Clinical Manifestations of Acromegaly

Molitch, Mark E.

doi:10.1016/s0889-8529(18)30204-4

Cited by 199 publications

(107 citation statements)

References 102 publications

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“…If untreated, the presence of these significant morphological and functional changes leads to a complex Jadresic et al (1982), Molitch (1992), Ezzat et al (1994), Mestron et al (2004 and Reid et al (2010) (Colao et al 2004)), diastolic dysfunction and progressive systolic impairment eventually leading to heart failure (Mosca et al 2013).…”

Section: Complicationsmentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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Acromegaly (ACM) is a chronic, progressive disorder caused by the persistent hypersecretion of GH, in the vast majority of cases secreted by a pituitary adenoma. The consequent increase in IGF1 (a GH-induced liver protein) is responsible for most clinical features and for the systemic complications associated with increased mortality. The clinical diagnosis, based on symptoms related to GH excess or the presence of a pituitary mass, is often delayed many years because of the slow progression of the disease. Initial testing relies on measuring the serum IGF1 concentration. The oral glucose tolerance test with concomitant GH measurement is the gold-standard diagnostic test. The therapeutic options for ACM are surgery, medical treatment, and radiotherapy (RT). The outcome of surgery is very good for microadenomas (80-90% cure rate), but at least half of the macroadenomas (most frequently encountered in ACM patients) are not cured surgically. Somatostatin analogs are mainly indicated after surgical failure. Currently their routine use as primary therapy is not recommended. Dopamine agonists are useful in a minority of cases. Pegvisomant is indicated for patients refractory to surgery and other medical treatments. RT is employed sparingly, in cases of persistent disease activity despite other treatments, due to its long-term side effects. With complex, combined treatment, at least three-quarters of the cases are controlled according to current criteria. With proper control of the disease, the specific complications are partially improved and the mortality rate is close to that of the background population.

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Section: Complicationsmentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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“…Aufgrund des meist langsamen Wachstums der Hypophysenadenome sowie der im Erwachsenenalter lange Zeit sehr unspezifi schen Symptomatik wird die Akromegalie leider nach wie vor erst viele Jahre nach Krankheitsbeginn diagnostiziert. Oft f ü hren erst Sehst ö rungen aufgrund der Kompression des chiasma opticum durch das Adenom, kompressionsbedingte Ausf ä lle anderer hypophys ä rer Achsen oder eine massive Ver ä nderung der Physiognomie zu einer entsprechenden spezifi schen Diagnostik [9] .…”

Section: Klinisches Bild Und Pathogeneseunclassified

“…Aufgrund der pulsatilen Sekretion Tabelle 2 Symptome bei der Akromegalie (nach [9] In der klinischen Routinediagnostik kommen zur Messung von Wachstumshormon-Konzentrationen durchweg Immunoassays zum Einsatz. Bedingt durch die oben erw ä hnte molekulare Heterogenit ä t von Wachstumshormon werden bei der Messung -abh ä ngig von der Spezifi t ä t der im jeweiligen Assay verwendeten Antik ö rper -nun jeweils unterschiedliche Teilspektren des " Gesamtwachstumshormons " erkannt.…”

Section: Wachstumshormon (Growth Hormone Gh)unclassified

Labordiagnostik bei Wachstumshormon-assoziierten Erkrankungen/Biochemical diagnosis of growth hormone related diseases

Bidlingmaier

2012

LaboratoriumsMedizin

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ZusammenfassungDie Krankheitsbilder des Wachstumshormonmangels und des Wachstumshormonexzesses imponieren klinisch unterschiedlich vor und nach dem Abschluss des Längenwachstums. Stets jedoch bilden die Messung der zirkulierenden Konzentrationen von Wachstumshormon und Insulinartigem Wachstumsfaktor I (Insulin-like growth-factor I, IGF-I) die Basis der laborchemischen Diagnostik. Mit den Immunoassays stehen praktikable, sensitive und meist auch spezifische Methoden zur Messung beider Hormone zur Verfügung. Trotzdem bestehen nach wie vor gravierende Diskrepanzen zwischen den Messergebnissen verschiedener Assays. Diese Diskrepanzen sind vor allem bedingt durch Unterschiede in der Isoformspezifität der Assays, die Verwendung unterschiedlicher Standardpräparationen sowie die Interferenz von Bindungsproteinen. Die methodenbedingten Unterschiede in den Messergebnissen erschweren die allgemeine Anwendung publizierter diagnostischer Entscheidungsgrenzen. Auf einer interdisziplinären Konsensuskonferenz unter Beteiligung der Growth Hormone Research Society, der IGF Society, und der International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) wurden die bestehenden Probleme analysiert und mögliche Strategien zu einer Verbesserung der Vergleichbarkeit der Messergebnisse verschiedener GH- und IGF-I-Assays aufgezeigt. Derzeit bleibt jedoch in der klinischen Praxis die Anwendung methodenspezifischer, an gut charakterisierten Kollektiven gewonnener Referenzbereiche unabdingbar.

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“…1,2 However, there are discrepancies in the prevalence of hypertension in acromegaly, among different authors it varies from 13% to 60%. 2,3 Hypertensive patients with acromegaly tend to be older and to suffer from the disease for a longer period of time than non-hypertensive acromegalic patients.…”

Section: Introductionmentioning

confidence: 99%

Altered circadian blood pressure profile in patients with active acromegaly. Relationship with left ventricular mass and hormonal values

Pietrobelli¹,

Akopian²,

Olivieri³

et al. 2001

J Hum Hypertens

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To determine the relationships between the circadian blood pressure profile and left ventricular mass, hormonal pattern and insulin sensitivity indices in patients with active acromegaly, ambulatory 24-h blood pressure monitoring (ABPM) was recorded in 25 subjects (47.0 ؎ 15.1 years, range 23-72). Serum growth hormone (GH) and insulin-like growth factor-1, fasting and mean plasma glucose and insulin during oral glucose tolerance test (OGTT), insulinogenic index, the sum of the plasma insulin levels and the homeostasis model insulin resistance index (Homa's index) were determined. Left ventricular mass index (LVMI) was calculated from two-dimensional guided M-mode echocardiogram. The prevalence of hypertension was 56% (n ‫؍‬ 14) and 40% (n ‫؍‬ 10) according to sphygmomanometric measurements and ABPM, respectively. Non-dipping profile was observed in six of 10 hypertensives and in

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Clinical Manifestations of Acromegaly

Cited by 199 publications

References 102 publications

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Labordiagnostik bei Wachstumshormon-assoziierten Erkrankungen/Biochemical diagnosis of growth hormone related diseases

Altered circadian blood pressure profile in patients with active acromegaly. Relationship with left ventricular mass and hormonal values

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