Thyroid and colorectal cancer screening in acromegaly patients: should it be different from that in the general population?

Terzolo, Massimo; Puglisi, Soraya; Reimondo, Giuseppe; Dimopoulou, Christina; Stalla, Günter

doi:10.1530/eje-19-1009

Cited by 24 publications

(30 citation statements)

References 85 publications

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“…In addition, downregulation of the IGF-1 receptor in melanoma may enhance the tumoral cell response to mitogen-activated protein kinase (MAPK) inhibitors (20). When it comes to acromegalic patients, a higher risk of various cancers has been reported such as colonic carcinoma (21). However, this is mostly related to uncontrolled disease, and recent data showed a massive improvement of the oncologic risk in these patients during the last decade due to multi-modal therapy (22).…”

Section: Gh/igf-1 and Melanomamentioning

confidence: 99%

Skin anomalies in acromegalic patients (Review of the practical aspects)

et al. 2021

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Section: Gh/igf-1 and Melanomamentioning

confidence: 99%

Skin anomalies in acromegalic patients (Review of the practical aspects)

et al. 2021

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“…For the evaluation of OSA, cardiomyopathy (ECHO), vertebral fractures, and colonoscopy is recommended for every acromegaly patient at OHSU, while thyroid ultrasound is performed on a needed basis as per guidelines ( 4 , 29 , 30 ) to prevent overdiagnosis of clinically irrelevant nodules. Conversely, at Parhon, thyroid ultrasound is performed essentially in every patient with a diagnosis of acromegaly in accordance with recommendations by some authors ( 31 ) and the country’s mild iodine deficiency ( 32 , 33 ), thus, a much higher frequency of thyroid nodules was found. Myocardial hypertrophy was diagnosed by ECG or ECHO at Parhon, which could account for the higher frequency.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

Varlamov

Niculescu

Banskota

et al. 2021

Endocrine Connections

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Purpose: The number of international acromegaly-related registries is increasing; however, heterogeneity of acromegaly symptoms and signs across countries is not well described. We compared clinical disease manifestations at diagnosis between two large University referral centers from two continents. Methods: Retrospective, comparative epidemiological study of acromegaly patients at two centers; 1) C. I. Parhon National Institute of Endocrinology, “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania (Parhon), and 2) Pituitary Center, Oregon Health & Science University, Portland, Oregon, United States (OHSU) from approved registries was undertaken. Data were extracted from medical charts and questionnaires. Binary logistic regression analysis was undertaken for the most frequently noted symptoms and clinical signs. Results: Study included 216 patients (87 Parhon, 129 OHSU). Age, sex and median delay in diagnosis were similar between centers. IGF-1 index was higher in patients at Parhon (3.3 vs 2.1, p < 0.001). The top five symptoms at both centers were; enlarged hands/feet, headache, arthralgia, fatigue, and irregular menses in women. A significant difference was noted for multiple signs and symptoms frequency, often >20 percentage points between centers. Center was a predictor of many signs and symptoms, independent of acromegaly biochemical severity or disease duration. Conclusion: We show in the first comparative study that differences in medical practice, documentation, and likely cultural differences can influence patients’ symptom(s) reporting and screening patterns in geographically different populations. Pooling data into large multicenter international registries databases may lead to loss of regional characteristics and thus a mixed overall picture of combined cohorts.

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“…Another distinctive aspect is the fact that acromegalic patients, especially with long-term undetected or uncontrolled disease, are traditionally described as having a higher risk than the general population for presenting with associated second non-pituitary tumor, either benign such as nodular goiter, colonic polyps, even testicular tumors and mammary fibro-adenomas in females, or malign such as thyroid cancer (79,80). In these cases, evaluation of dermatological elements is a valuable clue for implementing PRKACA gene testing in order to differentiate a cluster of tumors related to GH excess or related to CNC itself (81,82).…”

Section: Discussionmentioning

confidence: 99%

Dermatological and endocrine elements in Carney complex (Review)

et al. 2021

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Carney complex (CΝC) is a very rare, autosomal dominant, hereditary syndrome. Seventy percent of individuals with CNC have germline inactivating or deleting mutations of the CNC1 gene [currently known as protein kinase cAMP-dependent type I regulatory subunit α (PRKAR1A), located at the 17q22-24 chromosome level], with 30% of cases presenting with phosphodiesterase gene mutations. A member of the lentiginosis family, dermatological features include: skin pigmentation, cutaneous/mucosal myxomas, usually diagnosed by the age of 20 years (neonatal presentation is exceptional, requiring a meticulous differential diagnosis). Melanocyte-derived tumors such as epithelioid blue nevi (with different levels of pigmentation) and pigmented epithelioid melanocytoma (previously 'animal-type melanoma') are often found. Myxomas, mesenchymal tumors with mostly a benign pattern, may be recurrent. Primary cutaneous melanotic schwannoma are atypical, while non-skin sites are frequent. Corticotropinomas or somatotropinomas are part of the hereditary syndrome-related pituitary adenomas (representing 5% of all). Primary pigmented nodular adrenocortical disease involves bilateral cortical hyperplasia causing Cushing syndrome (CS) at an earlier age than non-CNC cases; osteoporotic fractures seem more prevalent compare to CS of other etiologies. Typically benign, a few cases of adrenocortical carcinoma have been identified. A total of 5% of familial non-medullary thyroid cancer is syndromic, also including CNC. CNC-related thyroid frame includes: hyperthyroidism, follicular hyperplasia/adenomas, follicular carcinoma (usually aggressive, bilateral or multifocal). Large cell calcifying Sertoli cell tumors of the testes have malignant behavior in adults; in children these may induce precocious puberty. Two particular mammary tumors are found: myxoid fibroadenomas and breast myxomatosis. Cutaneous/subcutaneous lesions, pigmented or not, or any focal swelling of non-identified cause needs careful examination, since dermatological elements are among the earliest and most discernable by which to detect lesions in CNC, a systemic condition with multi-level endocrine involvement.

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Thyroid and colorectal cancer screening in acromegaly patients: should it be different from that in the general population?

Cited by 24 publications

References 85 publications

Skin anomalies in acromegalic patients (Review of the practical aspects)

Skin anomalies in acromegalic patients (Review of the practical aspects)

Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

Dermatological and endocrine elements in Carney complex (Review)

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