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Early vascular alterations in acromegaly
Gregorio Brevetti1, Paolo Marzullo, Antonio Silvestro
1Department of Medicine, University Federico II, Via G. Iannelli 45/A, 80131 Naples, Italy. brevetti@unina.it
Insights
Acromegaly patients show early vascular changes, including impaired endothelial function and increased intima-media thickness. These alterations in blood vessels appear linked to excess growth hormone (GH) and may improve after treatment.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Vascular Biology
Background:
- Acromegaly, a disorder caused by excess growth hormone (GH), is linked to higher cardiovascular mortality.
- Early atherosclerotic changes in acromegaly patients are not well understood.
- Vascular health assessment is crucial for managing acromegaly complications.
Purpose of the Study:
- To investigate early atherosclerotic changes in patients with active and treated acromegaly.
- To evaluate endothelial function (flow-mediated dilation) and arterial structure (intima-media thickness).
- To determine the impact of GH excess on vascular alterations.
Main Methods:
- B-mode ultrasound was used to measure brachial artery flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT).
- Study included patients with active acromegaly, cured acromegaly, matched controls, and healthy subjects.
- Endothelium-independent vasodilation was also assessed.
Main Results:
- Active acromegalic patients exhibited significantly lower FMD compared to healthy and matched controls.
- Acromegalic patients showed higher IMT than healthy controls, but not matched controls.
- Cured acromegalic patients had improved FMD compared to active patients but remained lower than healthy controls.
- No significant difference in IMT was found between active and cured acromegaly groups.
Conclusions:
- Acromegaly is associated with significant functional (FMD) and morphological (IMT) vascular alterations.
- These vascular changes appear to be, at least partially, a direct consequence of GH excess.
- Treatment of acromegaly may lead to partial recovery of endothelial function.
Abstract:
Acromegaly is associated with increased cardiovascular mortality; however, little is known about the early atherosclerotic changes occurring in such patients. Endothelial function, in the form of flow-mediated dilation (FMD) of the brachial artery, and intima-media thickness (IMT) of the carotid artery were measured by B-Mode ultrasound in: 1) 18 patients with active acromegaly; 2) 12 subjects cured from acromegaly; 3) 18 subjects without acromegaly, each of them matched to an acromegalic patients for age, sex, risk factors and treatments; and 4) 10 healthy subjects. Results are expressed as median plus (25th, 75th) percentile. In active acromegalic patients, FMD was 5.7 (3.9, 7.7)%, significantly lower than in both healthy subjects (P < 0.01) and matched controls (P < 0.01). No difference between groups was observed for endothelium-independent vasodilation. Acromegalic patients had also higher IMT than healthy controls (P < 0.05), whereas no difference was observed with matched controls. In cured acromegalic patients, FMD was 9.2 (7.7, 10.5)%, significantly lower (P < 0.01) than in healthy controls but higher (P < 0.01) than in active patients. No difference in IMT was observed between active and cured patients. In conclusion, patients with acromegaly have functional and morphological vascular alteration that seems, at least in part, dependent on the GH excess itself.