Acromegaly Medical and Health News Headlines

PREVALENCE OF VERTEBRAL FRACTURES IN MEN WITH ACROMEGALY.

J Clin Endocrinol Metab. 2008 Sep 30;

Authors: Mazziotti G, Bianchi A, Bonadonna S, Cimino V, Patelli I, Fusco A, Pontecorvi A, De Marinis L, Giustina A

Context: Data on osteoporotic fractures in acromegaly are limited. An increased prevalence of radiological vertebral fractures was already observed in postmenopausal women with active acromegaly. It is unknown whether this observation may reflect a more general increased risk of fractures in acromegaly. Design: Cross-sectional study. Setting: Referral centers. Patients and control subjects: 40 males with acromegaly (25 patients with controlled disease and 15 patients with active disease) and in 31 control males, with age and gonadal status comparable to the patients. Interventions: Evaluation of vertebral fractures (quantitative morphometric analysis) and bone mineral density (BMD) at lumbar spine and total hip (dual-energy X-ray absorptiometry). Main outcome measure: Vertebral fractures. Results: Although BMD was not significantly different between acromegalic patients and control subjects, the prevalence of vertebral fractures was higher in acromegalic patients as compared with the control subjects (57.5% vs. 22.6%; Chi-square: 8.7; p=0.003). Fractured and non fractured acromegalic patients showed no significant difference in age and BMD Z-score. However, acromegalic patients with fractures had serum IGF-I values significantly higher and duration of active disease significantly longer with respect to patients without fractures. Moreover, patients with fractures showed significantly longer untreated hypogonadism as compared to patients without fractures. In a multivariate logistic regression analysis the duration of active acromegaly was the only risk factor significantly correlated with the occurrence of fractures (odds ratio: 1.1, C.I. 1.04-1.6). Conclusions: This study reports for the first time a high prevalence of osteoporotic vertebral fractures in an unselected acromegalic male population generally considered at low risk of osteoporosis suggesting that complicated osteoporosis is an important comorbidity of acromegaly.

PMID: 18827004 [PubMed - as supplied by publisher]

Gender dimorphism in body composition abnormalities in acromegaly. Males are more affected than females.

Eur J Endocrinol. 2008 Sep 19;

Authors: Sucunza N, Barahona MJ, Resmini E, Fernandez-Real J, Farrerons J, Lluch P, Puig T, Wagner A, Ricart W, Webb S

Acromegaly changes body composition (BC), but long-term gender differences have not been reported. Objective: To evaluate BC in active and controlled acromegalic patients. Design and methods: Clinical, biochemical variables and BC (by DEXA) were evaluated in 60 acromegalic patients (19 active, 41 controlled) and 105 controls, matched for age and gender. Results: Acromegalic males (n=24), had more total mass (89+/-13 vs. 76.5+/-15.3Kg; p<0.001), lean body mass (LBM) (64.6+/-8.7 vs. 56.4+/-5.8Kg; p<0.001), and bone mineral content (BMC) (2.9+/-0.5 vs. 2.6+/-0.3Kg; p<0.05) than controls (n=33). Controlled male patients (n=14), had more total mass (89+/-14.7 vs. 76.5+/-15.3Kg; p<0.05) and a trend to have more LBM (61.8+/-9.4 vs. 56.4+/-5.8Kg; p=0.065) than controls. Only in active disease, a decrease in fat mass (FM) was observed compared with controlled patients and controls (males: 19.5+/-5.3 vs. 27+/-6.2 and 25.9+/-4% p<0.001; females: 30.3+/-6.7 vs. 37.1+/-5.8 and 36.5+/-6.6% p<0.01). In females no further differences were observed. No differences in BMC were found between eugonadal and hypogonadal acromegalic patients, but in hypogonadal females, acromegaly appeared to prevent the BMC loss seen in hypogonadal postmenopausal controls. GH and IGF-I levels were negatively correlated with FM (males p<0.05; females p<0.001), but in the regression analysis only in women was GH a predictor of FM. Conclusions: Control of acromegaly reverts decreased FM in both genders; only in males more total mass and a trend for more LBM persist. The anabolic effect of GH on bone reverted in cured males, but persisted in females and appeared to override the bone loss of menopause.

PMID: 18805912 [PubMed - as supplied by publisher]

Cardiac manifestations of growth hormone deficiency after treatment for acromegaly: a comparison to patients with biochemical remission and controls.

Eur J Endocrinol. 2008 Sep 11;

Authors: van der Klaauw A, Bax J, Bleeker G, Holman E, Delgado V, Smit J, Romijn J, Pereira A

Objective: Both growth hormone (GH) excess and GH deficiency (GHD) lead to specific cardiac pathology. The aim of this study was to evaluate cardiac morphology and function in patients with GHD after treatment for acromegaly. Design: Cross-sectional study. Patients and methods: Cardiac parameters were studied by conventional two-dimensional echocardiography and Tissue Doppler imaging in 53 patients with acromegaly (16 patients with GHD, 20 patients with biochemical remission, and 17 patients with active disease). Patients with GHD were also compared to age- and gender-matched controls. Results: Left ventricular (LV) dimensions, wall thickness, and mass did not differ between the three groups, or between the patients with GHD and healthy controls. Systolic function, assessed by LV ejection fraction, tended to be lower in patients with GHD compared to patients with biochemical remission (65.9 +/- 7.3 % vs. 72.4 +/- 8.5 %, P=0.070), but was higher when compared to active acromegaly (58.8 +/- 9.3 %, P=0.047). No differences were found with healthy controls. Diastolic function, measured with early diastolic velocity (E'), was lower in patients with GHD both when compared to patients with biochemical remission (6.0 +/- 2.1 cm/s vs. 8.3 +/- 1.5 cm/s, P=0.005) and to healthy controls (8.1 +/- 1.9 cm/s, P=0.006). Conclusion: GHD after acromegaly results in specific decrease in diastolic function compared to patients with biochemical remission of acromegaly and healthy controls. In addition, systolic function tends to be decreased in patients with GHD compared to patients with biochemical remission, but was higher than in patients with active acromegaly.

PMID: 18787048 [PubMed - as supplied by publisher]

Does radiosurgery have a role in the treatment of acromegaly?

Nat Clin Pract Endocrinol Metab. 2008 Sep 2;

Authors: Swearingen B, Loeffler J

Surgical treatment of acromegaly aims to normalize the levels of growth hormone and insulin-like growth factor I (IGF-I) and to control tumor growth; however, not all patients achieve remission. Treatment of residual tumor or recurrent disease, therefore, requires additional modalities, such as somatostatin analogs or radiosurgery. Losa et al. have evaluated the efficacy and safety of radiosurgery in a cohort of 83 patients with acromegaly who had previously undergone surgical debulking. The authors reported a 5-year biochemical remission rate of 52.6% after treatment. Remission was found to correlate with the baseline growth hormone and IGF-I levels, but not with tumor volume. In this Practice Point commentary, we place the findings of Losa et al. into clinical context, discuss the possible limitations of their approach, and comment on the relevance of radiosurgery to the treatment of acromegaly.

PMID: 18762791 [PubMed - as supplied by publisher]

Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease.

Eur J Endocrinol. 2008 Sep 2;

Authors: Davi' MV, Dalle Carbonare L, Giustina A, Ferrari M, Frigo A, Lo Cascio V, Francia G

Background: Whether sleep apnoea syndrome (SAS) subsides after biochemical and clinical remission of acromegaly is controversial. Objective: To assess the presence of SAS in a cohort of acromegalic patients which included a subgroup with active disease and a subgroup in remission and to evaluate clinical and biochemical independent predictors of SAS. Design: Cross-sectional and longitudinal study. Setting: Italian university department of internal medicine. Patients: 36 acromegalic patients: 18 active and 18 controlled. Measurements: Polysomnography was performed in all patients and repeated in six with active acromegaly and SAS after achieving disease control. Echocardiographic parameters were also measured. Results: The prevalence of SAS was 47% in the overall acromegalic population: 56% in the active group and 39% in the controlled one. In a multivariate analysis IGF-1, male gender, age, body mass index, disease duration were associated with SAS . Impaired glucose tolerance or diabetes were more prevalent in patients with SAS, particularly in the severe cases. Among the 6 patients of the longitudinal study, 5 showed improvement of SAS, but none recovered. No correlation was found between echocardiographic parameters and severity of SAS. Conclusion: SAS can persist after recovery of acromegaly in several patients. Given the negative prognostic significance of this respiratory disorder, polysomnography should be included as routine procedure in the work-up of the acromegaly, even if in remission, being mandatory in those patients considered at high risk (elderly males, overweight, diabetic) Appropriate intensive treatment should be implemented to minimize the clinical impact of SAS in acromegaly.

PMID: 18765561 [PubMed - as supplied by publisher]

Results of surgical and somatostatin analogue therapy and their combination in acromegaly - a retrospective analysis of the German Acromegaly Register.

Eur J Endocrinol. 2008 Aug 28;

Authors: Petersenn S, Buchfelder M, Reincke M, Strasburger C, Franz H, Lohmann R, Quabbe H, Ploeckinger U

Background: Data on surgical and medical treatment outcome in acromegaly mostly originate from specialized centres. We retrospectively analysed data on surgery, primary somatostatin analogue therapy (SSA), surgery preceded by SSA and SSA preceded by surgery in 1485 patients from the German Acromegaly Register. Methods: Two trained nurses visited all centres (N=42) for data acquisition. Results: Primary surgery: Of 889 patients 554 yielded analyzable data (microadenomas 22.9%, macroadenoms 77.1%). GH and IGF-I normalized in 54.3 and 67.2%. Partial or total pituitary insufficiency occurred in 28.6% initially and 41.2% post surgery. Primary SSA (>/=3 months): Of 329 patients 145 yielded analyzable data (microadenomas 26.7%, macroadenoms 73.3%). GH and IGF-I normalized in 36.3 and 30.5%, increasing to 40.8 and 41.5% with longer SSA (>/=360 days) in 54 patients. Pituitary function did not change. SSA (>/=3 months) prior to surgery: Of 234 patients 93 yielded analyzable data. Post-surgery GH and IGF-I was normalized in 62.9 and 68.4%, significantly more often compared to primary surgery for GH (p<0.05), but not for IGF-I. Surgery followed by SSA: Of 122 patients 34 yielded analyzable data. GH and IGF-I normalized during SSA in 24.1 and 45.5%., Relative GH decrease was significantly larger compared to primary SSA. Conclusions: Pituitary surgery was more effective to lower GH and IGF-I concentrations than primary SSA. Primary SSA may be an option in selected patients. SSA prior to surgery only marginally improved surgical outcome. Debulking surgery may result in better final outcome in patients with a high GH concentration and a large tumor.

PMID: 18755874 [PubMed - as supplied by publisher]

Follow-up of Pituitary Tumor Volume in Patients with Acromegaly Treated with Pegvisomant in Clinical Trials.

Eur J Endocrinol. 2008 Aug 15;

Authors: Jimenez C, Burman P, Abs R, Clemmons D, Drake W, Hutson K, Messig M, Thorner M, Trainer P, Gagel R

Objective: We examined pituitary tumor volumes in patients treated with pegvisomant for 18 months or longer, and in whom the tumors were monitored for at least 3 years. We present details on nine of 304 patients in clinical trials with pegvisomant who experienced tumor growth within the first year of treatment. Method: MRI images prior to start of pegvisomant and at last follow-up were examined in forty-three patients (14% of participating patients). Twenty-nine had received prior radiation therapy (18% of irradiated patients) and all but five received somatostatin analogues between periods of pegvisomant treatment. Results: At follow-up, the median tumor volume was 0.6 cc (range 0.0-19.7 cc), in comparison with 1.6 cc (0.0-19.7 cc) at baseline (p <0.001). Twenty-five patients, of who 23 received radiation therapy, had tumor volume reduction. Seventeen patients had no significant change. One patient, who had not received radiation therapy, had an increase in tumor volume from 1.61 cc to 1.93 cc. Of the nine patients with tumor growth, six had progressive growth before initiating pegvisomant. Two patients with stable tumors while on octreotide experienced enlargement after octreotide discontinuation but remained stable on long-term pegvisomant therapy. Conclusion: The present data indicate that pegvisomant does not promote tumor growth and suggest that the nine observed cases of tumor progression, which occurred within eight months after commencing pegvisomant, are likely rebound expansions after discontinuation of somatostatin analogues and/or the natural history of aggressively growing pituitary tumors. Continued long-term surveillance of tumor volume, particularly in non-irradiated patients, is recommended.

PMID: 18708436 [PubMed - as supplied by publisher]

Clinical Use of Cabergoline as Primary and Adjunctive Treatment for Acromegaly.

Eur J Endocrinol. 2008 Aug 15;

Authors: Moyes V, Metcalfe K, Drake W

Background: Cabergoline is a dopamine agonist that may be used as primary or adjunctive therapy for acromegaly. Although one study suggested biochemical control may be achieved in a substantial proportion of patients1 it is still commonly perceived to be a relatively ineffective treatment. Design and Method: A prospective audit was performed of 15 consecutive acromegalic patients (8 male, 7 female, median age 55, range 31-92 at presentation) treated with cabergoline to determine the effective dose and tolerability. All had normal anterior pituitary function; two patients had hyperprolactinaemia. MRI revealed 9 adenomata, 2 partially empty sellae and 4 structurally normal pituitary glands. 9 patients had undergone trans-sphenoidal surgery 1-12 months, and 1 patient had received pituitary radiotherapy 18 years, prior to commencement of cabergoline. All patients had biochemical GH excess; median serum IGF-I 471ng/ml, range 239-746ng/ml. The calculated mean of a series of GH measurements ranged from 2.7-45.8miu/l, median 9.7miu/L. Results: On a median weekly dose of cabergoline of 1.75mg (range 0.5-7mg) normalisation of both IGF-I and GH occurred in four out of 15 patients (27%). Five of 15 patients (33%) achieved a serum IGF-I within the reference range with notable reductions seen in a further five patients. Nine patients (60%) achieved a mean serum GH level of less than 5miu/L. Duration of treatment was 2 to 52 months and was well tolerated in 14 patients. Conclusion: Cabergoline can be an effective and well tolerated primary or adjunctive therapy for acromegaly and useful clinical responses are noted even with modest doses.

PMID: 18708434 [PubMed - as supplied by publisher]

Cryohypophysectomy used in the treatment of a case of feline acromegaly.

J Small Anim Pract. 2008 Aug 5;

Authors: Blois SL, Holmberg DL

A 10-year-old female spayed cat was diagnosed with acromegaly secondary to a pituitary tumour. At the time of diagnosis, the cat had insulin-resistant diabetes mellitus and its insulin-like growth factor-I levels were elevated. Clinical signs included polyuria, polydipsia and weight gain. Persistent hyperglycaemia and glucosuria were identified, and fructosamine levels remained elevated. Magnetic resonance imaging of the brain showed a pituitary tumour. Transsphenoidal cryohypophysectomy was used to treat the pituitary tumour. Postoperatively, the serum insulin-like growth factor-I levels decreased and the diabetes mellitus was controlled with routine levels of insulin. To the authors' knowledge, this is the second reported case of acromegaly treated with cryohypophysectomy, and the first that reports a favourable long-term outcome. Cryohypophysectomy may be a safe and effective treatment for cats with a pituitary mass resulting in acromegaly.

PMID: 18684148 [PubMed - as supplied by publisher]