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Insulin-Like Growth Factor 1 (IGF-1) Signaling in Glucose Metabolism in Colorectal Cancer. Int J Mol Sci 2021; 22:ijms22126434. [PMID: 34208601 PMCID: PMC8234711 DOI: 10.3390/ijms22126434] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common aggressive carcinoma types worldwide, characterized by unfavorable curative effect and poor prognosis. Epidemiological data re-vealed that CRC risk is increased in patients with metabolic syndrome (MetS) and its serum components (e.g., hyperglycemia). High glycemic index diets, which chronically raise post-prandial blood glucose, may at least in part increase colon cancer risk via the insulin/insulin-like growth factor 1 (IGF-1) signaling pathway. However, the underlying mechanisms linking IGF-1 and MetS are still poorly understood. Hyperactivated glucose uptake and aerobic glycolysis (the Warburg effect) are considered as a one of six hallmarks of cancer, including CRC. However, the role of insulin/IGF-1 signaling during the acquisition of the Warburg metabolic phenotypes by CRC cells is still poorly understood. It most likely results from the interaction of multiple processes, directly or indirectly regulated by IGF-1, such as activation of PI3K/Akt/mTORC, and Raf/MAPK signaling pathways, activation of glucose transporters (e.g., GLUT1), activation of key glycolytic enzymes (e.g., LDHA, LDH5, HK II, and PFKFB3), aberrant expression of the oncogenes (e.g., MYC, and KRAS) and/or overexpression of signaling proteins (e.g., HIF-1, TGF-β1, PI3K, ERK, Akt, and mTOR). This review describes the role of IGF-1 in glucose metabolism in physiology and colorectal carcinogenesis, including the role of the insulin/IGF system in the Warburg effect. Furthermore, current therapeutic strategies aimed at repairing impaired glucose metabolism in CRC are indicated.
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Battistone MF, Miragaya K, Rogozinski A, Agüero M, Alfieri A, Ballarino MC, Boero L, Danilowicz K, Diez S, Donoso M, Fainstein-Day P, Furioso A, Garcia-Basavilbaso N, Glerean M, Katz D, Loto M, Mallea-Gil S, Martinez M, Sabate MI, Servidio M, Slavinsky P, Stalldecker G, Sosa S, Szuman G, Tkatch J, Caldo I, Lubieniecki D, Guitelman M. Increased risk of preneoplastic colonic lesions and colorectal carcinoma in acromegaly: multicenter case-control study. Pituitary 2021; 24:96-103. [PMID: 33057946 DOI: 10.1007/s11102-020-01090-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Current international guidelines recommend colonoscopy in patients with acromegaly at the time of diagnosis, even though the risk of developing colorectal neoplasm is still controversial. The main objective of this Argentine multicenter study was to analyze through screening colonoscopy the presence of advanced neoplastic lesions considered as precancerous, in patients with acromegaly compared to a control group. METHODS This is a case-control retrospective study. Full length colonoscopy of 70 acromegalic patients and 128 control subjects were studied. Polyps were classified into non pre-cancerous lesions and advance neoplastic lesions which included advanced adenomas (preneoplastic) and colorectal carcinomas. RESULTS Thirty three out of 70 acromegalic patients and 32 out of 128 subjects controls presented polyps in the colonoscopy [47.1% vs 25%, p = 0.002, OR 2.68]. Non precancerous polyps were found in 11 (15.7%) and 23 (17.9%) (p = 0.690), while advanced neoplastic lesions were found in 22 (31.4%) and 9 (7.0%) (p = 0,0001 - OR: 6.06) patients and controls respectively. Advanced adenomas and colorectal carcinomas were found in 18 (27.3%) and 9 (7.0%) (p = 0,0006-OR: 4,57), and 4 (5.7%) and 0 (0.0%) p = 0.0063) of patients and controls respectively. The presence of insulin resistance was the only statistically significant associated factor among acromegalic patients with and without colonic polyps. CONCLUSIONS Our findings show an increased risk of preneoplastic colonic lesions and colorectal carcinoma in patients with chronic and sustained GH excess compared to a control group. This supports the recommendation to perform screening colonoscopy at diagnosis of acromegaly.
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Affiliation(s)
| | - Karina Miragaya
- Servicio de Endocrinología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Amelia Rogozinski
- División Endocrinología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Monica Agüero
- Grupo de trabajo Endocrinología, Hospital Tornú, Buenos Aires, Argentina
| | - Analia Alfieri
- Servicio de Endocrinología, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | | | - Laura Boero
- División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina
| | - Karina Danilowicz
- División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina
| | - Sabrina Diez
- Servicio de Endocrinología, Hospital General de Agudos Dr. Ignacio Pirovano,, Buenos Aires, Argentina
| | - Marina Donoso
- Servicio de Endocrinología, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | | | - Alejandra Furioso
- División Endocrinología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Mariela Glerean
- Servicio de Endocrinología, Hospital Italiano, Buenos Aires, Argentina
| | - Debora Katz
- Sección Neuroendocrinología, FLENI, Buenos Aires, Argentina
| | - Monica Loto
- Servicio de Endocrinología, Hospital Británico, Buenos Aires, Argentina
| | - Susana Mallea-Gil
- Servicio de Endocrinología, Hospital Militar Central, Buenos Aires, Argentina
| | - Marcela Martinez
- Servicio de Endocrinología, Hospital C. Milstein, Buenos Aires, Argentina
| | - Maria Isabel Sabate
- Servicio de Endocrinología, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Marisa Servidio
- Unidad de Endocrinología, Hospital Teodoro Alvarez, Buenos Aires, Argentina
| | | | - Graciela Stalldecker
- Servicio de Endocrinología, Hospital General de Agudos Dr. Ignacio Pirovano,, Buenos Aires, Argentina
| | - Soledad Sosa
- División Endocrinología, Hospital de Clínicas José de San Martin UBA, Buenos Aires, Argentina
| | - Grabriela Szuman
- Servicio de Endocrinología, Sanatorio Municipal Dr. J. Mendez, Buenos Aires, Argentina
| | - Julieta Tkatch
- División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Ignacio Caldo
- Unidad de Gastroenterología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Daniela Lubieniecki
- Unidad de Gastroenterología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Mirtha Guitelman
- División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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Predictors of colonic pathologies in active acromegaly: single tertiary center experience. Wien Klin Wochenschr 2018; 130:511-516. [DOI: 10.1007/s00508-018-1367-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023]
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Zhang Z, Li Q, He W, Qiu H, Ye H, Wang Y, Shen M, He M, Yu Y, Shou X, Huang C, Yu H, Huang G, Tang W, Geng D, Fu C, Liu C, Ma Z, Ye Z, Zhang Q, Zhang Y, Shen Y, Yang Y, Wang M, Liu X, Lu Y, Hu R, Mao Y, Zhou L, Li Y, Li S, Tritos NA, Zhao Y. The comprehensive impact on human body induced by resolution of growth hormone excess. Eur J Endocrinol 2018; 178:365-375. [PMID: 29386229 DOI: 10.1530/eje-17-0872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/30/2018] [Indexed: 11/08/2022]
Abstract
CONTEXT Chronic excess of growth hormone (GH) often leads to systemic complications. The reversibility of these complications after GH resolution is not fully understood. OBJECTIVE To investigate when and to what extent will the comorbidities be ameliorated. DESIGN We conducted a prospective study comprising 24 patients with acromegaly, who achieved remission after transsphenoidal surgery. The dynamic changes of endocrine, cardiovascular, respiratory, sleep, bone and morphology parameters were evaluated at enrollment and 1 week, 1 month, 3 months, 6 months and 12 months after surgery. RESULTS Random GH dropped by 98.4% at the first day postoperatively. IGF-I index dropped by 50% and 64% at 1 week and 1 month respectively and remained unchanged onwards. Glucose metabolism improved significantly at 1 week and stabilized at 1 month. Testosterone in male patients recovered to normal range since 1 month. Systolic blood pressures dropped markedly at 3 months while diastolic blood pressures fell mildly at later visits. Abnormal lung function showed no improvement. The decrease of bone formation and resorption markers occurred at 1 week and 3 months, respectively. At 1 month, the tongue area declined while the airway volume increased significantly, accompanied with improved obstructive sleep apnea syndrome. Extremities, lips and nasal ala became smaller since 1 week. Liver, kidney and spleen volumes declined by 6.4, 15.9, 9.2%, respectively at 1 month. The volumes of pancreas and adrenal showed no change. CONCLUSIONS The rapid resolution of excessive GH led to the reversible changes of systemic comorbidities in a time-dependent and organ-specific manner.
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Affiliation(s)
- Zhaoyun Zhang
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Qin Li
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Wenqiang He
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huijia Qiu
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongying Ye
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Yongfei Wang
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ming Shen
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min He
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Yifei Yu
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Xuefei Shou
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chuanxin Huang
- Shanghai Institute of ImmunologyShanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Yu
- Department of NeurologyHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guoqian Huang
- Department of EchocardiographyHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Tang
- Department of RadiologyHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of RadiologyHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaowei Fu
- Department of EpidemiologySchool of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Congjin Liu
- Department of Nuclear MedicineHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zengyi Ma
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhao Ye
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qilin Zhang
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yichao Zhang
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue Shen
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yeping Yang
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Meng Wang
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Xingdang Liu
- Department of Nuclear MedicineHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun Lu
- Department of Nuclear MedicineHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Renming Hu
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Ying Mao
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liangfu Zhou
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor CenterShanghai, China
| | - Shiqi Li
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nicholas A Tritos
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yao Zhao
- Shanghai Pituitary Tumor CenterShanghai, China
- Department of NeurosurgeryHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Iwamuro M, Yasuda M, Hasegawa K, Fujisawa S, Ogura-Ochi K, Sugihara Y, Harada K, Hiraoka S, Okada H, Otsuka F. Colonoscopy examination requires a longer time in patients with acromegaly than in other individuals. Endocr J 2018; 65:151-157. [PMID: 29081443 DOI: 10.1507/endocrj.ej17-0322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aimed to determine the prevalence of colorectal neoplasms and to investigate the rate of and time required for cecal intubation in patients with acromegaly. A database search performed at our institution identified 29 patients with acromegaly who underwent colonoscopy. Data regarding the endoscopic, biological, and pathological examinations performed were retrospectively reviewed from the clinical records. Subsequently, the rate of and time required for cecal intubation were investigated in 23 patients with acromegaly and compared with the corresponding data of the control group. Control subjects were selected from a 2:1 matched historical control cohort, according to baseline characteristics. The mean age of the acromegaly group (17 female and 12 male) was 60.4 ± 12.6 years. Twelve patients had adenoma (41.4%), eight patients had hyperplastic polyps (27.6%), three patients had sessile serrated adenoma/polyps (10.3%), and three patients had colon cancer (10.3%). Successful cecal intubation was achieved in all patients in both groups. The difference in the time required for successful intubation between the acromegaly group (15.7 ± 9.8 minutes) and the control group (8.7 ± 6.0 minutes) was statistically significant. Linear regression analysis revealed that increased patient age was significantly related to longer colonoscope insertion times. In conclusion, although cecal intubation during colonoscopy was successful in all participants, it required a longer time in patients with acromegaly. Our results underscore the importance of and certain technical difficulties involved in colonoscopy procedures in patients with acromegaly, especially in older patients.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Miho Yasuda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Satoshi Fujisawa
- Endocrine Center, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kanako Ogura-Ochi
- Endocrine Center, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yuusaku Sugihara
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Keita Harada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Endocrine Center, Okayama University Hospital, Okayama 700-8558, Japan
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Abstract
BACKGROUND Acromegaly is a rare and underdiagnosed disorder caused, in more than 95% of cases, by a growth hormone (GH)-secreting pituitary adenoma. The GH hypersecretion leads to overproduction of insulin-like growth factor 1 (IGF-1) which results in a multisystem disease characterized by somatic overgrowth, multiple comorbidities, physical disfigurement, and increased mortality. OBJECTIVE This article aims to review the clinical features of acromegaly at diagnosis. DISCUSSION/CONCLUSION Acromegaly affects both males and females equally and the average age at diagnosis ranges from 40 to 50 years (up to 5% of cases < the age 20). Due to insidious onset and slow progression, acromegaly is often diagnosed five to more than ten years after its onset. The typical coarsening of facial features include furrowing of fronthead, pronounced brow protrusion, enlargement of the nose and the ears, thickening of the lips, skin wrinkles and nasolabial folds, as well as mandibular prognathism that leads to dental malocclusion and increased interdental spacing. Excessive growth of hands and feet (predominantly due to soft tissue swelling) is present in the vast majority of acromegalic patients. Gigantism accounts for up to 5% of cases and occurs when the excess of GH becomes manifest in the young, before the epiphyseal fusion. The disease also has rheumatologic, cardiovascular, respiratory, neoplastic, neurological, and metabolic manifestations which negatively impact its prognosis and patients quality of life. Less than 15% of acromegalic patients actively seek medical attention for change in appearance or enlargement of the extremities. The presentation of acromegaly is more often related to its systemic comorbidities or to local tumor effects.
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Affiliation(s)
- Lucio Vilar
- Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Rua Heitor Maia Filho, 100/502, Madalena, Recife, CEP 50.720-525, Brazil.
| | | | - Ruy Lyra
- Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Rua Heitor Maia Filho, 100/502, Madalena, Recife, CEP 50.720-525, Brazil
| | - Raissa Lyra
- Endocrine Research Center of Pernambuco, Recife, Brazil
| | - Luciana A Naves
- Division of Endocrinology, Brasilia University Hospital, Brasilia, Brazil
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Abstract
INTRODUCTION In acromegaly the long-term exposure to high growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels may result in specific complications in different human organs, including the thyroid gland and the colon. MATERIALS AND METHODS We will review here the evidence available regarding the characteristic thyroid and colon complications in acromegaly. RESULTS This review summarizes the published data observing noncancerous structural abnormalities (thyroid nodules, colonic polyps) and thyroid and colon cancer in patients diagnosed with acromegaly. CONCLUSION Thyroid micro-carcinomas are probably over-diagnosed among acromegalic patients. In regard to colon cancer, there is no sufficient data to suggest that colon cancer risk is higher in acromegaly compared to the general population.
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Affiliation(s)
- Amit Tirosh
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 49100, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Calderón MDR, Delgado E, García Campos F. Acromegaly and associated tumours: what should gastroenterologists know? GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:41-47. [PMID: 26966026 DOI: 10.1016/j.gastrohep.2015.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/21/2015] [Accepted: 12/04/2015] [Indexed: 06/05/2023]
Abstract
Acromegaly is a clinical syndrome caused by the excessive production of growth hormone. It is associated with high morbidity and significantly increased mortality, mainly due to cardiovascular and respiratory complications, and cancer. Mortality is reduced to that of the general population following successful treatment, in other words, when insulin-like growth factor (IGF-I) and growth hormone values return to normal levels. Not all tumours associated with this syndrome benefit from cost-effective early diagnosis programmes. An in-depth knowledge on the part of clinicians of the morbidity and mortality associated with acromegaly, allowing them in many cases to anticipate the expected clinical course of the disease, is the best therapeutic and follow-up strategy in these patients.
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Raman S, Grimberg A, Waguespack SG, Miller BS, Sklar CA, Meacham LR, Patterson BC. Risk of Neoplasia in Pediatric Patients Receiving Growth Hormone Therapy--A Report From the Pediatric Endocrine Society Drug and Therapeutics Committee. J Clin Endocrinol Metab 2015; 100:2192-203. [PMID: 25839904 PMCID: PMC5393518 DOI: 10.1210/jc.2015-1002] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT GH and IGF-1 have been shown to affect tumor growth in vitro and in some animal models. This report summarizes the available evidence on whether GH therapy in childhood is associated with an increased risk of neoplasia during treatment or after treatment is completed. EVIDENCE ACQUISITION A PubMed search conducted through February 2014 retrieved original articles written in English addressing GH therapy and neoplasia risk. Subsequent searches were done to include additional relevant publications. EVIDENCE SYNTHESIS In children without prior cancer or known risk factors for developing cancer, the clinical evidence does not affirm an association between GH therapy during childhood and neoplasia. GH therapy has not been reported to increase the risk for neoplasia in this population, although most of these data are derived from postmarketing surveillance studies lacking rigorous controls. In patients who are at higher risk for developing cancer, current evidence is insufficient to conclude whether or not GH further increases cancer risk. GH treatment of pediatric cancer survivors does not appear to increase the risk of recurrence but may increase their risk for subsequent primary neoplasms. CONCLUSIONS In children without known risk factors for malignancy, GH therapy can be safely administered without concerns about an increased risk for neoplasia. GH use in children with medical diagnoses predisposing them to the development of malignancies should be critically analyzed on an individual basis, and if chosen, appropriate surveillance for malignancies should be undertaken. GH can be used to treat GH-deficient childhood cancer survivors who are in remission with the understanding that GH therapy may increase their risk for second neoplasms.
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Affiliation(s)
- Sripriya Raman
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Adda Grimberg
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Steven G Waguespack
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Bradley S Miller
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Charles A Sklar
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Lillian R Meacham
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Briana C Patterson
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
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11
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Yamamoto M, Fukuoka H, Iguchi G, Matsumoto R, Takahashi M, Nishizawa H, Suda K, Bando H, Takahashi Y. The prevalence and associated factors of colorectal neoplasms in acromegaly: a single center based study. Pituitary 2015; 18:343-51. [PMID: 24947684 DOI: 10.1007/s11102-014-0580-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Colorectal neoplasms are well known to be a complication in cases of acromegaly; however, data on the prevalence of colorectal neoplasms in Asian patients with acromegaly are limited. Further, the factors associated with colorectal neoplasms in cases of acromegaly are controversial. Therefore, we aimed to clarify the prevalence of and factors associated with colorectal neoplasms in Japanese patients with acromegaly in a single center. METHODS We analyzed consecutive 57 patients who had undergone full-length colonoscopy at the time of diagnosis at Kobe University Hospital between 1986 and 2012. RESULTS Of the 57 patients, 22 (38.6%), 18 (31.6%) and 3 (5.3%) patients were diagnosed with hyperplastic polyps, adenomas, and adenocarcinomas, respectively and the prevalence was significantly higher than in a historical control group, Chinese patients with irritable bowel syndrome (The odds ratio was 4.0, 8.7, and 17.5, respectively). The prevalence of adenocarcinomas was also significantly higher in these patients than in the general Japanese population (odds ratio 14.5). Patients with acromegaly who had colorectal neoplasms had longer disease duration than those without colorectal neoplasms. Of note, the area under the growth hormone (GH) concentration-time curve (GH AUC) during the oral glucose tolerance test was significantly higher in patients with adenocarcinomas than in those with no colonic lesion or those with hyperplastic polyps. CONCLUSION Japanese patients with acromegaly exhibited an increased risk of colorectal neoplasms, especially colorectal adenocarcinomas. An increased GH AUC was associated with an increased risk for colon adenocarcinomas in patients with acromegaly.
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Affiliation(s)
- Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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12
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Zhong X, Shi C, Gong J, Guo B, Li M, Xu H. Experimental study of nasopharyngeal carcinoma radionuclide imaging and therapy using transferred human sodium/iodide symporter gene. PLoS One 2015; 10:e0117053. [PMID: 25615643 PMCID: PMC4304840 DOI: 10.1371/journal.pone.0117053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/17/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose The aim of this study was to design a method of radionuclide for imaging and therapy of nasopharyngeal carcinoma (NPC) using the transferred human sodium/iodide symporter (hNIS) gene. Methods A stable NPC cell line expressing hNIS was established (CNE-2-hNIS). After 131I treatment, we detected proliferation and apoptosis of NPC cells, both in vitro and vivo. In vivo, the radioactivity of different organs of nude mice was counted and 99mTc imaging using SPECT was performed. The apparent diffusion coefficient (ADC) value changes of tumor xenografts were observed by diffusion-weighted magnetic resonance imaging (DW-MRI) within 6–24 days of 131I treatment. The correlation of ADC changes with apoptosis and proliferation was investigated. Post-treatment expression levels of P53, Bax, Bcl-2, Caspase-3, and Survivin proteins were detected by western blotting. Results 131I uptake was higher in CNE-2-hNIS than in CNE-2 cells. The proliferation and apoptosis rate decreased and increased respectively both in vitro and vivo in the experimental group after 131I treatment. The experimental group tumors accumulated 99mTc in vivo, leading to a good visualization by SPECT. DW-MRI showed that ADC values increased in the experimental group 6 days after treatment, while ADC values were positively and negatively correlated with the apoptotic and Ki-67 proliferation indices, respectively. After treatment, CNE-2-hNIS cells up-regulated the expression of P53 and Survivin proteins and activated Caspase-3, and down-regulated the expression of Bcl-2 proteins. Conclusions The radionuclide imaging and therapy technique for NPC hNIS-transfected cell lines can provide a new therapy strategy for monitoring and treatment of NPC.
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Affiliation(s)
- Xing Zhong
- Department of Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Changzheng Shi
- Department of Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Jian Gong
- Department of Nuclear Medicine, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Bin Guo
- Department of Nuclear Medicine, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Mingzhu Li
- Department of Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Hao Xu
- Department of Nuclear Medicine, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
- * E-mail:
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13
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Valdes CJ, Tewfik MA, Guiot MC, Di Maio S. Synchronous esthesioneuroblastoma and growth-hormone-secreting pituitary macroadenoma: combined open and endoscopic management. J Neurol Surg Rep 2014; 75:e194-9. [PMID: 25485212 PMCID: PMC4242820 DOI: 10.1055/s-0034-1372472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/24/2014] [Indexed: 11/03/2022] Open
Abstract
Background Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory neuroepithelium. In this article we report a case of esthesioneuroblastoma presenting concomitantly with a growth-hormone (GH)-secreting pituitary macroadenoma. Results A 52 year old woman underwent surgery for suspected nasal polyps. Intralesional debulking of an intranasal tumor disclosed a low-grade esthesioneuroblastoma. Magnetic resonance imaging (MRI) demonstrated a large nasal and intracranial tumor, in addition to a separate sellar and suprasellar tumor. The patient was frankly acromegalic. She underwent a first-stage gross total resection of the esthesioneuroblastoma via a combined extended subfrontal and extended endonasal approach, followed by focused radiation therapy. She then returned for endoscopic removal of the GH-secreting pituitary macroadenoma. Conclusion The combined open and endoscopic management of this patient is described and a review of the literature presented. To our knowledge this is the first case of synchronous esthesioneuroblastoma and macroadenoma, in this case GH secreting, described in the literature.
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Affiliation(s)
- Costanza J Valdes
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Christine Guiot
- Department of Neuropathology, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Salvatore Di Maio
- Division of Neurosurgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
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14
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Abstract
Acromegaly increases cancer risk. We aimed to determine the prevalence and the predictors of tumors in acromegalic patients treated at our department. We retrospectively evaluated 160 acromegalic patients [79 female (mean age 52.0 ± 10.4 years) and 81 male (mean age 49.1 ± 12.4 years)] between 1990 and 2012, with a mean follow up period of 7.1 ± 5.7 years. The patients were screened with colonoscopy, mammography, thyroid and prostate ultrasonography. Malignancy was found in 34 (21.3%) patients. No significant difference was observed in the distribution of malignancy among sexes (20.3% in F vs. 22.2% in M). Thyroid cancer was the most frequent (n = 17, 10.6%) followed by the breast cancer (n = 4, 2.5%) and colorectal cancer (n = 3, 1.8%). Renal cell cancer in two patients, bladder cancer in two patients, periampullary tumor, rectal carcinoid tumor, malignant melanoma, prostate cancer, lung cancer, parotid mucoepidermoid carcinoma and malignant mesenchymal tumor in brain in one patient were detected. One patient had both thyroid and renal cell cancer. Age of patients at diagnosis of acromegaly was significantly higher in patients with cancer (45.8 ± 9.9 vs. 40.9 ± 11.3 years, p < 0.05). No significant difference was found in duration of the disease, initial GH levels and IGF-1% upper limit of normal values, the prevalence of diabetes, hypertension, coronary heart disease, hyperlipidemia and treatment modalities between the patients with/without cancer. In logistic regression analysis, older age at diagnosis was associated with malignancy risk. The risk of cancer in acromegaly especially the thyroid cancer risk seems to be more increased than known in the literature. Therefore, acromegaly patients should be screened routinely for cancer, especially for thyroid cancer due to it being up to four times higher prevalence than breast and colorectal cancer.
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Affiliation(s)
- Selcuk Dagdelen
- Department of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
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15
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Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 2014; 35:341-75. [PMID: 24423981 PMCID: PMC4026349 DOI: 10.1210/er.2013-1058] [Citation(s) in RCA: 319] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the high prevalence of performance-enhancing drug (PED) use, media attention has focused almost entirely on PED use by elite athletes to illicitly gain a competitive advantage in sports, and not on the health risks of PEDs. There is a widespread misperception that PED use is safe or that adverse effects are manageable. In reality, the vast majority of PED users are not athletes but rather nonathlete weightlifters, and the adverse health effects of PED use are greatly underappreciated. This scientific statement synthesizes available information on the medical consequences of PED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem. PED users frequently consume highly supraphysiologic doses of PEDs, combine them with other PEDs and/or other classical drugs of abuse, and display additional associated risk factors. PED use has been linked to an increased risk of death and a wide variety of cardiovascular, psychiatric, metabolic, endocrine, neurologic, infectious, hepatic, renal, and musculoskeletal disorders. Because randomized trials cannot ethically duplicate the large doses of PEDs and the many factors associated with PED use, we need observational studies to collect valid outcome data on the health risks associated with PEDs. In addition, we need studies regarding the prevalence of PED use, the mechanisms by which PEDs exert their adverse health effects, and the interactive effects of PEDs with sports injuries and other high-risk behaviors. We also need randomized trials to assess therapeutic interventions for treating the adverse effects of PEDs, such as the anabolic-androgen steroid withdrawal syndrome. Finally, we need to raise public awareness of the serious health consequences of PEDs.
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Affiliation(s)
- Harrison G Pope
- McLean Hospital (H.G.P.), Harvard Medical School, Belmont, Massachusetts 02478; University of Southern California (R.I.W.), Los Angeles, California 90089; University of Virginia (A.R.), Charlottesville, Virginia 22904; Department of Pharmaceutical Biosciences, (F.N.), Upsala University, SE-751 24, Upsala, Sweden; United States Anti-Doping Agency (L.B.), Colorado Springs, Colorado 80919; and Brigham and Women's Hospital (S.B.), Harvard Medical School, Boston, Massachusetts 02115
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Abstract
It has been difficult to identify factors that affect the risk of cancer, but we know that people are at higher risk as they get older, or if they have a strong family history of cancer. The potential influence of environmental and behavioral factors remains poorly understood. Early population-based and case-control studies suggested that higher serum levels of IGF1 could be associated with increased cancer risk. Since GH therapy increases IGF1 levels, concern has been raised regarding its potential role as a cancer initiation factor. Experimental evidence and some clinical studies showed that when GH/IGF1 secretion or action was inhibited, a decreased incidence and rate of progression of cancers occurred. However, human populations comprise a garden variety of genotypes that respond differently to the same kind of exposures. Human population studies frequently reveal only very small effects to these exposures. So, are GH and cancer guilty by association? After more than 20 years, leukemia, a major safety issue initially believed associated with GH treatment in children with GH deficiency (GHD), has not been confirmed but the risk of second malignancies in patients previously treated with irradiation has been detected or confirmed through the National Cooperative Growth Study. Overall, this large study confirmed the favorable overall safety profile of GH therapy in children with GHD, and also highlighted specific populations at potential risk. The risk of secondary malignancy following radiotherapy is surely related to radiotherapy more than GH therapy that may increase growth but is less likely to start the oncogenic process. In GH-deficient adults treated with GH, observational studies (KIMS, HypoCCS) have shown that when IGF1 levels were targeted within normal age-related reference ranges, the occurrence of malignancies was not higher than in the general population.
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Affiliation(s)
- Sandra Pekic
- Faculty of Medicine, University of Belgrade and Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Belgrade,
Dr Subotica 13, 11000 Belgrade, Serbia
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Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol 2012; 2012:540398. [PMID: 22518126 PMCID: PMC3296170 DOI: 10.1155/2012/540398] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/30/2011] [Accepted: 10/30/2011] [Indexed: 12/24/2022] Open
Abstract
Acromegaly and gigantism are due to excess GH production, usually as a result of a pituitary adenoma. The incidence of acromegaly is 5 cases per million per year and the prevalence is 60 cases per million. Clinical manifestations in each patient depend on the levels of GH and IGF-I, age, tumor size, and the delay in diagnosis. Manifestations of acromegaly are varied and include acral and soft tissue overgrowth, joint pain, diabetes mellitus, hypertension, and heart and respiratory failure. Acromegaly is a disabling disease that is associated with increased morbidity and reduced life expectancy. The diagnosis is based primarily on clinical features and confirmed by measuring GH levels after oral glucose loading and the estimation of IGF-I. It has been suggested that the rate of mortality in patients with acromegaly is correlated with the degree of control of GH. Adequately treated, the relative mortality risk can be markedly reduced towards normal.
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Affiliation(s)
- Gloria Lugo
- Department of Endocrinology, University Hospital A Coruña, Xubias deArriba 84, 15006 A Coruña, Spain
| | - Lara Pena
- Department of Investigation, University Hospital A Coruña, Xubias de Arriba 84, 15006 A Coruña, Spain
| | - Fernando Cordido
- Department of Endocrinology, University Hospital A Coruña, Xubias deArriba 84, 15006 A Coruña, Spain
- Department of Medicine, University of A Coruña, 15006 A Coruña, Spain
- *Fernando Cordido:
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