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Identification, treatment and management of cardiovascular risks in patients with acromegaly
Fausto Bogazzi1, Martina Lombardi2, Chiara Cosci2
1a Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy. f.bogazzi@endoc.med.unipi.it ; fbogazzi@hotmail.com.
Insights
Acromegaly, a growth hormone/IGF-1 excess disorder, often causes heart problems like left ventricular hypertrophy. Prompt treatment can reverse cardiac issues, especially in younger patients, but other conditions require independent management.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Acromegaly, characterized by growth hormone/IGF-1 excess, frequently leads to cardiovascular complications, termed acromegalic cardiomyopathy.
- Key features include left ventricular hypertrophy, diastolic dysfunction, and potential progression to systolic dysfunction and heart failure.
Purpose of the Study:
- To review the cardiovascular manifestations of acromegaly.
- To discuss the impact of disease control on cardiac abnormalities.
- To recommend appropriate cardiac evaluation and management strategies for acromegalic patients.
Main Methods:
- Literature review of studies on acromegaly and its cardiovascular effects.
- Analysis of the prevalence and progression of cardiac abnormalities.
- Evaluation of the influence of treatment on cardiac function and associated conditions.
Main Results:
- Cardiac abnormalities, including left ventricular hypertrophy and diastolic dysfunction, are common in acromegaly.
- Reversal of cardiac issues is possible with effective treatment, particularly in younger patients with shorter disease duration.
- Hypertension, valve disease, and coronary heart disease prevalence are not consistently improved by acromegaly control; arrhythmias are common but their clinical significance is unclear.
Conclusions:
- Prompt and effective management of growth hormone/IGF-1 hypersecretion is crucial for potentially reversing acromegalic cardiomyopathy, especially in younger individuals.
- Independent management of comorbidities like hypertension, arrhythmias, and valve disease is necessary, regardless of acromegaly disease activity.
- A comprehensive cardiac evaluation including echocardiography, ECG, and risk factor assessment is recommended for all acromegalic patients.
Abstract:
Acromegaly, a syndrome related to growth hormone/IGF-1 excess, is frequently complicated by cardiovascular abnormalities (acromegalic cardiomyopathy). Extremely frequent are left ventricular hypertrophy and alterations of diastolic filling, which may progress to systolic dysfunction and eventually heart failure. Cardiac abnormalities may normalize after successful medical or surgical treatment of acromegaly, particularly in young patients with short-lasting disease, but this is less likely to occur in elderly patients. Both hypertension and cardiac valve disease are frequently encountered in acromegaly, but neither seems to be favorably influenced by disease control. The prevalence of coronary heart disease (CHD) is controversial but is probably not increased in acromegaly. Arrhythmias are relatively common in untreated acromegalic patients, although their clinical relevance is unknown. A cardiac evaluation of acromegalic patients should include echocardiography, basal electrocardiogram and blood pressure measurement, and evaluation of common risk factors for CHD. Appropriate and prompt treatment allowing a rapid control of growth hormone/IGF-1 hypersecretion is warranted because many features of acromegalic cardiomyopathy may be reverted, particularly in younger patients. In view of the lack of association with acromegaly, common risk factors for CHD, hypertension, arrhythmias or valve disease should be managed independently, irrespective of control of disease activity.
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