Prevalence of lung structure abnormalities in patients with acromegaly and their relationship with gas exchange: cross-sectional analytical study with a control group

Abstract

CONTEXT AND OBJECTIVE: Different functional respiratory alterations have been described in acromegaly, but their relationship with pulmonary tissue abnormalities is unknown. The objective of this study was to observe possible changes in lung structure and explain their relationship with gas exchange abnormalities. DESIGN AND SETTING: Cross-sectional analytical study with a control group, conducted at a university hospital. METHODS:The study included 36 patients with acromegaly and 24 controls who were all assessed through high-resolution computed tomography of the thorax (CT). Arterial blood gas, effort oximetry and serum growth hormone (GH) and insulin-like growth factor I (IGF-1) were also assessed in the patients with acromegaly. RESULTS:The abnormalities found in the CT scan were not statistically different between the acromegaly and control groups: mild cylindrical bronchiectasis (P = 0.59), linear opacity (P = 0.29), nodular opacity (P = 0.28), increased attenuation (frosted glass; P = 0.48) and decreased attenuation (emphysema; P = 0.32). Radiographic abnormalities were not associated with serum GH and IGF-1. Hypoxemia was present in seven patients; however, in six of them, the hypoxemia could be explained by underlying clinical conditions other than acromegaly: chronic obstructive pulmonary disease in two, obesity in two, bronchial infection in one and asthma in one. CONCLUSION: No changes in lung structure were detected through thorax tomography in comparison with the control subjects. The functional respiratory alterations found were largely explained by alternative diagnoses or had subclinical manifestations, without any plausible relationship with lung structural factors.RESUMO CONTEXTO E OBJETIVO: Diferentes alterações funcionais respiratórias são descritas na acromegalia. Sua relação com anormalidades do tecido pulmonar é desconhecida. O objetivo foi observar possíveis alterações da estrutura pulmonar e explicar sua relação com anormalidades da troca gasosa. TIPO DE ESTUDO E LOCAL: Estudo transversal, analítico, com grupo de controle, realizado em um hospital universitário. MÉTODOS: Incluíram-se 36 pacientes com acromegalia e 24 controles que foram avaliados com tomografia computadorizada de alta resolução de tórax (TC); os acromegálicos também foram avaliados com gasometria arterial, oximetria de esforço e dosagens de hormônio de crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). RESULTADOS: As alterações encontradas na TC não foram estatisticamente diferentes entre os grupos acromegálico e de controle: bronquiectasia cilíndrica leve (P = 0,59), opacidades lineares (P = 0,29), opacidades nodulares (P = 0,28), aumento da atenuação (vidro fosco) (P = 0,48) e redução da atenuação (enfisema; P = 0,32). As alterações radiológicas não se relacionaram com as dosagens de GH e IGF-1. Hipoxemia estava presente em sete pacientes; contudo, em seis deles a hipoxemia poderia ser explicada por condição clínica subjacente diversa da acromegalia: doença pulmonar obstrutiva crônica em do...

Insulin-Like Growth Factor-1 Signaling in Lung Development and Inflammatory Lung Diseases

“…Patients with Laron syndrome have abnormal phenotype of the growth factor receptor (mutated or inactivated), who demonstrate growth and organic development retardation, short stature, delayed bone age, and reduced exercise capacity, but their lung function is normal, and none of lung injury or bronchopulmonary dysplasia has been reported [ 40 ]. Acromegaly may present with high levels of growth hormone and varying levels of IGF-1 and similar lung structure and functions compared with health controls, and none of the lung functional, radiological, and biological findings correlated with IGF-1 levels [ 41 , 42 ].…”

“…According to Jian et al, 46% RA-ILD patients have bronchiectasis on HRCT scan, and serum levels of IGF-1 are increased in RA-ILD compared to those in RA and control subjects [ 89 ]. The prevalence of mild cylindrical bronchiectasis is 22.2% in 36 patients with acromegaly but is not statistically different from 24 control subjects (16.7%) and is not associated with serum levels of IGF-1 ( P = 0.74) [ 41 ]. Another study by Camilo et al shows 35% of 20 patients with acromegaly have bronchiectasis, but serum IGF-1 levels are not statistically associated with lung function changes [ 290 ].…”

Correlations between forced oscillation technique parameters and pulmonary densitovolumetry values in patients with acromegaly

“…In HU units, these areas may represent areas of pulmonary consolidation and ground-glass opacities. Some authors have reported pulmonary parenchymal abnormalities in acromegalic patients observed by high-resolution CT, including increased attenuation and linear and nodular opacities ( 7 , 32 ). These lesions may have contributed, at least in part, to the differences in the densitovolumetry values observed in the present study.…”

Computed tomography airway lumen volumetry in patients with acromegaly: Association with growth hormone levels and lung function

“…Anatomical distortions of the thorax geometry and changes in soft tissues, joints, the respiratory mucosa, lung volume and respiratory muscle activity have been reported in previous studies . With regard to functional abnormalities related to the respiratory tract in patients with acromegaly, few studies have specifically approached this topic, particularly in the trachea and large airways, which have been considered a ‘forgotten zone’, with potential for obstructive events …”

“…2,3 With regard to functional abnormalities related to the respiratory tract in patients with acromegaly, few studies have specifically approached this topic, particularly in the trachea and large airways, which have been considered a 'forgotten zone', with potential for obstructive events. [3][4][5] The advent of multislice CT brought significant advances in imaging diagnosis in all fields of medicine. In addition, using imaging analysis programmes, it is possible to estimate lung volumes and correlate them with classic tools for the measurement of lung function.…”