Colonoscopic Screening and Follow-Up in Patients with Acromegaly: A Multicenter Study in Italy

Abstract

Acromegaly is an infrequent disease attributable to endogenous excess of GH and IGF-I. Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a problem in acromegaly is currently unresolved. We performed a cross-sectional study to assess the risk of colonic neoplasia in patients with acromegaly. Colonoscopic screening was performed in 235 patients with acromegaly at five tertiary care hospitals in Italy between January 1, 1996, and December 31, 2001. A repeat colonoscopy was performed in 121 patients after a mean interval of 32.1 months. Colonoscopic findings in patients with acromegaly were compared with those of 233 patients with nonspecific abdominal complaints who were referred for endoscopy during the study period. A total of 65 patients (27.7%) and 36 controls (15.5%) had colonic neoplasia. In 55 patients (23.4%) and 34 control subjects (14.6%), the most important findings were adenomas (odds ratio, 1.7; range, 1.1-2.5), whereas 10 patients (4.3%) and two control subjects (0.9%) had carcinoma (odds ratio, 4.9; range, 1.1-22.4). The risk of colonic neoplasia was higher for younger patients with acromegaly compared with age-matched controls. Patients with acromegaly with or without colonic neoplasia did not differ significantly for IGF-I levels or duration of disease. A neoplastic recurrence was found in 16.5% of patients who underwent follow-up; 90% of them had had a neoplasm removed at the first colonoscopy. Acromegaly carries with it a moderate, but definitive, increase in the risk of colonic neoplasia that occurs at a younger age than in the general population. Patients who are found to harbor a colonic neoplasia are at risk for recurrence.

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

“…In our original series, we observed 5% to have a carcinoma and 25% to have one or more adenomas (11). Similar findings have been reported by other groups (12). In the non-acromegalic population, the vast majority of colorectal cancers derive from adenomatous polyps through the progressive accumulation of mutations in oncogenes and tumour suppressor genes, a process that takes w10-20 years (13,14).…”

“…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).…”

Frequency of various types of neoplasia in a group of acromegalic patients

“…Some studies have shown a higher frequency of differentiated thyroid carcinomas in acromegalic patients (16,21,22) due to the increased level of GH and IGF-I. Calculated risk of thyroid cancer in these patients appears to be sixty-fold higher than in the overall population (23,24).…”

“…Despite the variation of polyps and cancer prevalence at this site (9-38%) in different series (12)(13)(14)(15)(16), the correlation between acromegaly and tumors is frequently observed, and many studies have shown that an increase in IGF-I is correlated with an increase in the prevalence of polyps (12,13), adenomas (17) and proliferation of colon epithelium cells (12).…”

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

“…Some only consider it at 50-55 years (Renehan et al 2001), but even younger patients harbor colonic tumors, so initial colonoscopy at ACM diagnosis has been suggested (Terzolo et al 2005). Repeated colonoscopy every 10 years in controlled ACM with a normal initial result and every 5 years in those with benign tumors or uncontrolled disease appears reasonable (Dworakowska et al 2010).…”