The potential link between acromegaly and risk of acute ischemic stroke in patients with pituitary adenoma: a new perspective

Abstract

Acromegaly is an endocrine disorder due to the excess production of growth hormone (GH) from the anterior pituitary gland after closed epiphyseal growth plates. Acromegaly is mainly caused by benign GH-secreting pituitary adenoma. Acute ischemic stroke (AIS) is one of the most common cardiovascular complications. It ranks second after ischemic heart disease (IHD) as a cause of disability and death in high-income countries globally. Thus, this review aimed to elucidate the possible link between acromegaly and the development of AIS. The local effects of acromegaly in the development of AIS are related to the development of pituitary adenoma and associated surgical and radiotherapies. Pituitary adenoma triggers the development of AIS through different mechanisms, particularly aneurysmal formation, associated thrombosis, and alteration of cerebral microcirculation. Cardiovascular complications and mortality were higher in patients with pituitary adenoma. The systemic effect of acromegaly-induced cardio-metabolic disorders may increase the risk for the development of AIS. Additionally, acromegaly contributes to the development of endothelial dysfunction (ED), inflammatory and oxidative stress, and induction of thrombosis that increases the risk for the development of AIS. Moreover, activated signaling pathways, including activator of transcription 3 (STAT3), nuclear factor kappa B (NF-κB), nod-like receptor pyrin 3 (NLRP3) inflammasome, and mitogen-activated protein kinase (MAPK) in acromegaly may induce systemic inflammation with the development of cardiovascular complications mainly AIS. Taken together, acromegaly triggers the development of AIS through local and systemic effects by inducing the formation of a cerebral vessel aneurysm, the release of pro-inflammatory cytokines, the development of oxidative stress, ED, and thrombosis correspondingly.

Keywords: Acromegaly; Acute ischemic stroke; Growth hormone; Insulin-like growth factor 1.

Fig. 1

The pathophysiology of acromegaly

Fig. 2

The pathophysiology of acute ischemic stroke

Fig. 3

Acromegaly and thrombosis: Hypersecretion of growth hormone (GH) and insulin-like growth factor I (IGF-I) in acromegaly is associated with the development of inflammatory, oxidative stress, and endothelial dysfunction (ED) together with induction of thrombosis may increase the risk for the development of acute ischemic stroke (AIS)

Fig. 4

Acromegaly and inflammatory pathways: Growth hormone (GH) excess triggers the activation of signal transducer and activator of transcription 3 (STAT3), Janus kinase (JAK), nuclear factor kappa B (NF-κB), nod-like receptor pyrin 3 (NLRP3) and mitogen-activated protein kinase (MAPK) in acromegaly leading to systemic inflammation with the development of cardiovascular complications mainly acute ischemic stroke