Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities.
Rosario PivonelloRenata S AuriemmaLudovica F S GrassoClaudia PivonelloChiara SimeoliRoberta PatalanoMariano GaldieroAnnamaria ColaoPublished in: Pituitary (2017)
Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
Keyphrases
- risk factors
- early stage
- cardiovascular disease
- growth hormone
- left ventricular
- sleep apnea
- heart failure
- blood pressure
- cardiovascular events
- physical activity
- obstructive sleep apnea
- squamous cell carcinoma
- oxidative stress
- skeletal muscle
- arterial hypertension
- type diabetes
- adipose tissue
- blood glucose
- coronary artery disease
- metabolic syndrome
- insulin resistance
- mesenchymal stem cells
- combination therapy
- cardiovascular risk factors
- middle aged
- ejection fraction
- replacement therapy