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Persistent diastolic dysfunction despite successful long-term octreotide treatment in acromegaly
S W van Thiel1, J J Bax, N R Biermasz
1Department of Endocrinology and Metabolism, Leiden University Medical Center, The Netherlands.
European Journal of Endocrinology
|August 3, 2005
Summary
Long-term octreotide control of acromegaly does not fully reverse cardiac diastolic dysfunction. Surgically cured patients show better diastolic function, suggesting subtle growth hormone abnormalities persist with octreotide treatment.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Acromegaly, a condition of excess growth hormone, can cause left-ventricular (LV) dysfunction.
- The complete reversibility of cardiac changes in acromegaly with long-term treatment remains unclear.
Purpose of the Study:
- To evaluate the reversibility of left-ventricular (LV) dysfunction in acromegaly patients after long-term disease control.
- To compare cardiac function in patients treated with octreotide versus those cured by surgery/radiotherapy.
Main Methods:
- Compared LV systolic and diastolic function in patients with active acromegaly, inactive acromegaly on octreotide, and inactive acromegaly cured by surgery/radiotherapy.
- Utilized tissue Doppler imaging to assess diastolic function parameters, including the E'/A' ratio.
Main Results:
- Active acromegaly showed decreased systolic function, increased LV mass index, and prolonged isovolumetric relaxation time compared to inactive acromegaly.
- Diastolic function, assessed by the E'/A' ratio, was significantly more impaired in octreotide-treated patients than in surgically cured patients.
- No significant differences in systolic parameters were observed between well-controlled (octreotide) and cured (surgery/radiotherapy) patients.
Conclusions:
- Long-term octreotide treatment for acromegaly does not fully restore diastolic function.
- Surgically cured acromegaly patients exhibit superior diastolic function compared to those on octreotide.
- Findings suggest persistent biological effects from subtle growth hormone abnormalities with octreotide, necessitating a review of acromegaly control criteria.