Acromegaly and the Colon: Scoping Beyond the Pituitary.

Gautami S Patel,Pranay K Joshi,Diana I Zamora,Ibrahim Sange,Mridul Soni,Kevin Rodriguez,Devarashetty Shreya,Idan Grossmann,Saawan C Patel

doi:10.7759/cureus.20018

Abstract

Acromegaly is a complex endocrinological disorder commonly caused by hypersecretion of growth hormone (GH) typically due to pituitary gland tumors. Patients with acromegaly who are successfully treated and biochemically managed have a reasonably average life expectancy. However, it causes a cascade of multi-systemic involvement throughout the patient’s life, including cardiovascular, neuropsychiatric, respiratory, metabolic, neurological, neoplastic, and gastrointestinal involvement, resulting in a higher rate of hospitalization, lower quality of life, and a shorter life expectancy. Although cardiovascular complications are the primary cause of death in patients with acromegaly, malignancy is now emerging as a major killer in these individuals. Colorectal carcinoma has been reported to be prevalent in acromegaly individuals. This review article has compiled studies to demonstrate a link between acromegaly and colorectal neoplasia, intending to provide a strong foundation for their clinical relationship. This article has summarised a potential pathogenic mechanism and provided insights into the clinical presentation of such patients. Furthermore, this article has provided a brief overview of current screening recommendations for colorectal neoplasia in acromegaly patients.

Highlights

BackgroundAcromegaly is an endocrinological disorder characterized by an abnormally elevated growth hormone (GH) level in the serum predominantly caused by a pituitary adenoma [1,2]
While gigantism occurs due to excess GH levels before epiphyseal closure leading to an abnormal linear overgrowth of bones, acromegaly manifests after the epiphyseal closure presenting with morphological features like broad hands, feet, and fingers, wide and thick nasal bones, prominent zygomatic arch, bulging forehead occasionally leading to frontal bossing, swollen lips with marked facial lines due to soft tissue thickening, dental malocclusion due to mandibular overgrowth with prognathism along with maxillary widening leading to tooth separation [6,7]
According to the studies covered in this article, despite patients with acromegaly having significant morphological alterations, the condition is a causal factor for colorectal neoplasia such as colorectal polyps and colorectal carcinoma

Summary

Introduction

Is an endocrinological disorder characterized by an abnormally elevated growth hormone (GH) level in the serum predominantly caused by a pituitary adenoma [1,2]. Pierre Marie, a French neurologist, coined the term “acromegaly” to describe this disease’s morphological features [3]. It is a rare disease with an incidence rate of 0.2 to 1.1 per 100,000 people and a prevalence rate ranging between 2.8 and 13.7 cases per 100,000 people. GH and IGF-1 have several systemic manifestations, including cardiovascular, neuropsychiatric, respiratory, metabolic, neurological, neoplastic, and gastrointestinal complications [7,8]

Objectives

Results

Conclusion