Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients

Abstract

We conclude that successful transsphenoidal surgery is able to induce a significant improvement in some cardiac parameters and a slight reduction in systolic blood pressure in acromegalic patients.

Impact of successful transsphenoidal surgery on cardiovascular risk factors in acromegaly

“…In fact, a significant decrease in SBP was observed by clinical measurement and confirmed by ABPM, extending our previous findings in a smaller series of cured patients (22,23), so that, according to current criteria (33), hypertension could be resolved in about 33% of patients defined as hypertensive by ABPM before surgery. In addition, in agreement with the findings of previous studies (14 -16), a blunted circadian BP rhythm was present in about 50% of the patients with active acromegaly, but was restored in 80% after surgery.…”

“…In the present study, we first confirmed that successful TSS significantly improved cardiac abnormalities in patients with acromegaly (21-23), provided that strict criteria are retained to define surgical success (22,23). We decided to focus on LVM and diastolic function, because systolic function is normal at rest until a late stage of the disease (6) and ejection fraction was normal in all our study patients before surgery (data not shown).…”

“…In addition, in agreement with the findings of previous studies (14 -16), a blunted circadian BP rhythm was present in about 50% of the patients with active acromegaly, but was restored in 80% after surgery. Of note, in a previous study, BP was not significantly influenced by surgery in patients who did not meet strict control for GH/IGF-hypersecretion (22,23). In contrast, IGT and diabetes mellitus, which were present in about 33% of the patients with active disease, were found to normalize in all cases of successful surgery.…”

“…It is not clear, however, to what extent GH/IGF-I reduction in itself is responsible for cardiac improvement and whether it is able to reduce the overall cardiovascular risk significantly in these patients. Using 24-h ambulatory blood pressure monitoring (ABPM), which provides accurate information about BP values and in particular the BP profile (24,25), we have recently reported a significant decrease in systolic BP 6 months after successful TSS (22), which could be observed even in elderly patients with acromegaly (23). At the same time, it was possible to restore the circadian BP rhythm in most patients who showed a blunted preoperative rhythm (22).…”

“…Using 24-h ambulatory blood pressure monitoring (ABPM), which provides accurate information about BP values and in particular the BP profile (24,25), we have recently reported a significant decrease in systolic BP 6 months after successful TSS (22), which could be observed even in elderly patients with acromegaly (23). At the same time, it was possible to restore the circadian BP rhythm in most patients who showed a blunted preoperative rhythm (22). Of note, glucose tolerance also normalized in patients with preoperative glucose intolerance or diabetes mellitus (23).…”