Persistent inflammation and endothelial dysfunction in patients with treated acromegaly

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Immunology

Background:

• Acromegaly, caused by excess growth hormone (GH) and insulin-like growth factor 1 (IGF1), is associated with cardiovascular disease (CVD) risk factors.
• Inflammatory effects of IGF1 are known, and CVD risk factors often persist post-treatment in acromegaly patients.

Purpose of the Study:

• To investigate persistent inflammation and endothelial dysfunction in treated acromegaly patients.
• To determine if these factors contribute to the elevated CVD risk observed in acromegaly.

Main Methods:

• Cross-sectional study assessing cardiovascular structure, function, and inflammatory parameters in 71 treated acromegaly patients and 41 controls.
• Analysis of immune cell populations and inflammatory markers in peripheral blood, including stimulated whole blood assays.
• Vascular ultrasound measurements (flow-mediated dilation, nitroglycerine-mediated dilation, pulse wave velocity, intima-media thickness) in a subgroup.

Main Results:

• Treated acromegaly patients exhibited skewed cytokine production toward inflammation, particularly those with uncontrolled disease.
• Endothelial dysfunction was indicated by a lower flow-mediated dilation/nitroglycerine-mediated dilation ratio in controlled patients.
• While some markers of endothelial dysfunction were paradoxically lower, persistent inflammatory changes were evident.

Conclusions:

• Acromegaly patients, even after treatment, display persistent inflammatory changes.
• Endothelial dysfunction is present in treated acromegaly, contributing to CVD risk.
• These findings underscore the need for monitoring and managing cardiovascular risks in treated acromegaly.