Acromegaly and ultrasound: how, when and why?

Abstract

Background Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. Purpose This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. Conclusions Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.

Circulating insulin-like growth factor-I and risk of 25 common conditions: outcome-wide analyses in the UK Biobank Study

“…The findings for IHD, 9 osteoarthritis, 12 colon polyps, 14,15 and uterine fibroids 49 are in line with some of the available prospective or genetic evidence from population-based studies, and the results for kidney stones are supported by studies in adults with acromegaly. 5 It is possible that some of these associations were masked by reverse causality in the first five years of follow-up, and follow-up with larger numbers is needed to clarify whether IGF-I might associate with these outcomes. This is the first study to adopt an outcome-wide approach to the investigation of IGF-I and risk of 25 common conditions (other than cancer); this comprehensive approach allowed us to assess and compare the effect sizes of multiple outcomes within the UK Biobank and reduce outcome-selection bias.…”

“…kidney stones, enlarged prostate 4 ), respiratory disease, sleep apnoea, and some cancers. 5,6 Higher IGF-I concentrations in adults without acromegaly have been shown to also be associated with increased risks of several cancers, 7 but corresponding evidence for noncancer outcomes is inconsistent and/or limited to cross-sectional design. Although some of the available prospective observational and genetic evidence suggests that higher IGF-I levels might be positively associated with type 2 diabetes, 8,9 ischaemic heart disease (IHD), [9][10][11] hip and knee osteoarthritis, 12 enlarged prostate, 13 and colon adenomas, 14,15 some studies also reported null, [16][17][18][19][20][21][22][23][24] and inverse 25 associations for these outcomes.…”

Somatotropic‐Testicular Axis: A crosstalk between GH/IGF‐I and gonadal hormones during development, transition, and adult age

“…Indeed, BPH is reported in approximately half the acromegalic subjects 65,67 and the prevalence of parenchymal alterations (ie, cysts, calcifications and nodules) is also increased 65,66,68 . Slight increase in PSA levels and International Prostate Symptom Scores (IPSS) are also reported in these patients, although prostatic symptoms are often absent 67,69 . Moreover, as results from a large population study, prostatic cancer (PCa) incidence is increased both in healthy individuals with IGF‐I levels in the upper reference range 70,71 and in acromegalic patients 72 .…”

“…65,66,68 Slight increase in PSA levels and International Prostate Symptom Scores (IPSS) are also reported in these patients, although prostatic symptoms are often absent. 67,69 Moreover, as results from a large population study, prostatic cancer (PCa) incidence is increased both in healthy individuals with IGF-I levels in the upper reference range 70,71 and in acromegalic patients. 72 However, a recent meta-analysis of 23 studies in acromegaly reveals some potential sources of bias in the association between acromegaly and PCa: for example, cancer incidence was more pronounced in smaller and single-center studies (selection bias) and the enlarged PV in acromegaly may lead to more frequent US examination (diagnostic workup bias).…”

Circulating Insulin-Like Growth Factor-I and Risk of 25 Common Conditions: Outcome-Wide Analyses in The UK Biobank Study

“…carpal tunnel syndrome), genitourinary diseases (e.g. kidney stones, enlarged prostate [4]), respiratory disease, sleep apnoea, and some cancers [5,6].…”