Colon Polyps in Acromegaly

Ezzat, Shereen; Strom, Carey B; Мелмед, Шломо

doi:10.7326/0003-4819-114-9-754

Cited by 85 publications

(45 citation statements)

References 9 publications

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“…Several previous studies have suggested that these patients are also at an increased risk of neoplasia, especially colorectal cancer and pre-malignant adenomatous polyps, although the degree of risk remains under debate (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In our original series, we observed 5% to have a carcinoma and 25% to have one or more adenomas (11).…”

Section: Introductionmentioning

confidence: 67%

Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines

Dworakowska

Gueorguiev²,

Kelly³

et al. 2010

European Journal of Endocrinology

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Objective: It is suggested that patients with acromegaly have an increased risk of colorectal cancer and pre-malignant adenomatous polyps. However, the optimum frequency with which colonoscopic screening should be offered remains unclear. Design: To determine the optimum frequency for repeated colonoscopic surveillance of acromegalic patients. Methods: We retrospectively reviewed the case records of all patients with acromegaly seen in our centre since 1992: 254 patients had at least one surveillance colonoscopy, 156 patients had a second surveillance colonoscopy, 60 patients had a third surveillance colonoscopy and 15 patients had a fourth surveillance colonoscopy. Results: The presence of hyperplastic or adenomatous polyps was assessed in all patients, while one cancer was detected at the second surveillance. At the third surveillance, mean (GS.D.) serum IGF1 levels (ng/ml) in patients with hyperplastic polyps were significantly higher than those with normal colons (P!0.05). The presence of an adenoma rather than a normal colon at the first colonoscopy was associated with a significantly increased risk of adenoma at the second (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.9-10.4) and at the third (OR 8.8, 95% CI 2.9-26.5) screens. Conversely, a normal colon at the first surveillance gave a high chance of normal findings at the second (78%) or third surveillance (78%), and a normal colon at the second colonoscopy was associated with normality at the third colonoscopy (81%). Conclusions: Repeated colonoscopic screening of patients with acromegaly demonstrated a high prevalence of new adenomatous and hyperplastic colonic polyps, dependent on both the occurrence of previous polyps and elevated IGF1 levels.

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Section: Introductionmentioning

confidence: 67%

Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines

Dworakowska

Gueorguiev²,

Kelly³

et al. 2010

European Journal of Endocrinology

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“…Thyroid, heart, liver, and bone seem to be strictly GH and IGF-I targeted, but recent reports suggest a proliferating effect of GH/IGF-I on colonic mucosa, as demonstrated by an increased prevalence of colonic polyps detected at pancolonoscopy (8,9). To date, no study has been performed to assess the prevalence of benign prostate hyperplasia and/or prostate cancer in acromegaly.…”

Section: Discussionmentioning

confidence: 97%

Prostatic Hyperplasia: An Unknown Feature of Acromegaly

Colao

Marzullo

Ferone

et al. 1998

The Journal of Clinical Endocrinology & Metabolism

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This study was designed to investigate whether GH and insulinlike growth factor I (IGF-I) excess could lead to the development of benign prostatic hyperplasia and/or prostatic carcinoma. Prostatic diameters and volume as well as the occurrence of prostatic diseases were studied by ultrasonography in 10 untreated acromegalic patients less than 40 yr of age and 10 age-and body mass index-matched healthy males. Serum GH, IGF-I, PRL, testosterone, dihydrotestosterone, prostate-specific antigen, and prostatic acid phosphatase levels were assessed. All patients had secondary hypogonadism, as diagnosed by low testosterone levels, and 4 of 10 patients had hyperprolactinemia. After 1 yr of treatment with octreotide (0.3-0.6 mg/day), ultrasound scan and hormone parameters were repeated. The 4 hyperprolactinemic acromegalics were treated with octreotide and cabergoline (1-2 mg/week) to suppress PRL levels.Symptoms due to prostatic, seminal vesicle, and/or urethral disorders or obstruction were experienced by neither acromegalics nor controls. Digital rectal examination revealed no occurrence of prostatic nodules or other abnormalities. Compared to healthy subjects, a remarkable increase in transversal prostatic diameter and volume was observed in acromegalics. In healthy subjects, prostate volume ranged from 15.1-21.8 mL, whereas in acromegalics it ranged from 21.8 -41.8 mL. Similarly, an increased median lobe was observed. In fact, the transitional zone diameter was just detectable in 5 of 10 controls, whereas it was measurable in all acromegalics (18 Ϯ 1.2 vs.2.8 Ϯ 0.3 mm; P Ͻ 0.001). The prevalence of periurethral calcifications was more than doubled in acromegalics (50%) compared to that in controls (20%). Treatment with octreotide for 1 yr produced normalization of circulating GH and IGF-I levels in 7 of 10 patients. In these 7 patients, ultrasound evaluation showed a significant reduction of the antero-posterior diameter (26.1 Ϯ 1 vs. 28.9 Ϯ 1.6 mm; P Ͻ 0.01), the transversal diameter (44.9 Ϯ 2 vs. 48 Ϯ 2 mm; P Ͻ 0.01), and the cranio-caudal diameter (36.5 Ϯ 1 vs. 41.3 Ϯ 1.5 mm; P Ͻ 0.001), whereas the transitional zone diameter was unchanged (16.4 Ϯ 1.5 vs. 17.4 Ϯ 1.7 mm). As a consequence, a significant decrease in prostate volume was recorded (22.1 Ϯ 1.1 vs. 29.8 Ϯ 2.5 mL; P Ͻ 0.001). Prostate volume increased in 2 of the 3 patients who did not achieve normalization of GH and IGF-I after octreotide treatment. Finally, after treatment, serum testosterone levels were significantly increased (from 1.5 Ϯ 0.3 to 3.5 Ϯ 0.3 g/L), whereas dihydrotestosterone, dehydroepiandrosterone sulfate, ⌬ 4 -androstenedione, 17␤-estradiol, prostate-specific antigen, and prostatic acid phosphatase were unchanged. Serum PRL levels were suppressed after cabergoline treatment in all 4 hyperprolactinemic patients throughout the study period.In conclusion, prostate enlargement occurs in young acromegalics with a higher than expected prevalence of micro-and macrocalcifications. This suggests that a careful prostate screening should b...

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“…However, there are significant differences between series in relation to possible gender differences in incidence of (Alexander et al 1980, Etxabe et al 1993 and one showing an increase in females (Bengtsson et al 1988). Various series indicate an increased risk of premalignant polyps and colon cancer in acromegaly (Klein et al 1982, Ituarte et al 1984, Pines et al 1985, Brunner et al 1990, Ezzat et al 1991, Jenkins et al 1997. The absence of an increased incidence and mortality rate from colonic neoplasia in earlier series may simply reflect the attrition rate of cardiovascular disease in an era before effective treatment of growth hormone excess was available for the majority of patients.…”

Section: Acromegalymentioning

confidence: 99%

The epidemiology of endocrine tumours.

Monson¹

2000

Endocrine-Related Cancer

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Colon Polyps in Acromegaly

Cited by 85 publications

References 9 publications

Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines

Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines

Prostatic Hyperplasia: An Unknown Feature of Acromegaly

The epidemiology of endocrine tumours.

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