Acromegaly is associated with increased cancer risk: a survey in Italy

Abstract

It is debated if acromegalic patients have an increased risk to develop malignancies. The aim of the present study was to assess the standardized incidence ratios (SIRs) of different types of cancer in acromegaly on a large series of acromegalic patients managed in the somatostatin analogs era. It was evaluated the incidence of cancer in an Italian nationwide multicenter cohort study of 1512 acromegalic patients, 624 men and 888 women, mean age at diagnosis 45 ± 13 years, followed up for a mean of 10 years (12573 person-years) in respect to the general Italian population. Cancer was diagnosed in 124 patients, 72 women and 52 men. The SIRs for all cancers was significantly increased compared to the general Italian population (expected: 88, SIR 1.41; 95% CI, 1.18-1.68, < 0.001). In the whole series, we found a significantly increased incidence of colorectal cancer (SIR 1.67; 95% CI, 1.07-2.58, = 0.022), kidney cancer (SIR 2.87; 95% CI, 1.55-5.34, < 0.001) and thyroid cancer (SIR 3.99; 95% CI, 2.32-6.87, < 0.001). The exclusion of 11 cancers occurring before diagnosis of acromegaly (all in women) did not change remarkably the study outcome. In multivariate analysis, the factors significantly associated with an increased risk of malignancy were age and family history of cancer, with a non-significant trend for the estimated duration of acromegaly before diagnosis. In conclusion, we found evidence that acromegaly in Italy is associated with a moderate increase in cancer risk.

Thyroid Cancer and Acromegaly

“…Periodic thyroid ultrasound (US) and careful evaluation of detected lesions are important parts in the follow-up of acromegalic patients. The sonographic characteristics considered to be suspicious of TC, such as microcalcifications, irregular margins (infiltrative and microlobulated), taller than wide shape, and rim calcifications with small extrusive soft tissue component (evidence of extrathyroidal extension), are the same of the general population with NTD [5,9].…”

“…Although there is a risk of TC in acromegalic patients, its clinical behavior does not seem to be different [5]. Therefore, acromegalic patients with TC may be treated with total thyroidectomy or hemithyroidectomy according to its FNA result and size and the presence of clinically apparent metastatic lymph nodes [28].…”

“…Most acromegalic patients die from cardiovascular, cerebrovascular, or respiratory diseases [3,4]. Nevertheless, in the past two decades, some studies have also described an association between acromegaly and an increased risk of some cancers such as colorectal and thyroid cancer (TC), which is the most common endocrine malignancy, among others [5].…”

“…These findings may result from the fact of improving diagnostic and treatment of acromegaly extending the life duration which increases the prevalence of both benign and malignant neoplasms [3][4][5][6][7][8][9][10][11].…”

Nodular Thyroid Disease and Papillary Thyroid Carcinoma in Functional Pituitary Adenomas

“…Although thyroid nodules are common, only 8-16% of them are malignant (16). Screening for papillary thyroid carcinoma (PTC) is recommended in patients with acromegaly due to their higher risk of developing tumors, but not for prolactinoma and CD patients (2)(3)(4)(5)(6)(7)(8)(9)(17)(18)(19)(20)(21). We found only one study that evaluated the prevalence of PTC in prolactinomas (12) and one case report on the co-existence of CD and PTC (22).…”