Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?

Ana M. Ramos-Leví,Mónica Marazuela

doi:10.3389/fendo.2019.00120

Ana M. Ramos-Leví, Mónica Marazuela

Open Access

https://doi.org/10.3389/fendo.2019.00120

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Abstract

Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.

Highlights

Is a rare chronic disease caused by GH hypersecretion, characterized by overgrowth of tissues, which leads to a considerable burden of complications and co-existing illnesses, such as cardiovascular, respiratory, endocrine, and metabolic morbidities [1,2,3]
We review the most relevant comorbidities related to the cardiovascular system that patients with acromegaly may encounter
Whilst heart valve disease has been reported to occur in general population a wide age-related range of 0.7–40% [47, 48], cardiac valvulopathy may affect up to 75% of acromegalic patients at the time of diagnosis [49]

Summary

INTRODUCTION

Is a rare chronic disease caused by GH hypersecretion, characterized by overgrowth of tissues, which leads to a considerable burden of complications and co-existing illnesses, such as cardiovascular, respiratory, endocrine, and metabolic morbidities [1,2,3]. The effects of SSA seem more significant when used for periods longer than 6 months, especially in patients in whom control of GH/IGFI excess is attained [101, 109] In this regard, if efficacy of SSA on cardiovascular comorbidities depends on their benefit in controlling acromegaly itself, a prompt diagnosis will allow early initiation of treatment and a potential arrest, or even regression, of morphological and functional cardiac abnormalities [82]. Pituitary radiotherapy may be associated to the development of cerebrovascular disease [20, 132, 133]

CONCLUSIONS

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Methods