Acromegaly colonoscopy findings12/15/2023 ![]() Consenting patients had data abstracted from medical records and entered in a database. This was a prospective cohort study of an acromegaly registry established at the Cedars-Sinai Medical Center Pituitary Center (CSMC-PC), with retrospective chart data at CSMC-PC for some patients dating as far back as 1985. We sought, using medical records from a single referral center, to estimate the proportion of acromegaly patients with various comorbid conditions, and to determine if biochemical disease control was associated with reduced rate of cardiovascular risk factors. Successful treatment appears to reduce myocardial thickness and improve sleep apnea, but a link between biochemical control and hypertension, diabetes, and other key outcomes has not been established. The risk of developing these comorbid conditions generally increases with the length and severity of biochemical abnormalities. In addition to direct effects from the tumor mass, untreated patients with acromegaly may develop diabetes mellitus, hypertension, cardiomyopathy, sleep apnea, and colon polyps at rates much higher than the non-acromegaly population. In patients with very mild signs and symptoms, guidelines suggest an initial trial of the dopamine agonist cabergoline. Current guidelines recommend somatostatin receptor ligands (SRLs) (octreotide and lanreotide) or GH-receptor antagonist pegvisomant for initial medical therapy in patients with moderate-to-severe signs and symptoms of GH excess. Initial treatment is generally transsphenoidal surgical resection of the adenoma, but about half of the patients require additional treatment. The primary goal of therapy is to normalize GH and IGF-1 levels, as these values have been shown to correspond to a reduction in mortality similar to that of an unaffected population. Diagnosis is made clinically on the basis of typical signs and symptoms and confirmed with laboratory assessment of GH and/or IGF-1 levels. Most acromegaly patients are diagnosed at an average age of about 40 years. Although untreated acromegaly has clinically significant consequences, most signs and symptoms appear slowly, often resulting in delayed diagnosis. The disease affects between 40 and 130 individuals per million persons, or approximately 20,000 people in the US, and recent studies indicate incidence of pituitary tumors in the US is increasing. IGF-1 in turn facilitates somatic growth and metabolic function. GH has direct metabolic effects and also stimulates hepatic insulin-like growth factor-I (IGF-1) production. New onset comorbidities (reported 6 months after study start) were uncommon (8 years of treatment, demonstrating the difficulty of achieving control in some patients.Īcromegaly results from excessive growth hormone (GH) production, usually caused by a benign pituitary adenoma. ![]() Of 120 patients, 79 (65.8%) achieved control during the study period. Initial treatment was surgery in 104 patients (86%), pharmacotherapy in 16 (13.2%), and radiation therapy in 1 (0.8%). Macroadenomas were observed in 93 of 106 patients (87.7%), and microadenomas in 13 (12.3%). Mean study period was 8.8 (SD: 7.2) years. Mean age at diagnosis was 42.4 (SD: 15.0). Study period was from first to last insulin-like growth factor-I and growth hormone tests. Study patients were followed for ≥12 months after initial treatment. Methodsĭata were from a single-center acromegaly registry. The study aim was to estimate the proportion of acromegaly patients with various comorbidities and to determine if biochemical control was associated with reduced proportion of cardiovascular risk factors.
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