Acromegaly and thyroid cancer: analysis of evolution in a series of patients

Abstract

Background Acromegaly is associated with higher morbidity and mortality mainly due to cardiovascular disease. Data on the incidence and evolution of thyroid cancer in acromegaly are controversial. Our objective was to describe the characteristics of a group of acromegalic patients with differentiated thyroid carcinoma (DTC) and analyze their evolution. Methods This is a retrospective multicenter study of 24 acromegalic patients with DTC. The AJCC Staging System 8th Edition was used for TNM staging, and the initial risk of recurrence (RR), initial response and response at the end of follow-up (RFU) were defined according to the 2015 ATA Guidelines. As a control group, 92 patients with DTC without acromegaly were randomly included. Statistical analyses were done using SPSS Statistics 20.0. Results Median age of patients at diagnosis of acromegaly was 49.5 years (range 12–69). The median delay in diagnosis of acromegaly was 3 years (range 0.5–23). Mean baseline IGF-1 level was 2.9 ± 1.1 ULN. Median age at DTC diagnosis was 51.5 years (18–69). At the moment of diagnosis of DTC, 58.3% of the patients had active acromegaly. Median time from DTC diagnosis to acromegaly control was 1.25 years (0.5–7). Mean DTC tumor diameter of the biggest lesion was 14.6 ± 9.2 mm, being multifocal in 37.5%. All tumors were papillary carcinomas, two cases being of an aggressive variety. Lymph node dissection was performed in 8 out of 24 patients and 62.5% had metastases. Only one patient had distant metastases. Radioiodine ablation was given to 87.5% of patients. Nineteen patients (79%) were stage I, four (17%) stage II and one (4%) stage IVb. Initial RR was low in 87% (21/24), intermediate in 9% (2/24) and high in 4% (1/24) patient. RFU was: 83% (19/23) patients with no evidence of disease, 9% (2/23) with indeterminate response, 4% (1/23) with biochemical incomplete response and 4% (1/23) with structural incomplete response, at a median time of FU of 36.5 months. When comparing RFU between acromegalics and controls no statistically significant differences were found. Conclusions Patients with acromegaly and DTC mostly had a low initial RR. When compared with the control group, we found that DTC patients with acromegaly did not have a worse evolution.

Evolución del cáncer papilar de tiroides en acromegalia

“…La acromegalia es una patología crónica de naturaleza progresiva lenta, como consecuencia de los síntomas no específicos [3], tardando varios años en ser diagnosticada, algunos autores refieren como promedio 10 años [4,5], reflejo de esta demora resulta que hasta el 80% son macroadenomas al diagnóstico [6], y la sintomatología con la que debutan puede estar Figura 2 RMN S/C de hipófisis: posquirúrgico. ocasionada por la naturaleza expansiva del tumor [5], motivando la realización de estudios complementarios en los que se filie la masa pituitaria, además de la evaluación bioquímica con el perfil hormonal siguiendo el algoritmo diagnostico con IGF-1 superior a 2.5 DE y falta de supresión de la GH a la hiperglucemia [7].…”

Prevalence, incidence, and risk of cancers in patients with acromegaly: review

“…What is noteworthy, the prevalence of thyroid neoplasms among patients with acromegaly is comparable in males and females. [61] and the data show that there is no difference in the aggressiveness of thyroid carcinoma between patients with acromegaly and the control group [62]. Studies showed that 25% to 90 % of acromegalic patients manifested goitre and 65 % had multinodular goitre, which shows the positive correlation between the GH and IGF-1 levels and thyroid volume [62].…”

“…[61] and the data show that there is no difference in the aggressiveness of thyroid carcinoma between patients with acromegaly and the control group [62]. Studies showed that 25% to 90 % of acromegalic patients manifested goitre and 65 % had multinodular goitre, which shows the positive correlation between the GH and IGF-1 levels and thyroid volume [62]. To understand the linkage between the thyroid benign and malignant nodules emergence in the course of acromegaly, the molecular aspects need to be highlighted.…”

“…While discussing the prevalence of thyroid carcinomas in acromegalics, it is important to mention that there is a risk of overdiagnosis in patients which are followed up frequently in the course of the disease. This methodological threat refers also to the fact that authors of some studies classified patients even with small thyroid nodules for cytology examination, resulting in thyroid microcarcinomas diagnoses, which are low-risk tumours [61], [62], [64] and would not be diagnosed in representatives of general population.…”

Thyroid Hormone Changes Related to Growth Hormone Therapy in Growth Hormone Deficient Patients

“…Biological evidence of close relationships between the two axes are mainly based on clinical observations in GH-deficient patients treated with rhGH at physiological doses and also in opposite circumstances-in acromegalic patients with pathological GH excess, in whom the thyroid gland is often affected. In patients with supraphysiological level of GH, goiter is reported in 55-87% [39,40] and thyroid cancer in 8.7-10.6% [41][42][43].…”