acromegaly (p < 0.01). In the fecal microbiota, the Firmicutes/Bacteroidetes ratio was lower in patients with acromegaly than in healthy controls (p = 0.011). Application of the transfer learned model to the pattern of microbiota allowed us to identify the patients with acromegaly with perfect accuracy. CONCLUSIONS Patients with acromegaly have their own oral and gut microbiota even if they do not have acromegaly-related complications. Moreover, the excess IGF-1 levels could be correctly predicted based on the pattern of the microbiome.
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Affiliation(s)
- Serdar Sahin
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Aycan Gundogdu
- Department of Microbiology and Clinical Microbiology, School of Medicine, Erciyes University, Kayseri, Turkey
- Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey
| | - Ufuk Nalbantoglu
- Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey
- Department of Computer Engineering, Erciyes University, Kayseri, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Aysa Hacioglu
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Muhammed Emre Urhan
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ahmet Numan Demir
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Hora
- Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey
| | - Emre Durcan
- Department of Endocrinology and Metabolic Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Gülsah Elbüken
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Namik Kemal University, Tekirdaǧ, Turkey
| | - Hatice Sebile Dokmetas
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sayid Shafi Zuhur
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Namik Kemal University, Tekirdaǧ, Turkey
| | - Fahrettin Kelestimur
- Department of Endocrinology and Metabolic Diseases, School of Medicine, Yeditepe University, Istanbul, Turkey.
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Battistone MF, Miragaya K, Rogozinski A, Agüero M, Alfieri A, Ballarino MC, Boero L, Danilowicz K, Diez S, Donoso M, Fainstein-Day P, Furioso A, Garcia-Basavilbaso N, Glerean M, Katz D, Loto M, Mallea-Gil S, Martinez M, Sabate MI, Servidio M, Slavinsky P, Stalldecker G, Sosa S, Szuman G, Tkatch J, Caldo I, Lubieniecki D, Guitelman M. Increased risk of preneoplastic colonic lesions and colorectal carcinoma in acromegaly: multicenter case-control study. Pituitary 2021; 24:96-103. [PMID: 33057946 DOI: 10.1007/s11102-020-01090-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Current international guidelines recommend colonoscopy in patients with acromegaly at the time of diagnosis, even though the risk of developing colorectal neoplasm is still controversial. The main objective of this Argentine multicenter study was to analyze through screening colonoscopy the presence of advanced neoplastic lesions considered as precancerous, in patients with acromegaly compared to a control group. METHODS This is a case-control retrospective study. Full length colonoscopy of 70 acromegalic patients and 128 control subjects were studied. Polyps were classified into non pre-cancerous lesions and advance neoplastic lesions which included advanced adenomas (preneoplastic) and colorectal carcinomas. RESULTS Thirty three out of 70 acromegalic patients and 32 out of 128 subjects controls presented polyps in the colonoscopy [47.1% vs 25%, p = 0.002, OR 2.68]. Non precancerous polyps were found in 11 (15.7%) and 23 (17.9%) (p = 0.690), while advanced neoplastic lesions were found in 22 (31.4%) and 9 (7.0%) (p = 0,0001 - OR: 6.06) patients and controls respectively. Advanced adenomas and colorectal carcinomas were found in 18 (27.3%) and 9 (7.0%) (p = 0,0006-OR: 4,57), and 4 (5.7%) and 0 (0.0%) p = 0.0063) of patients and controls respectively. The presence of insulin resistance was the only statistically significant associated factor among acromegalic patients with and without colonic polyps. CONCLUSIONS Our findings show an increased risk of preneoplastic colonic lesions and colorectal carcinoma in patients with chronic and sustained GH excess compared to a control group. This supports the recommendation to perform screening colonoscopy at diagnosis of acromegaly.
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Affiliation(s)
| | - Karina Miragaya
- Servicio de Endocrinología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Amelia Rogozinski
- División Endocrinología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Monica Agüero
- Grupo de trabajo Endocrinología, Hospital Tornú, Buenos Aires, Argentina
| | - Analia Alfieri
- Servicio de Endocrinología, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | | | - Laura Boero
- División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina
| | - Karina Danilowicz
- División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina
| | - Sabrina Diez
- Servicio de Endocrinología, Hospital General de Agudos Dr. Ignacio Pirovano,, Buenos Aires, Argentina
| | - Marina Donoso
- Servicio de Endocrinología, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | | | - Alejandra Furioso
- División Endocrinología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Mariela Glerean
- Servicio de Endocrinología, Hospital Italiano, Buenos Aires, Argentina
| | - Debora Katz
- Sección Neuroendocrinología, FLENI, Buenos Aires, Argentina
| | - Monica Loto
- Servicio de Endocrinología, Hospital Británico, Buenos Aires, Argentina
| | - Susana Mallea-Gil
- Servicio de Endocrinología, Hospital Militar Central, Buenos Aires, Argentina
| | - Marcela Martinez
- Servicio de Endocrinología, Hospital C. Milstein, Buenos Aires, Argentina
| | - Maria Isabel Sabate
- Servicio de Endocrinología, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Marisa Servidio
- Unidad de Endocrinología, Hospital Teodoro Alvarez, Buenos Aires, Argentina
| | | | - Graciela Stalldecker
- Servicio de Endocrinología, Hospital General de Agudos Dr. Ignacio Pirovano,, Buenos Aires, Argentina
| | - Soledad Sosa
- División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina
| | - Grabriela Szuman
- Servicio de Endocrinología, Sanatorio Municipal Dr. J. Mendez, Buenos Aires, Argentina
| | - Julieta Tkatch
- División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Ignacio Caldo
- Unidad de Gastroenterología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Daniela Lubieniecki
- Unidad de Gastroenterología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Mirtha Guitelman
- División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina
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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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Abstract
Acromegaly results in a significantly increased morbidity and mortality due to cardiovascular and respiratory complications, as well as malignancies arising mainly from the colon. Furthermore, an increased lifetime risk of malignant transformation of pre-malignant colonic lesions relates to a worse overall prognosis from colorectal cancer, which is currently considered a major disease-related complication. In this review we provide some insight into colonic changes in this condition, summarize current knowledge and evidence on the use of colonoscopic screening in patients with acromegaly, and suggest a recommended screening protocol.
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Affiliation(s)
- Dorota Dworakowska
- Department of Hypertension and Diabetes, Medical University of Gdansk, Gdansk, Poland
- Guys Richard Dimbleby Department of Cancer Research, King's College London, London, United Kingdom
- Endocard LTD, London, United Kingdom
- *Correspondence: Dorota Dworakowska
| | - Ashley B. Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
- Barts and the London School of Medicine, Centre for Endocrinology, William Harvey Institute, London, United Kingdom
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