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Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?
Ana M Ramos-Leví1, Mónica Marazuela1
1Department of Endocrinology, Instituto de Investigación Princesa, Hospital Universitario La Princesa, Universidad Autónoma, Madrid, Spain.
Insights
Patients with acromegaly often develop serious cardiovascular issues like hypertension and heart disease, increasing mortality. Early screening and management are crucial for these patients to prevent worsening cardiac problems.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Acromegaly, characterized by excessive growth hormone (GH) and insulin-like growth factor-I (IGF-I) secretion, is associated with significant cardiovascular morbidity and mortality.
- Cardiovascular complications are a leading cause of death in acromegaly patients, impacting quality of life and increasing healthcare burden.
Purpose of the Study:
- To review the most common cardiovascular comorbidities in acromegaly.
- To describe the underlying pathophysiology of these conditions.
- To provide recommendations for early diagnosis, management, and treatment.
Main Methods:
- Literature review focusing on cardiovascular complications in acromegaly.
- Analysis of pathophysiological mechanisms linking GH/IGF-I excess to cardiac abnormalities.
- Synthesis of current diagnostic and therapeutic strategies.
Main Results:
- Hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease are frequent in acromegaly.
- Uncontrolled GH/IGF-I excess, disease duration, age, and other risk factors predispose to cardiovascular complications.
- Early screening and prompt management can mitigate cardiac progression.
Conclusions:
- Cardiovascular comorbidities are a major concern in acromegaly, necessitating vigilant clinical attention.
- Understanding the pathophysiology aids in developing targeted diagnostic and management approaches.
- Implementing screening tools facilitates early detection and intervention for better patient outcomes.
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.
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