Complications and Comorbidities of Acromegaly-Retrospective Study in Polish Center

Abstract

Introduction: In acromegaly, chronic exposure to impaired GH and IGF-I levels leads to the development of typical acromegaly symptoms, and multiple systemic complications as cardiovascular, metabolic, respiratory, endocrine, and bone disorders. Acromegaly comorbidities contribute to decreased life quality and premature mortality. The aim of our study was to assess the frequency of acromegaly complications and to evaluate diagnostic methods performed toward recognition of them.

Materials and methods: It was a retrospective study and we analyzed data of 179 patients hospitalized in the Department of Endocrinology, Diabetes and Isotope Therapy in Wroclaw Medical University (Poland) in 1976 to 2018 to create a database for statistical analysis.

Results: The study group comprised of 119 women (66%) and 60 men (34%). The median age of acromegaly diagnosis was 50.5 years old for women (age range 20-78) and 46 for men (range 24-76). Metabolic disorders (hyperlipidemia, diabetes, and prediabetes) were the most frequently diagnosed complications in our study, followed by cardiovascular diseases and endocrine disorders (goiter, pituitary insufficiency, osteoporosis). BP measurement, ECG, lipid profile, fasting glucose or OGTT were performed the most often, while colonoscopy and echocardiogram were the least frequent.

Conclusions: In our population we observed female predominance. We revealed a decrease in the number of patients with active acromegaly and an increase in the number of well-controlled patients. More than 50% of patients demonstrated a coexistence of cardiac, metabolic and endocrine disturbances and only 5% of patients did not suffer from any disease from those main groups.

Keywords: GH; IGF-I; acromegaly; comorbidity; complication; pituitary adenoma.

Figure 1

Distribution of patients with active, controlled and cured acromegaly over 5-year time frames. (A) – the numerical value; (B) – the percentage value AA, active acromegaly; WCA, well-controlled acromegaly; SCA, surgery cured acromegaly.

Figure 2

Differences between patients operated once and patients with reoperations. (A) GH concentrations; (B) IGF-I concentrations; (C) maximal tumor dimensions.

Figure 3

Type of used pharmacotherapy over 5-year time frames.

Figure 4

Heatmap of particular complications co-occurrence. Each row in the heatmap denotes a patient. Each column is a complication. Bright fields mark complications that a patient suffered from. In addition, the dendrograms on the left-hand side and the top panel present grouping of patients, and grouping of complications, respectively.