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Cardiovascular Effects of Excess Growth Hormone: How Real is the Threat?
Frederick Berro Rivera1, Marianne Katharina Taliño2, Marie Francesca Ansay2
1Department of Medicine, Lincoln Medical and Mental Health Center, Bronx, NY 10451, USA.
Insights
Patients with acromegaly face significant cardiovascular disease risks, including heart failure and valvular disease. Growth hormone excess, particularly insulin-like growth factor-1, drives these complications, impacting cardiac function and mortality.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Acromegaly, characterized by excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1), is associated with a high mortality rate, primarily due to cardiovascular diseases (CVD).
- Understanding the specific cardiovascular manifestations and their underlying mechanisms in acromegaly is crucial for patient management.
Purpose of the Study:
- To summarize the cardiovascular complications in patients with acromegaly.
- To elucidate the role of GH/IGF-1 excess in the pathophysiology of these cardiovascular issues.
Main Methods:
- Literature review of studies investigating cardiovascular disease in acromegaly.
- Analysis of the impact of GH/IGF-1 on cardiac structure and function.
Main Results:
- The most common cardiovascular complications include heart failure (HF), valvular disease, hypertension, arrhythmias, and coronary artery disease (CAD).
- Heart failure in acromegaly typically presents as biventricular enlargement and diastolic dysfunction, linked more to disease duration than hormone levels.
- Valvular disease, particularly affecting the aortic and mitral valves, is prevalent in patients with longer disease duration.
Conclusions:
- Cardiovascular disease is a major cause of mortality in acromegaly, driven by chronic GH/IGF-1 excess.
- Specific mechanisms for arrhythmia and CAD in acromegaly require further investigation.
Abstract:
Patients with acromegaly carry a high risk of developing cardiovascular diseases (CVD). In fact, CVD is the leading cause of mortality among this group of patients. The most frequent cardiovascular complications are heart failure (HF), valvular disease, hypertension, arrhythmias, and coronary artery disease (CAD). The pathophysiology centers on the family of growth hormone (GH). These hormones are involved in normal cardiac development and function; however, excess of insulin-like growth factor-1 (IGF-1), the principally active hormone, can also cause negative effects on the cardiovascular system. HF in acromegaly usually presents with biventricular enlargement and diastolic dysfunction and is strongly associated with the duration of GH excess rather than the degree of hormone elevation. There is a high prevalence of valvular disease affecting aortic and mitral valves among patients with longer disease duration. The development of hypertension in acromegaly may be attributed to the effects of chronic GH/IGF-1 excess on different organ systems, which act via several mechanisms. The aspect of arrhythmia and CAD complicating acromegaly are currently not fully understood.
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