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Endocrine Reviews 25 (1): 102-152
Copyright © 2004 by The Endocrine Society

Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management

Annamaria Colao, Diego Ferone, Paolo Marzullo and Gaetano Lombardi

Department of Molecular and Clinical Endocrinology and Oncology (A.C., P.M., G.L.), "Federico II" University of Naples, 80131 Naples, Italy; and Department of Endocrinological and Metabolic Sciences and Center for Excellence for Biological Research (D.F.), University of Genova, 16132 Genova, Italy

Correspondence: Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Department of Molecular and Clinical Endocrinology and Oncology, "Federico II" University, via S. Pansini 5, 80131 Napoli, Italy. E-mail: colao{at}unina.it.

This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases, although currently neoplastic complications have been questioned as a relevant cause of increased risk of death. Biventricular hypertrophy, occurring independently of hypertension and metabolic complications, is the most frequent cardiac complication. Diastolic and systolic dysfunction develops along with disease duration; and other cardiac disorders, such as arrhythmias, valve disease, hypertension, atherosclerosis, and endothelial dysfunction, are also common in acromegaly. Control of acromegaly by surgery or pharmacotherapy, especially somatostatin analogs, improves cardiovascular morbidity. Respiratory disorders, sleep apnea, and ventilatory dysfunction are also important contributors in increasing mortality and are beneficially advantaged by controlling GH and IGF-I hypersecretion. An increased risk of colonic polyps, which more frequently recur in patients not controlled after treatment, has been reported by several independent investigations, although malignancies in other organs have also been described, but less convincingly than at the gastrointestinal level. Finally, the most important cause of morbidity and functional disability of the disease is arthropathy, which can be reversed at an initial stage, but not if the disease is left untreated for several years.




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Partial Surgical Removal of Growth Hormone-Secreting Pituitary Tumors Enhances the Response to Somatostatin Analogs in Acromegaly
J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 85 - 92.
[Abstract] [Full Text] [PDF]

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 J. Clin. Endocrinol. Metab.Home page
E. Resmini, M. Casu, V. Patrone, G. Murialdo, F. Bianchi, M. Giusti, D. Ferone, and F. Minuto
Sympathovagal Imbalance in Acromegalic Patients
J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 115 - 120.
[Abstract] [Full Text] [PDF]

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 Postgrad. Med. J.Home page
J Ayuk and M C Sheppard
Growth hormone and its disorders
Postgrad. Med. J., January 1, 2006; 82(963): 24 - 30.
[Abstract] [Full Text] [PDF]

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 Endocr Relat CancerHome page
K Wagner, K Hemminki, E Israelsson, E Grzybowska, R Klaes, B Chen, D Butkiewicz, J Pamula, W Pekala, and A Forsti
Association of polymorphisms and haplotypes in the human growth hormone 1 (GH1) gene with breast cancer
Endocr. Relat. Cancer, December 1, 2005; 12(4): 917 - 928.
[Abstract] [Full Text] [PDF]

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 J. Clin. Endocrinol. Metab.Home page
N. R. Biermasz, A. M. Pereira, J. W. A. Smit, J. A. Romijn, and F. Roelfsema
Morbidity after Long-Term Remission for Acromegaly: Persisting Joint-Related Complaints Cause Reduced Quality of Life
J. Clin. Endocrinol. Metab., May 1, 2005; 90(5): 2731 - 2739.
[Abstract] [Full Text] [PDF]

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 J. Clin. Endocrinol. Metab.Home page
J. J. Puder, S. Nilavar, K. D. Post, and P. U. Freda
Relationship between Disease-Related Morbidity and Biochemical Markers of Activity in Patients with Acromegaly
J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 1972 - 1978.
[Abstract] [Full Text] [PDF]


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