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Review
. 2018 Mar;41(3):419-425.
doi: 10.1002/clc.22867. Epub 2018 Mar 25.

Acromegalic cardiomyopathy: Epidemiology, diagnosis, and management

Ajay N Sharma  1 , Marilyn Tan  2 , Ezra A Amsterdam  3 , Gagan D Singh  3
Affiliations
Review

Acromegalic cardiomyopathy: Epidemiology, diagnosis, and management

Ajay N Sharma et al. Clin Cardiol. 2018 Mar.

Abstract

Acromegalic cardiomyopathy is the leading cause of morbidity and all-cause mortality in patients with acromegaly. Though acromegaly is a rare condition, the associated derangements are vast and severe. Stemming from an increase in circulating growth hormone (GH) and insulin-like growth factor-1 levels (IGF-1), acromegalic cardiomyopathy results in pathological changes in myocyte growth and structure, cardiac contractility, and vascular function. These molecular changes manifest commonly as biventricular hypertrophy, diastolic and systolic dysfunction, and valvular regurgitation. Early recognition of the condition is paramount, though the insidious progression of the disease commonly results in a late diagnosis. Biochemical testing, based on IGF-1 measurements, is the gold standard of diagnosis. Management should be centered on normalizing serum levels of both IGF-1 and GH. Transsphenoidal resection remains the most cost-effective and permanent treatment for acromegaly, though medical therapy possesses benefit for those who are not surgical candidates. Ultimately, achieving control of hormone levels results in a severe reduction in mortality rate, underscoring the importance of early recognition and treatment.

Keywords: Acromegalic Cardiomyopathy; Acromegaly; Clinical Manifestations; Diagnosis; Epidemiology; Prognosis.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
Pathogenesis of acromegalic cardiomyopathy. Abbreviations: GH, growth hormone; IGF‐1, insulin‐like growth factor 1
Figure 2
Figure 2
Physical manifestations of acromegaly.4 Patient is a 6 ft 8 in., 280‐pound African American male. (A) The patient had bossing and macroglossia. (B) Enlargement of the hands due to swelling of the soft tissue, and growth of bone, cartilage, and muscle. (C) The patient's shoe, size 19, compared with a size‐11 shoe
Figure 3
Figure 3
Diagnostic algorithm for acromegaly.40 Abbreviations: CT, computed tomography; GH, growth hormone; GHRH, growth hormone–releasing hormone; IGF‐1, insulin‐like growth factor 1; MRI, magnetic resonance imaging; OGTT, oral glucose tolerance test
See this image and copyright information in PMC

References

    1. Castellano G, Affuso F, Di Conza P, et al. The GH/IGF‐1 Axis and Heart Failure. Curr Cardiol Rev. 2009;5:203–15. - PMC - PubMed
    1. Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol. 2012;2012:1–10. - PMC - PubMed
    1. Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary 1999;2:29–41. - PubMed
    1. Mantri NM, Amsterdam E, Tan M, et al. Power failure: acromegalic cardiomyopathy. Am J Med. 2016;129:674–7. - PubMed
    1. Nixon J V. The AHA Clinical Cardiac Consult Lippincott Williams & Wilkins; 2010.

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