[Sudden cardiac death in acromegaly. Anatomopathological observation of a case]

Area of Science:

• Cardiovascular Pathology
• Endocrinology
• Cardiac Electrophysiology

Background:

• Cardiovascular complications, including acromegalic cardiomyopathy, are significant causes of morbidity and mortality in acromegaly.
• The pathological basis of sudden death in acromegaly, particularly concerning the cardiac conduction system, is not well-described.
• Acromegalic cardiomyopathy is characterized by cardiac decompensation, arrhythmias, and increased risk of sudden cardiac death.

Observation:

• A case of sudden death in a 54-year-old male with acromegaly was investigated.
• Autopsy revealed acromegalic cardiomyopathy with hyperacute myocardial infarction of the left ventricle's anteroseptal wall.
• Microscopic examination showed fibrolipomatosis and dispersion of the atrioventricular node (AVN), extending to the His bundle, and sclerosis/lipomatosis of the right bundle branch.

Findings:

• The observed pathology in the atrioventricular conduction system, including AVN dispersion and premature intramural right bundle branch, is rare and distinct from previously reported lesions.
• Microscopic findings support the hypothesis of cardiac electrical instability, correlating with the patient's history of ventricular extrasystoles, left bundle branch block, and angina.
• Sudden death was attributed to hyperacute myocardial infarction in a patient with acromegalic cardiomegaly, electrical instability, and a history of angina, potentially exacerbated by hormonal stimulation.

Implications:

• This case underscores the critical role of cardiovascular pathology and conduction system abnormalities in acromegaly-related sudden death.
• The findings suggest that persistent hormonal stimulation in acromegaly may contribute to arrhythmogenesis and electrical instability.
• Further research into the specific cardiac electrical and structural changes in acromegaly is warranted to improve patient outcomes and risk stratification.