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Filchenko I, Korostovtseva L, Bochkarev M, Tsoy U, Sviryaev Y. Cardiovascular remodeling in active and controlled acromegaly: association with sleep-disordered breathing. Sleep Breath 2023; 27:2305-2314. [PMID: 37148385 DOI: 10.1007/s11325-023-02838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE We hypothesized that an unfavorable cardiovascular profile in acromegaly is associated with sleep-disordered breathing (SDB), while acromegaly control improves both respiratory sleep characteristics and the cardiovascular profile. METHODS The patients underwent the assessment of breathing during sleep and cardiovascular profile assessment at the start of the study including arterial stiffness, blood pressure, echocardiography, nocturnal heart rate variability (HRV). The assessment was repeated in patients with acromegaly at 1 year after transsphenoidal adenectomy (TSA). RESULTS A total of 47 patients with acromegaly and 55 control subjects were enrolled. At one year after TSA, 22 patients with acromegaly were reassessed. Multiple linear regression analysis with adjustment for age, sex and body mass index (BMI) showed the associations of insulin growth-like factor 1 (IGF-1) with obstructive apnea index (OAI: β=0.035/h, p<0.001), but not with cardiovascular parameters, in patients with acromegaly. The analysis of combined acromegaly and control dataset with adjustment for age, sex and BMI showed the association the presence of acromegaly with diastolic blood pressure (DBP; β=17.99 mmHg, p<0.001), ejection fraction (EF; β=6.23%, p=0.009), left heart remodeling (left ventricle posterior wall: β=0.81 mm, p=0.045) and the association of the presence of SDB (apnea-hypopnea index≥15/h) with left ventricular function (EF: -4.12%, p=0.040; end systolic volume: 10.12 ml, p=0.004). Control of acromegaly was accompanied by the decrease in OAI (5.9 [0.8, 14.5]/h and 1.7 [0.2, 5.1]/h, p=0.004) and nocturnal heart rate (66.1 [59.2, 69.8] bpm and 61.7 [54.0, 67.2] bpm, p=0.025) and by the increase in blood pressure (DBP: 78.0 [70.3, 86.0] mm Hg and 80.0 [80.0, 90.0] mm Hg, p=0.012). CONCLUSION The comorbidities of acromegaly, including sleep-disordered breathing, appear to have a long-term effect on cardiovascular remodeling in active acromegaly. Future studies should investigate the applicability of the treatment of SDB for the reduction of cardiovascular risk in acromegaly.
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Affiliation(s)
- Irina Filchenko
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341.
| | - Lyudmila Korostovtseva
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Mikhail Bochkarev
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Uliana Tsoy
- Almazov National Medical Research Center, Laboratory of Endocrinology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Yuri Sviryaev
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
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Nemes A, Kormányos Á, Ambrus N, Lengyel C, Valkusz Z. Myocardial, Valvular, and Vascular Structural and Functional Properties in Acromegaly. J Clin Med 2023; 12:6857. [PMID: 37959322 PMCID: PMC10648583 DOI: 10.3390/jcm12216857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Acromegaly is an uncommon systematic endocrine disease caused by the hypersecretion of human growth hormone and, consequently, of insulin-like growth factor-1 during adulthood. Acromegaly could cause a typical cardiomyopathy characterized by left ventricular hypertrophy associated with diastolic dysfunction, which later could progress to systolic dysfunction. Moreover, some valvular and vascular abnormalities are also associated with acromegaly. This present review aims to summarize available information regarding acromegaly-associated abnormalities in myocardial, valvular, and vascular structural and functional properties and their relationship to disease activity and treatment options.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary; (Á.K.); (N.A.); (C.L.); (Z.V.)
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Spille DC, Vorona E, Catalino MP, Reuter G, Beckers A, Holling M, Fava A, Stummer W, Laws ER, Suero-Molina E. Vascular anomalies in patients with growth hormone-secreting pituitary adenomas: illustrative case report and systematic review of the literature. Pituitary 2023; 26:132-143. [PMID: 36508085 PMCID: PMC9908726 DOI: 10.1007/s11102-022-01291-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Endonasal resection is the first-line treatment for patients harboring growth hormone (GH)-secreting pituitary adenomas. The complexity of the parasellar neurovascular structures makes pre-operative diagnostic imaging essential to understanding the anatomy of this region. We aimed to describe vascular anomalies in acromegalic patients and emphasize their relevance for surgery and preoperative planning. METHODS A systematic review following the PRISMA statement was performed in July 2021. RESULTS Thirty-three studies were evaluated. Elevated GH and insulin-like growth factor-1 (IGF-1) levels are linked to the occurrence of cardiovascular risk factors. This is attributed to endothelial dysfunction, mainly caused by changes in flow-mediated dilatation (FMD), which is probably the main cause of vascular anomalies in acromegaly. The occurrence of protrusions of the internal carotid artery (ICA) (35-53%), a narrow intercarotid distance, and an asymmetrical course was described. In 13-18% of acromegalic patients, the presence of an intracerebral aneurysm could be reported (incidence in the general population:0.8-1.3%). The selected studies were however performed with a small patient sample (range:1-257). We present a case report of a 57y/o male patient with anomalies of the ICA ("kissing carotid arteries") harboring a GH-secreting adenoma, which was resected via an endoscopic endonasal approach. CONCLUSIONS There is an association between acromegaly and endothelial dysfunction, which increases cardiovascular risk factors and vascular anomalies. Preoperative vascular imaging, e.g., CT angiography, should be implemented as a standard to identify patients at risk and estimate surgical morbidity. However, no evidence-based recommendations exist so far, so future studies are necessary.
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Affiliation(s)
- Dorothee Cäcilia Spille
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Elena Vorona
- Department of Medicine B of Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology Division for Endocrinology and Diabetes, 48149, Münster, Germany
| | | | - Gilles Reuter
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Albert Beckers
- Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Markus Holling
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Arianna Fava
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, IS, Italy
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric Suero-Molina
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
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Role of cardiovascular magnetic resonance in the clinical evaluation of left ventricular hypertrophy: a 360° panorama. Int J Cardiovasc Imaging 2022; 39:793-809. [PMID: 36543912 DOI: 10.1007/s10554-022-02774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Left ventricular hypertrophy (LVH) is a frequent imaging finding in the general population. In order to identify the precise etiology, a comprehensive diagnostic approach should be adopted, including the prevalence of each entity that may cause LVH, family history, clinical, electrocardiographic and imaging findings. By providing a detailed evaluation of the myocardium, cardiovascular magnetic resonance (CMR) has assumed a central role in the differential diagnosis of left ventricular hypertrophy, with the technique of parametric imaging allowing more refined tissue characterization. This article aims to establish a parallel between pathophysiological features and imaging findings through the broad spectrum of LVH entities, emphasizing the role of CMR in the differential diagnosis.
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Christidi A, Mavrogeni SI. Rare Metabolic and Endocrine Diseases with Cardiovascular Involvement: Insights from Cardiovascular Magnetic Resonance - A Review. Horm Metab Res 2022; 54:339-353. [PMID: 35526533 DOI: 10.1055/a-1846-4878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
The identification of rare diseases with cardiovascular involvement poses significant diagnostic challenges due to the rarity of the diseases, but also due to the lack of knowledge and expertise. Most of them remain underrecognized and undiagnosed, leading to clinical mismanagement and affecting the patients' prognosis, as these diseases are per definition life-threatening or chronic debilitating. This article reviews the cardiovascular involvement of the most well-known rare metabolic and endocrine diseases and their diagnostic approach through the lens of cardiovascular magnetic resonance (CMR) imaging and its prognostic role, highlighting its fundamental value compared to other imaging modalities.
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Affiliation(s)
- Aikaterini Christidi
- Cardiovascular Magnetic Resonance, Euromedica General Clinic, Thessaloniki, Greece
| | - Sophie I Mavrogeni
- Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece, Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Athens, Greece
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Guo X, Wang Y, Yao Y, Bao X, Duan L, Zhu H, Xing B, Liu J. Sub-macroscopic skin presentation of acromegaly and effect of pituitary tumor surgery: A study using dermatoscopy and ultra-high-frequency ultrasound. Front Endocrinol (Lausanne) 2022; 13:1093942. [PMID: 36818464 PMCID: PMC9933496 DOI: 10.3389/fendo.2022.1093942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/22/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Excessive growth hormone and insulin-like growth factor 1 contribute to cutaneous changes in acromegaly. We investigated the sub-macroscopic skin manifestation of acromegaly patients and explored its reversibility upon hormone reduction after pituitary adenoma surgery. DESIGN Prospectively cohort study. METHODS We enrolled 26 patients with acromegaly and 26 patients with non-functioning pituitary adenomas undergoing pituitary adenomectomy at Peking Union Medical College Hospital from July 2021 to March 2022. Skin presentations were evaluated by dermatoscopy and ultra-high-frequency ultrasound before and after surgery. RESULTS Skin thickening, follicular plugs, perifollicular pigmentations, perifollicular orange haloes, red structureless areas, increased hair shafts, honeycomb-like pigmentations, widened dermatoglyphics, dilated appendage openings, excessive seborrhea, hyperhidrosis, enlarged pores, and acne-like lesions were commonly occurring in acromegaly patients, and their incidences were higher than the controls (P<0.05). At 3-month follow-up after surgery, the thickness of skin reduced (4.0 ± 0.4 to 3.7 ± 0.4, P=0.007), the incidences of hyperhidrosis (92.3% to 69.2%, P=0.035) and acne-like lesions (53.8% to 26.9%, P=0.048) declined, and the severity of multiple cutaneous lesions improved. Patients with surgical endocrine remission (53.8%) had greater declines in the thickness of skin than those without remission. Patients with improvement of >1 skin lesions were younger (P=0.028) and had higher baseline GH levels (P=0.021) than those with improvement of ≤1 skin lesion. CONCLUSIONS Dermatoscopy and ultra-high-frequency ultrasound provided augmented visual examination of the cutaneous changes in acromegaly. Some of the skin lesions could improve or reverse after pituitary surgery. Baseline GH levels, age, and endocrine remission were correlated with skin improvement at 3-month follow-up.
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Affiliation(s)
- Xiaopeng Guo
- Department of Neurosurgery, Center for Pituitary Surgery, China Pituitary Disease Registry Center, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yukun Wang
- Department of Dermatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Center for Pituitary Surgery, China Pituitary Disease Registry Center, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Center for Pituitary Surgery, China Pituitary Disease Registry Center, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian Duan
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Center for Pituitary Surgery, China Pituitary Disease Registry Center, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Bing Xing, ; Jie Liu,
| | - Jie Liu
- Department of Dermatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Bing Xing, ; Jie Liu,
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Hinojosa-Amaya JM, Varlamov EV, Yedinak CG, Cetas JS, McCartney S, Banskota S, Fleseriu M. Echocardiographic findings in acromegaly: prevalence of concentric left ventricular remodeling in a large single-center cohort. J Endocrinol Invest 2021; 44:2665-2674. [PMID: 33893617 DOI: 10.1007/s40618-021-01579-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Acromegaly is a rare disease and is associated with increased cardiovascular (CV) morbidity and mortality, especially in patients with uncontrolled disease. We aimed to analyze the prevalence and severity of cardiomyopathy and valvular heart disease in a large cohort of patients with a confirmed acromegaly diagnosis, at baseline and after treatment. METHODS We retrospectively reviewed an institutional approved database; 190 patients with confirmed acromegaly and follow-up data available (years 2006-2018). Patients with at least one baseline echocardiogram, were included. Demographic, disease control and echocardiogram variables were collected for analysis. RESULTS Of the 190 patients 110 (58%) had a baseline echocardiogram and 43 (39.1%) had at least one follow-up echocardiogram after surgical, medical or multimodal treatment. Baseline left ventricular hypertrophy (LVH) prevalence was 17.8% (64.7% concentric; 35.3% eccentric), diastolic and systolic dysfunction, and overt cardiomyopathy with heart failure were 15.8, 7.9, and 3.0%, respectively. Concentric remodeling of the left ventricle (LV) was noted in 31.4% of patients without LVH. Valve defects were found in 87.3% of patients (14.6% with significant valvular heart disease). CONCLUSION Early diagnosis of acromegaly and disease control should be attempted to prevent LVH/LV dysfunction and development of valvular heart disease. Concentric LV remodeling develops prior to obvious LV hypertrophy in almost a third of patients with acromegaly, which is a novel finding. Similar to other epidemiological studies, we found a high prevalence of LVH/LV dysfunction. Although possible, reversal of systolic and diastolic dysfunction is sporadic after treatment of acromegaly.
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Affiliation(s)
- J M Hinojosa-Amaya
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonóma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - E V Varlamov
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - C G Yedinak
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - J S Cetas
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Operative Care Division, Portland Veterans Administration Hospital, 3710 SW US Veterans Hospital Road, Portland, OR, USA
| | - S McCartney
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - S Banskota
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - M Fleseriu
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA.
- Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA.
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA.
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