Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues

Cozzi, Renato; Ambrosio, Maria Rosaria; Attanasio, Roberto; Bozzao, Alessandro; Marinis, Laura De; Menis, Ernesto De; Guastamacchia, Edoardo; Lania, Andrea; Lasio, Giovanni; Logoluso, Francesco; Maffei, Pietro; Poggi, Maurizio; Toscano, Vincenzo; Zini, Michele; Chanson, Philippe; Katznelson, Laurence

doi:10.2174/1871530320666200127103320

Cited by 5 publications

(4 citation statements)

References 90 publications

(113 reference statements)

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“…In addition, the surveillance of Parkinson disease and Alzheimer disease was not mentioned in the guidelines and consensus recommendations for acromegaly. 42,43 Finally, this study is not a prospective study; therefore, there might be some possible effects of reverse causality. To diminish the possibility of reverse causality, we excluded the participants with preexisting PD and all-cause dementia and we conducted sensitivity analysis with 1-year lag, which showed similar result with main results (eTable 4).…”

Section: Discussionmentioning

confidence: 95%

Risk of Neurodegenerative Diseases in Patients With Acromegaly

et al. 2022

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Background and Objectives:A few recent studies have reported an association between insulin-like growth factor-1 (IGF-1) and neurodegenerative disease, but there was no report on any association between acromegaly and neurodegenerative disease. We investigated whether the risk of Alzheimer's disease, Parkinson's disease and other neurodegenerative diseases were increased among patients with acromegaly using nationwide data of Korea.Methods:We studied the association between acromegaly and Parkinson’s disease and dementia in 1,611 patients with acromegaly and controls (age- and sex-matched 8055 participants with no diagnosis of acromegaly) from the National Health Insurance System database between 2006 and 2016 with a mean follow-up period of 7.34 years. Cox proportional hazards regression analysis was used to assess the risk of all outcomes in patients with acromegaly compared with controls with adjusting for age, sex, household income, place, type 2 diabetes, hypertension, and dyslipidaemia.Results:The average age of the acromegaly patients and the controls was 54.16 years old (40.4% men). The incidence rate of Parkinson’s disease in patients with acromegaly (1.54 per 1,000 person-years) was significantly higher than that in the control group (0.55 per 1,000 person-years) (log-rank test p=0.001). Acromegaly was associated with a higher risk of Parkinson’s disease (hazard ratio [HR]= 2.609, 95% confidence interval [CI]: 1.410 to 2.609) than the control. In addition, acromegaly was associated with a higher risk of all-cause dementia (HR=2.299, 95% CI: 1.362–3.881), Alzheimer`s disease (HR=2.228, 95% CI: 1.191–4.168) and Non-AD dementia (HR=6.553, 95% CI: 1.754–24.482) than the control during the first three years after diagnosis and treatment. In subgroup analysis, diabetes was associated with higher risk of all-cause dementia (P for interaction=0.028) in patients with acromegaly compared with controls.Discussion:Our study results suggest that acromegaly is associated with neurodegenerative disease. Further study is needed on the association between IGF-1/growth hormone level and neurodegenerative disease.

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Section: Discussionmentioning

confidence: 95%

Risk of Neurodegenerative Diseases in Patients With Acromegaly

et al. 2022

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“…We collected photos of 19 ACRO. According to acromegaly clinical guidelines, diagnosis of acromegaly was based on previous laboratory and pituitary MRI findings, data were collected from patients' charts [15]. Each patient was clinically examined and photographic documentation was collected: photos of the face in frontal and in profile projection with a relaxed expression and closed mouth, frontal and lateral intraoral photos, photos for the evaluation of the oral lingual encumbrance and photos of oral anatomical details (such as diastemas or malocclusions).…”

Section: Methodsmentioning

confidence: 99%

The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: a questionnaire-based study

et al. 2021

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Purpose Oro-facial manifestations of acromegaly are among the earliest signs of the disease and are reported by a significant number of patients at diagnosis. Despite this high prevalence of acromegaly oral manifestation, dentists do not play a pivotal role in acromegaly identification and diagnosis. The aim of our study was to evaluate the ability of dentists and orthodontists in the early recognition of the oro-facial manifestations of acromegaly. Methods A telematic questionnaire was administered to dentists and orthodontists. The questionnaire included photos with facial and oral-dental details and lateral teleradiography of acromegaly patients (ACRO). Results The study included 426 participants: 220 dentists and 206 orthodontists. Upon reviewing the photos, dentists most often observed mandibular prognathism and lips projection, while orthodontists also reported the impairment of relative soft tissue. Orthodontists, who usually use photos to document patients’ oral-facial characteristics, paid more attention to oral-facial impairment than dentists. During dental assessment, 90% of the participants usually evaluated tongue size and appearance, diastemas presence, and signs of sleep impairment (mainly orthodontists). Orthodontists were also more able to identify sella turcica enlargement at teleradiography. A total of 10.8% of the participants had ACRO as patients and 11.3% referred at least one patient for acromegaly suspicion. Conclusion The study highlighted dentists’ strategic role in identifying ACRO. Increasing dentists’ awareness about acromegaly clinical issues may improve early diagnosis, potentially resulting in an increased quality of life and decreased mortality among ACRO.

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“…Biochemical treatment for the limitation of GH hypersecretion can only partially improve facial appearance, especially regarding soft tissues, but in most cases, oro-facial changes are not completely reversible and persist despite pharmacological treatment [19,25]. Table 1 provides a summary of the main oro-maxillo-facial features of acromegaly associated with the possible non-endocrinological treatments [36][37][38][39][40][41][42]. Functional treatment with gymnastics for the temporomandibular joint or application of a customized bite The BruxApp app can be adopted under the control of the dentist to monitor and correct incorrect or flawed positions maintained during the day by the patient and to guide postural re-education…”

Section: Oral Manifestations and Maxillo-facial Featuresmentioning

confidence: 99%

Oral Manifestations and Maxillo-Facial Features in the Acromegalic Patient: A Literature Review

Stefani

Dassiè

Wennberg

et al. 2022

JCM

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Acromegaly is a chronic disease caused by an abnormal secretion of growth hormone (GH) by a pituitary adenoma, resulting in an increased circulating concentration of insulin-like growth factor 1 (IGF-1). The main characteristics are a slow progression of signs and symptoms, with multisystemic involvement, leading to acral overgrowth, progressive somatic changes, and a complex range of comorbidities. Most of these comorbidities can be controlled with treatment. The literature reveals that the most evident and early signs are those related to soft tissue thickening and skeletal growth, especially in the head and neck region. Methods: The authors reviewed the available literature on the clinical oro-dental features of acromegaly, selecting articles from PubMed and Google Scholar. The aim of this review was to summarize all the reported clinical oro-dental features of acromegalic patients. Results: The most common facial dimorphisms involved the maxillo-facial district, with hypertrophy of the paranasal sinuses, thickening of the frontal bones, and protruding glabella, which may be associated with joint pain and clicks. Regarding the oro-dental signs, the most frequent are dental diastema (40–43%), mandibular overgrowth (22–24%), mandibular prognathism (20–22%), and macroglossia (54–58%). These signs of acromegaly can be significantly reduced with adequate treatment, which is more effective when initiated early. Conclusions: Increased awareness of acromegaly among dentists and maxillo-facial surgeons, along with the early identification of oro-facial changes, could lead to an earlier diagnosis and treatment, thereby improving patients’ quality of life and prognosis.

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Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues

Cited by 5 publications

References 90 publications

Risk of Neurodegenerative Diseases in Patients With Acromegaly

Risk of Neurodegenerative Diseases in Patients With Acromegaly

The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: a questionnaire-based study

Oral Manifestations and Maxillo-Facial Features in the Acromegalic Patient: A Literature Review

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