Thyroid cancer is the most common cancer associated with acromegaly

Abstract

The aim of the study was to screen the malignancy in an acromegalic patient group and to determine whether there was any increased risk and the incidence of malignancy and its association with disease characteristics such as duration of disease, latency in diagnosis, and GH and IGF-1 levels. One hundred-five (65 female, 40 male) patients with acromegaly followed and treated at Cerrahpasa Medical School, Endocrinology and Metabolism outpatient clinic between 1983 and 2007 were included in this study. The patients were screened with colonoscopy, mammography, and thyroid and prostate ultrasonography (US). Malignancy was detected in 16 (15%) patients. Thyroid cancer was found in 5 patients (4.7%), breast cancer in 3 (2.8%), colon cancer in 2 (1.9%), lung cancer in 2 (1.9%), cervix cancer in 1 (0.9%), myelodysplastic syndrome (MDS) in 1 (0.9%), cholangiocarcinoma in 1 (0.9%), and multiple endocrine neoplasm (MEN) type 1 in 1 patient (0.9%). Cancer was more common in the male patients (P = 0.046) and high levels of GH increased the risk of cancer development (P = 0.046). In this series, the most commonly detected cancer types were thyroid followed by breast and colon cancers. Although high levels of initial GH seemed to increase the risk of cancer development in acromegalic patients, age, gender, age at the time of diagnosis, duration of disease, and initial IGF-I levels were not associated with cancer development.

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and cancer: an old debate revisited

“…Since then, CRC has become the spotlight with a still unsolved debate on the exact extent of its risk in acromegaly. Similarly, a high prevalence of thyroid cancer has been suggested by several investigators in the past years (24,26), and these two malignancies are discussed in more detail below. Despite biological evidence and epidemiologic data from the non-acromegalic population suggesting an elevated risk of breast cancer in subjects in the higher IGF1 quartiles, in acromegalic women such an association has not convincingly been demonstrated in any large epidemiological series.…”

“…A review of 17 series published between 1957 and 2015, where overall cancer incidence in acromegaly was investigated, revealed 7723 patients with 708 cases of cancer, resulting in a mean cancer incidence of 10.8%, with percentages varying from 4.8 to 21.3% (12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28). Standardized incidence ratio (SIR) was available from 11 series, and in three of them, cancer incidence was not increased (12,18,28).…”

MANAGEMENT OF ENDOCRINE DISEASE: GH therapy and cancer risk in hypopituitarism: what we know from human studies

“…However, a large epidemiological study failed to show higher prevalence of colonic neoplasia in acromegaly (72). Recent findings in acromegalics who underwent colonoscopy show only 0.9% having colon cancer (73). Furthermore, newer studies show that colonic epithelial cell proliferation in acromegalics correlates with IGF1 but IGF1 does not induce neoplasia (74).…”

Zmiany ogniskowe w tarczycy u pacjentów z akromegalią — badanie kliniczno-kontrolne oraz aktualizacja metaanalizy

“…Also, a large meta-analysis revealed higher frequency of thyroid nodular disease and thyroid cancer among acromegalic patients. Thyroid cancer is suggested to be even more prevalent than colorectal carcinoma [4,5]; however, the amount of case-control studies on this topic remains unsatisfactory [4].…”