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Danilowicz K, Sosa S. Acromegaly and Cancer: An Update. Arch Med Res 2023; 54:102914. [PMID: 38007382 DOI: 10.1016/j.arcmed.2023.102914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
Acromegaly is a chronic and rare disease. The diagnosis usually takes several years. Multiple comorbidities are associated with acromegaly. Long-term exposure to growth factors may lead to complications such as the development of benign or malignant tumors. However, the association between acromegaly and cancer remains a matter of debate due to multiple limitations in epidemiological data. There is controversy between acromegaly and mortality, but evidence shows a significant improvement in mortality rates with disease control and careful management of comorbidities. Older age, increased growth hormone levels (GH) at last follow-up, higher insulin-like growth factor-1 (IGF-1) levels at diagnosis, malignancy and radiotherapy were proposed as independent predictors of mortality. In this review we summarize the current state of knowledge in this field. Incidence of different cancer types is described. Rigorous surveillance of endocrine diseases may contribute to increased tumor detection. Personalized screening should probably be recommended.
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Affiliation(s)
- Karina Danilowicz
- Division of Endocrinology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Soledad Sosa
- Division of Endocrinology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
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Xiao Z, Xiao P, Wang Y, Fang C, Li Y. Risk of cancer in acromegaly patients: An updated meta-analysis and systematic review. PLoS One 2023; 18:e0285335. [PMID: 38032888 PMCID: PMC10688666 DOI: 10.1371/journal.pone.0285335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/20/2023] [Indexed: 12/02/2023] Open
Abstract
The incidence of cancer in acromegaly patients may be higher than that in the general population, although this has not been fully elucidated yet. This study analyzed the risk of various important types of cancer in acromegaly patients. The study was registered in INPLASY (registration number: INPLASY202340037). The PubMed, Web of Science, and EMBASE databases were searched for studies based on strict inclusion and exclusion criteria, from the time of database inception up to June 30, 2022. All observational studies of acromegaly patients with cancer were included, without language restrictions. We used the Newcastle-Ottawa scale (NOS) checklist to assess the quality of evidence. A meta-analysis revealed the relationship between acromegaly and cancer using the standardized incidence rates (SIRs) and 95% confidence intervals (CIs) retrieved from the included studies. Nineteen studies were included and analyzed. The overall incidence of cancer (SIR = 1.45, 95%CI = 1.20-1.75), as well as that of thyroid (SIR = 6.96, 95%CI = 2.51-19.33), colorectal and anal (SIR = 1.95, 95%CI = 1.32-2.87), brain and central nervous system (SIR = 6.14, 95%CI = 2.73-13.84), gastric (SIR = 3.09, 95%CI = 1.47-6.50), urinary (SIR = 2.66, 95%CI = 1.88-3.76), hematological (SIR = 1.89, 95%CI = 1.17-3.06), pancreatic and small intestine (SIR = 2.59, 95%CI = 1.58-4.24), and connective tissue (SIR = 3.15, 95%CI = 1.18-8.36) cancers, was higher among patients with acromegaly than among the general population. No association between acromegaly and hepatobiliary, respiratory, reproductive, skin, breast, or prostate cancer was observed. This study demonstrated that acromegaly patients have a modestly increased chance of cancer as compared to the general population. Risk factors for cancer need to be further explored to monitor patients with acromegaly at a high risk for cancer more carefully.
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Affiliation(s)
- Zhehao Xiao
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pingping Xiao
- College of Physics Science and Engineering Technology, Yichun University, Yichun, China
| | - Yong Wang
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen Fang
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Xiao ZH, Wang C, Wang Y, Yuan SK, Huang C, Chen RF, Li Y. Cancer Risk and its Association With Diabetes Mellitus in Patients With Acromegaly: A Two Center-based Study. Endocr Pract 2023; 29:699-704. [PMID: 37343764 DOI: 10.1016/j.eprac.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To compare the incidence of cancer in patients with acromegaly with that of the local population in China and explore possible risk factors. METHODS Data from 117 patients diagnosed with acromegaly at 2 centers between 2011 and 2022 were analyzed, and their cancer diagnoses were recorded. The cancer standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated by comparison with those of the local population. The patients were divided into 2 groups, having cancer diagnosis or not. The relationships between cancer and sex, body mass index, age, growth hormone levels, diagnosis delay, tumor size, disease duration, treatment, disease status, and other comorbidities were analyzed. RESULTS Eight (6.8%) of 117 patients were diagnosed with cancer. The incidence of overall (SIR = 3.29, 95% CI = 1.42-6.94), colorectal (SIR = 16.67, 95% CI = 4.45-42.67), and thyroid cancers (SIR = 14.29, 95% CI = 1.73-51.60) was increased, but that of lung cancer (SIR = 4.17, 95% CI = 0.50-15.05) was not. Diagnostic delay (10.1[8.6-14.3] vs 3.8[1.3-9.0]; P = .005) and duration of acromegaly (12.8[8.9-16.4] vs 5.6[2.3-10.9]; P = .008) were prolonged in the cancer group. Diabetes mellitus (odds ratio = 7.01, 95% CI = 1.23-39.99) was an independent risk factor for acromegaly with cancer. CONCLUSION Acromegaly patients are at a higher risk of cancer and its association with diabetes mellitus. Considering the rarity of the disease, an Acromegaly Cancer Registry Center should be established in China as soon as possible.
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Affiliation(s)
- Zhe-Hao Xiao
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng Wang
- Emergency Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Wang
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shang-Kun Yuan
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng Huang
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ren-Fang Chen
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of medical oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
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Oguz SH, Firlatan B, Sendur SN, Dagdelen S, Erbas T. Follow, consider, and catch: second primary tumors in acromegaly patients. Endocrine 2023; 80:160-173. [PMID: 36517649 DOI: 10.1007/s12020-022-03282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM The risk of second primary tumors is increased in general cancer population, however, there is no data on acromegalic cancer patients in this regard. The aim of this study is to determine the prevalence of patients with two primary tumors among acromegalic cancer patients and to evaluate if patients with two primaries have distinct clinical characteristics or risk factors compared to those with one. METHODS This is a single-center retrospective cohort study. The study included 63 patients with at least one malignant tumor out of a total number of 394 acromegaly patients. Patients with multiple primary neoplasms were evaluated in detail. RESULTS This study revealed a 16% cancer prevalence in acromegaly patients, with 14% (9/63) having two primary neoplasms. Papillary thyroid carcinoma was the most prevalent tumor in the entire cancer cohort (41%, 26/63), and in the group of patients with two primaries (44%, 4/9). Patients with two primary tumors were older than those with one when diagnosed with acromegaly (48.3 ± 16.6 vs. 43.3 ± 10.7 years), which might be attributed to a longer diagnostic delay (median of 4.5 vs. 2 years). The period between the onset of acromegaly symptoms and diagnosis was not associated with earlier cancer diagnosis. No relationship between circulating GH or IGF-I levels and the number of neoplasms was found. CONCLUSION The development of second primary tumors in acromegalic patients with cancer diagnosis is not rare. Acromegalic cancer patients should be closely monitored for new symptoms or signs that could be associated with second primary tumors.
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Affiliation(s)
- Seda Hanife Oguz
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Busra Firlatan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Suleyman Nahit Sendur
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selcuk Dagdelen
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tomris Erbas
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
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Di Somma C, Scarano E, Arianna R, Romano F, Lavorgna M, Serpico D, Colao A. Long-Term Safety of Growth Hormone Deficiency Treatment in Cancer and Sellar Tumors Adult Survivors: Is There a Role of GH Therapy on the Neoplastic Risk? J Clin Med 2023; 12:jcm12020662. [PMID: 36675591 PMCID: PMC9861672 DOI: 10.3390/jcm12020662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Experimental studies support the hypothesis that GH/IGF-1 status may influence neoplastic tissue growth. Epidemiological studies suggest a link between GH/IGF-1 status and cancer risk. However, several studies regarding GH replacement safety in childhood cancer survivors do not show a prevalence excess of de novo cancers, and several reports on children and adults treated with GH have not shown an increase in observed cancer risk in these patients. The aim of this review is to provide an at-a-glance overview and the state of the art of long-term effects of GH replacement on neoplastic risk in adults with growth hormone deficiency who have survived cancer and sellar tumors.
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Affiliation(s)
- Carolina Di Somma
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
- UNESCO Chair “Education for Health and Sustainable Development”, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Elisabetta Scarano
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Rossana Arianna
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Fiammetta Romano
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Mariarosaria Lavorgna
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Domenico Serpico
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Annamaria Colao
- Endocrinology, Diabetes and Andrology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
- UNESCO Chair “Education for Health and Sustainable Development”, University of Naples “Federico II”, 80131 Naples, Italy
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Peng G, Li X, Zhou Y, Bai J, Hong P, Li W, Zhang Y, Zhang L, Liao Q, Liao M, Zhou L, Sun Z, Shen R, Zheng H, Long M. Clinical Characteristics and Associated Factors of Colonic Polyps in Acromegaly. Exp Clin Endocrinol Diabetes 2022; 130:714-722. [PMID: 36075228 DOI: 10.1055/a-1913-7900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the clinical characteristics and associated factors of colonic polyps in patients with acromegaly. METHODS Clinical characteristics and colonoscopy findings of 86 acromegaly patients who received treatment were retrospectively reviewed, and colonoscopy findings and the correlation with growth hormone (GH)-secreting pituitary adenoma (GHPA) volume and hormonal/metabolic levels were analyzed. RESULTS The prevalence of colonic polyps in acromegaly patients was 40.7% and increased significantly with advanced age, especially in those ≥50 years. Multiple polyps (62.8%) and colonic polyps in the left colon (54.2%) were detected more frequently. Compared to acromegaly patients without polyps, those with polyps displayed higher insulin-like growth factor-1 × upper limit of normal (IGF-1×ULN) levels (P=0.03). IGF-1 levels and GHPA volumes in patients with polyps showed increasing trends, although the differences were not significant. GH levels were higher in patients with polyps of diameter ≤5 mm than those with polyps of diameter >5 mm (P=0.031). The univariate and multivariate logistic regression analysis revealed that GHPA volumes (OR: 1.09, 95% CI: 1.01-1.20; P=0.039) and IGF-1×ULN Q2 levels (OR: 6.51, 95% CI: 1.20-44.60; P=0.038) were independent factors for predicting the risk of colonic polyp occurrence in acromegaly patients. A nomogram was prepared to evaluate the risk of colonic polyps in acromegaly patients. CONCLUSION The acromegalic patients are a population with a high prevalence of colonic polyps. GHPA volumes and IGF-1×ULN levels may be predictors of colonic polyp occurrence.
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Affiliation(s)
- Guiliang Peng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Xing Li
- Department of Endocrinology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuanyuan Zhou
- Department of Gastroenterology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Jianying Bai
- Department of Gastroenterology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Pian Hong
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Weixing Li
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Yuling Zhang
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Lei Zhang
- Department of Radiology, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Qian Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Mingyu Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Ling Zhou
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Zheng Sun
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
| | - Rufei Shen
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
| | - Min Long
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
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Haque A, Sahu V, Lombardo JL, Xiao L, George B, Wolff RA, Morris JS, Rashid A, Kopchick JJ, Kaseb AO, Amin HM. Disruption of Growth Hormone Receptor Signaling Abrogates Hepatocellular Carcinoma Development. J Hepatocell Carcinoma 2022; 9:823-837. [PMID: 35996397 PMCID: PMC9391993 DOI: 10.2147/jhc.s368208] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/20/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Hepatocellular carcinoma (HCC) is the most common type of primary liver cancers. It is an aggressive neoplasm with dismal outcome because most of the patients present with an advanced-stage disease, which precludes curative surgical options. Therefore, these patients require systemic therapies that typically induce small improvements in overall survival. Hence, it is crucial to identify new and promising therapeutic targets for HCC to improve the current outcome. The liver is a key organ in the signaling cascade triggered by the growth hormone receptor (GHR). Previous studies have shown that GHR signaling stimulates the proliferation and regeneration of liver cells and tissues; however, a definitive role of GHR signaling in HCC pathogenesis has not been identified. Methods In this study, we used a direct and specific approach to analyze the role of GHR in HCC development. This approach encompasses mice with global (Ghr-/- ) or liver-specific (LiGhr-/- ) disruption of GHR expression, and the injection of diethylnitrosamine (DEN) to develop HCC in these mice. Results Our data show that DEN induced HCC in a substantial majority of the Ghr+/+ (93.5%) and Ghr +/- (87.1%) mice but not in the Ghr-/- (5.6%) mice (P < 0.0001). Although 57.7% of LiGhr-/- mice developed HCC after injection of DEN, these mice had significantly fewer tumors than LiGhr+/+ (P < 0.001), which implies that the expression of GHR in the liver cells might increase tumor burden. Notably, the pathologic, histologic, and biochemical characteristics of DEN-induced HCC in mice resembled to a great extent human HCC, despite the fact that etiologically this model does not mimic this cancer in humans. Our data also show that the effects of DEN on mice livers were primarily related to its carcinogenic effects and ability to induce HCC, with minimal effects related to toxic effects. Conclusion Collectively, our data support an important role of GHR in HCC development, and suggest that exploiting GHR signaling may represent a promising approach to treat HCC.
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Affiliation(s)
- Abedul Haque
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vishal Sahu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jamie Lynne Lombardo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bhawana George
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John J Kopchick
- Edison Biotechnology Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hesham M Amin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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Durmuş ET, Atmaca A, Çolak R, Durmuş B. Cancer prevalence and cancer screening in patients with acromegaly: a single center experience. Endocrine 2022; 77:363-371. [PMID: 35608772 DOI: 10.1007/s12020-022-03082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the prevalence of cancer in patients with acromegaly and the variables associated with malignant and premalignant lesions detected by cancer screening. METHODS The data of 214 patients diagnosed with acromegaly in our institution were evaluated retrospectively. Prevalence of cancer was compared with national rates to estimate standardized incidence ratios (SIRs). The relationships of malignant and premalignant lesions detected by cancer screening with demographic, clinical, and radiological variables were also analyzed. RESULTS Cancer was detected in 24 (13.4%) of 179 patients enrolled in the study. Compared to the general population, the incidence of all malignancies was increased in both women and men with acromegaly (SIR: 4.78, 95% CI: 2.43-8.53, p = 0.002 and SIR: 8.97, 95% CI: 5.51-14.7, p < 0.001, respectively). The most common cancers were thyroid, colorectal, breast, kidney, gastric, and testicular cancer, respectively. Duration of disease was the only independent risk factor for the development of cancer (OR: 1.007, 95% CI: 1.002-1.011, p = 0.002). Malignant/premalignant lesions were detected in 21.5% of the patients with a colonoscopy scanning procedure and in 20.8% with an esophagogastroduodenoscopy procedure, and current age was found to be higher among the patients with malignant/premalignant lesions (p = 0.023 and p = 0.003, respectively). Breast cancer was detected in 3.7% of screening tests performed with mammography. CONCLUSION In this study, it was shown that the prevalence of cancer increases with acromegaly and this increase is associated with disease duration. Considering the increase in the number of premalignant lesions, the scope of cancer screening recommendations in the guidelines should be expanded to ensure early diagnosis.
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Affiliation(s)
- Elif Tutku Durmuş
- Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey.
| | - Ayşegül Atmaca
- Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Ramis Çolak
- Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Buğra Durmuş
- Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
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Pekic S, Stojanovic M, Popovic V. Pituitary tumors and the risk of other malignancies: is the relationship coincidental or causal? ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R1-R13. [PMID: 37435457 PMCID: PMC10259320 DOI: 10.1530/eo-21-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/21/2021] [Indexed: 07/13/2023]
Abstract
Pituitary adenomas are benign neoplasms of the pituitary. The most prevalent are prolactinomas and non-functioning pituitary adenomas, followed by growth hormone- and ACTH-secreting adenomas. Most pituitary adenomas seem to be sporadic and their persistent growth is very atypical. No molecular markers predict their behavior. The occurrence of pituitary adenomas and malignancies in the same patient can be either pure coincidence or caused by shared underlying genetic susceptibility involved in tumorigenesis. Detailed family history on cancers/tumors in the first, second and third generation of family members on each side of the family has been reported in a few studies. They found an association of pituitary tumors with positive family history for breast, lung and colorectal cancer. We have reported that in about 50% of patients with pituitary adenomas, an association with positive family history for cancer has been found independent of secretory phenotype (acromegaly, prolactinoma, Cushing's disease or non-functioning pituitary adenomas). We also found earlier onset of pituitary tumors (younger age at diagnosis of pituitary tumors) in patients with a strong family history of cancer. In our recent unpublished series of 1300 patients with pituitary adenomas, 6.8% of patients were diagnosed with malignancy. The latency period between the diagnosis of pituitary adenoma and cancer was variable, and in 33% of patients, it was longer than 5 years. Besides the inherited trophic mechanisms (shared underlying genetic variants), the potential influence of shared complex epigenetic influences (environmental and behavioral factors - obesity, smoking, alcohol intake and insulin resistance) is discussed. Further studies are needed to better understand if patients with pituitary adenomas are at increased risk for cancer.
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Affiliation(s)
- Sandra Pekic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia
| | - Marko Stojanovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia
| | - Vera Popovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
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Esposito D, Ragnarsson O, Johannsson G, Olsson DS. Incidence of Benign and Malignant Tumors in Patients With Acromegaly Is Increased: A Nationwide Population-based Study. J Clin Endocrinol Metab 2021; 106:3487-3496. [PMID: 34343297 DOI: 10.1210/clinem/dgab560] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Whether cancer risk in acromegaly is increased remains controversial, and the risk of benign tumors has been little studied. OBJECTIVE To investigate the incidence of benign and malignant tumors in acromegaly in a nationwide population-based study. METHODS Adult patients diagnosed with acromegaly between 1987 and 2017 were identified in the Swedish National Patient Registry. The diagnoses of benign and malignant tumors were recorded. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for neoplasms with 95% CIs were calculated using the Swedish general population as reference. RESULTS The study included 1296 patients (52% women). Mean (SD) age at diagnosis was 51.6 (14.7) years. Median (range) follow-up time was 11.7 (0-31) years. Overall, 186 malignancies were identified in acromegalic patients compared with 144 expected in the general population (SIR 1.3; 95% CI 1.1-1.5). The incidence of colorectal and anal cancer (SIR 1.5; 95% CI 1.0-2.2), and renal and ureteral cancer (SIR 4.0; 95% CI 2.3-6.5) was increased, whereas the incidence of malignancies of the respiratory system, brain, prostate, and breast was not. Only 3 cases of thyroid cancer were recorded. Mortality due to malignancies was not increased (SMR 1.1; 95% CI 0.9-1.4). Incidence of benign tumors was increased more than 2-fold (SIR 2.4; 95% CI 2.1-2.7). CONCLUSION Patients with acromegaly had an increased risk of both benign and malignant tumors, including colorectal and anal cancer, and renal and ureteral cancer. Whether this is associated with acromegaly itself or due to more intensive medical surveillance remains to be shown.
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Affiliation(s)
- Daniela Esposito
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Dal J, Skov BG, Andersen M, Feldt-Rasmussen U, Feltoft CL, Karmisholt J, Nielsen EH, Dekkers OM, Jørgensen JOL. Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta-analysis of the literature. Clin Endocrinol (Oxf) 2021; 94:625-635. [PMID: 33306249 DOI: 10.1111/cen.14392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Data on sex differences in acromegaly at the time of diagnosis vary considerably between studies. DESIGN A nationwide cohort study including all incident cases of acromegaly (1978-2010, n = 596) and a meta-analysis on sex differences in active acromegaly (40 studies) were performed. METHOD Sex-dependent differences in prevalence, age at diagnosis, diagnostic delay, pituitary adenoma size, insulin-like growth factor 1 (IGF-I) and growth hormone (GH) concentrations were estimated. RESULTS The cohort study identified a balanced gender distribution (49.6% females) and a comparable age (years) at diagnosis (48.2 CI95% 46.5-49.8 (males) vs. 47.2 CI95% 45.5-48.9 (females), p = 0.4). The incidence rate significantly increased during the study period (R2 = 0.42, p < 0.01) and the gender ratio (F/M) changed from female predominance to an even ratio (SR: 1.4 vs. 0.9, p = 0.03). IGF-ISDS was significantly lower in females compared to males, whereas neither nadir GH nor pituitary adenoma size differed between males and females. In the meta-analysis, the weighted percentage female was 53.3% (CI95% 51.5-55.2) with considerable heterogeneity (I2 = 85%) among the studies. The mean age difference at diagnosis between genders was 3.1 years (CI95% 1.9-4.4), and the diagnostic delay was longer in females by 0.9 years (CI95% -0.4 to 2.1). Serum IGF-I levels were significantly lower in female patients, whereas nadir GH, and pituitary adenoma size were comparable. CONCLUSION There are only a minor sex differences in the epidemiology of acromegaly at the time of diagnosis except that female patients are slightly older and exhibit lower IGF-I concentrations and a longer diagnostic delay.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Benedikte G Skov
- Department of Endocrinology, Aarhus University Hospital, Aarhus C, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus L Feltoft
- Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiolgy and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
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12
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Cortês Nascimento G, de Araujo Cortês Nascimento AGP, de Maria Ribeiro Veiga Parente C, Rodrigues VP, de Sousa Azulay RS, de Carvalho Rocha VC, da Silva Pereira Damianse S, Magalhães M, Dos Santos Faria M, Gomes MB. Pituitary neuroendocrine tumors and differentiated thyroid cancer: do metabolic and inflammatory risk factors play roles? J Endocrinol Invest 2021; 44:735-744. [PMID: 32681462 DOI: 10.1007/s40618-020-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE It is postulated that patients with different types of pituitary neuroendocrine tumors (PitNETs) may present a higher incidence of cancer. Factors underlying individuals becoming overweight, such as insulin resistance, hyperleptinemia, and low-grade inflammation, may play a role in the risk of differentiated thyroid carcinoma (DTC) in such patients. This study aimed to investigate the frequency of and obesity-related risk factors associated with DTC in patients with PitNETs. METHODS This cross-sectional study involved 149 patients with nonacromegalic PitNETs (AG group), 71 patients with acromegaly (ACRO group), and 156 controls (CG group). All participants underwent insulin and blood glucose measurements with the determination of the homeostatic model assessment-insulin resistance (HOMA-IR) index, leptin, and high-sensitivity C-reactive protein (hsCRP), and they also underwent thyroid ultrasound. Clinically significant nodules were biopsied for subsequent cytopathological evaluation, and participants were operated on when indicated. RESULTS Patients in the AG group had high levels of insulin resistance and significantly higher levels of leptin and hsCRP compared with those of patients in the ACRO group. There were no cases of DTC in the AG group; two findings, one incidental, of DTC occurred in the CG group, and three cases of DTC were present in the ACRO group. Acromegaly was associated with DTC after adjusted analysis. CONCLUSIONS Our findings in patients with nonacromegalic PitNETs do not indicate a high risk for DTC despite the presence of metabolic and inflammatory risk factors for neoplastic events. In contrast, acromegaly promotes a greater risk of DTC.
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Affiliation(s)
- G Cortês Nascimento
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil.
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil.
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil.
| | - A G P de Araujo Cortês Nascimento
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
- Department of Pathology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | | | - V P Rodrigues
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
- Department of Morphology, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - R S de Sousa Azulay
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - V C de Carvalho Rocha
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - S da Silva Pereira Damianse
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M Magalhães
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M Dos Santos Faria
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M B Gomes
- Diabetes Unit-Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Spricido IY, Feckinghaus CM, Silva RHM, Mesa Junior CO, Boguszewski CL. Prevalence of thyroid cancer in patients with acromegaly and non-growth hormone secreting pituitary adenomas: A prospective cross-sectional study. Growth Horm IGF Res 2021; 56:101378. [PMID: 33486451 DOI: 10.1016/j.ghir.2021.101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/08/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the prevalence of differentiated thyroid cancer (DTC) in patients with non-GH secreting pituitary adenomas [NGHPA group: non-functioning (NFPA), prolactin (PRL) and corticotropin (ACTH)-secreting adenomas] compared to patients with acromegaly, a pituitary disease that has been associated with increased risk for thyroid cancer. PATIENTS AND METHODS Prospective, cross-sectional study involving consecutive outpatients followed in our institution with diagnosis of acromegaly (n = 71; 43 women, median age 57 yrs) and NGHPA (n = 57; 38 women, median age 48 yrs.; PRL (n = 35), ACTH (n = 7), NFPA (n = 15). All participants were subjected to thyroid ultrasound (US) by the same examiner, and US-guided fine needle aspiration (FNA) biopsy when indicated. RESULTS Thyroid volume was higher in acromegaly than in NGHPA (median 12.5 ml vs 6.3 ml; p < 0.0001), and thyroid nodules were present in 27/71 (38.0%) of acromegaly patients and in 14/57 (24.6%) of NGHPA group. FNA was indicated in 15/27 (55.5%) of acromegaly patients [Bethesda I (n = 1); II (n = 11), III (n = 1), two patients refused FNA], and in 8/14 (57.1%) of the NGHPA group [Bethesda I (n = 2); II (n = 4); V (n = 1); VI (n = 1)]. The two patients of NGHPA group with Bethesda V and VI were operated and papillary carcinoma was confirmed histologically. CONCLUSION DTC was not detected in our acromegaly patients and its presence in patients with NGHPA suggests that DTC predisposition is not related to GH excess.
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Affiliation(s)
- Isadora Yasbick Spricido
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Carolina Monteguti Feckinghaus
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Rômulo Henrique Malaquias Silva
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Cleo Otaviano Mesa Junior
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Cesar Luiz Boguszewski
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.
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Ucan B, Kizilgul M, Karci AC, Duger H, Erkam Sencar M, Imga NN, Demirci T, Berker D, Erman Cakal. THE PREVALENCE OF CANCER AND ITS RELATION TO DISEASE ACTIVITY IN PATIENTS WITH ACROMEGALY: TWO CENTERS' EXPERIENCE. Endocr Pract 2021; 27:51-55. [PMID: 33475501 DOI: 10.4158/ep-2020-0398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Acromegaly is characterized by increased serum concentrations of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Although animal studies have demonstrated a relationship between these hormones and cancer risk, the results of human studies evaluating cancer prevalence in acromegaly are inconsistent. We aimed to investigate the prevalence of malignant neoplasms in patients with acromegaly. METHODS Cancer risk was evaluated in a cohort of 280 patients (male/female: 120/160; mean age: 50.93 ± 12.07 years) with acromegaly. Patients were categorized into 2 groups according to the presence or absence of cancer. Standard incidence ratios were calculated as compared to the general population. RESULTS From 280 patients, cancer was diagnosed in 19 (6.8%) patients; 9 (47%) of them had thyroid cancer, which was the most common cancer type. Standard incidence ratios of all cancers were 0.8 (95% CI, 0.5-1.1) and 1.0 (95% CI, 0.8-1.3) in men and women, respectively. Compared to patients without cancer, the current age was higher in patients with cancer (59 [49-65] to 51 [42-59], P = .027). In contrast, the age at diagnosis was similar in both groups. Not only was the time to diagnosis and disease duration similar in both groups but also the basal and current GH and IGF-1 levels. The prevalence of active disease was also similar between the groups (32% to 23%, P = .394). CONCLUSION Our findings were not consistent with the studies suggesting that patients with acromegaly encounter an increased cancer risk. Furthermore, there were similar basal and current GH and IGF-1 levels in patients with acromegaly, both with and without cancer.
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Affiliation(s)
- Bekir Ucan
- Department of Endocrinology and Metabolism, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Alper Cagri Karci
- Department of Endocrinology and Metabolism, University of Health Sciences, Numune Training and Research Hospital, Ankara, Turkey
| | - Hakan Duger
- Department of Endocrinology and Metabolism, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Narin Nasiroglu Imga
- Department of Endocrinology and Metabolism, University of Health Sciences, Numune Training and Research Hospital, Ankara, Turkey
| | - Taner Demirci
- Department of Endocrinology and Metabolism, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism, University of Health Sciences, Numune Training and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Caputo M, Prencipe N, Bisceglia A, Bona C, Maccario M, Aimaretti G, Grottoli S, Gasco V. Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood. Endocr Pract 2021; 26:1337-1350. [PMID: 33471665 DOI: 10.4158/ep-2020-0286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Differential diagnosis of nonadenomatous sellar masses causing hypopituitarism is still a challenge. Among these masses, growing evidence has demonstrated that primary pituitary lymphoma is a specific and emerging entity. The aim of our study was to describe our experience with a case of primary pituitary lymphoma and to perform a review of the available literature. METHODS We searched relevant databases up to March 2020, identifying 36 suitable articles basing on inclusion criteria (primary pituitary lymphoma in adult immunocompetent subjects). Overall, 43 cases were included in the review, adding a new case diagnosed and treated in our hospital. Epidemiologic data, clinical presentation, hormonal status, radiologic findings, pathology, treatment, and outcome were extracted. RESULTS Mean age at diagnosis was 58.9 years, without gender difference. Symptoms related to mass were common (52.3%), in particular cranial nerve palsy (70.5%), headache (56.8%), and alteration in visual field (40.9%). Impaired hormonal status was detected in 89.7% of patients; of them, 58.9% presented with anterior pituitary failure (partial or total), while 25.6% presented with panhypopituitarism. Overall, diabetes insipidus was present in 30.8% and hyperprolactinemia in 41.0% of patients. The majority of patients presented a radiologically invasive mass in the suprasellar region and cavernous sinus (65.9% and 40.9%, respectively) and histologic diagnosis of diffuse B-cell lymphoma (54.5%). CONCLUSION The differential diagnosis of sellar and parasellar masses causing hypopituitarism should include primary pituitary lymphoma, even in absence of systemic symptoms or posterior pituitary dysfunction. The disease has a heterogeneous pattern, so a collaboration between endocrinologists, neuroradiologists, neurosurgeons, and hematologists is desirable.
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Affiliation(s)
- Marina Caputo
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
| | - Nunzia Prencipe
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Alessandro Bisceglia
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Chiara Bona
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Silvia Grottoli
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
| | - Valentina Gasco
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Torino, Italy
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Park KH, Lee EJ, Seo GH, Ku CR. Risk for Acromegaly-related Comorbidities by Sex in Korean Acromegaly. J Clin Endocrinol Metab 2020; 105:5696792. [PMID: 31903478 DOI: 10.1210/clinem/dgz317] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Reports on the incidence, characteristics, and comorbidity in Asian patients with acromegaly are scarce. OBJECTIVE To evaluate the incidence of acromegaly and the risk of comorbidities in East Asia, especially South Korea. DESIGN This nationwide population-based cohort study using the Korean Health Insurance Review and Assessment claims database evaluated the incidence of acromegaly, initially diagnosed from 2010 to 2013. We identified comorbidities during, before, and 2 years after diagnosis. Acromegaly and control cases (718 and 7180, respectively) were included in the analysis. SETTING A longitudinal case-control study using a nationwide population cohort. RESULTS The mean annual incidence rate of acromegaly was 3.57 cases per 1 000 000. Malignancies occurred in 61 patients with acromegaly (8.5%) during the study period and thyroid cancer was the most common malignancy (n = 38). In the acromegaly group, the overall risk of malignancy was higher: hazard ratio (HR), 2.82 (95% confidence interval [CI]: 2.12-3.74). Malignancy risk was more pronounced in females, with increased risk from the prediagnosis period that is sustained until the postdiagnosis period. Prevalence of diabetes mellitus (DM) and heart failure increased significantly in acromegalic patients. Over the entire period, DM developed in 51.1% and 57.0% of male and female acromegalic patients, respectively. Mortality risk was higher (HR 1.65, 95%; CI: 1.13-2.41) and statistically significant in females (HR 1.75, 95%; CI: 1.07-2.84). CONCLUSION Comorbidities associated with acromegaly differed by sex in Korean subjects. High malignancy and mortality risk should be considered in female patients when managing acromegaly in Korea.
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Affiliation(s)
- Kyeong Hye Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi, Republic of Korea
| | - Eun Jig Lee
- Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Severance Hospital Pituitary Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| | - Cheol Ryong Ku
- Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Severance Hospital Pituitary Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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Wu JC, Huang WC, Chang HK, Ko CC, Lirng JF, Chen YC. Natural History of Acromegaly: Incidences, Re-operations, Cancers, and Mortality Rates in a National Cohort. Neuroendocrinology 2020; 110:977-987. [PMID: 31822015 DOI: 10.1159/000505332] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acromegaly is so rare that its natural history, including incidence, risk of cancers, and mortality rates, remains elusive. This natural study utilized a nationwide database to provide a better understanding of acromegaly's disease course. METHODS A cohort of 1,195 acromegaly patients were identified and followed-up from 1997 to 2013. Incidence, operation, and re-operation rates were calculated. Excessive mortality and cancer risk related to acromegaly were estimated by standardized mortality ratio (SMR) and standardized incidence ratio (SIR). RESULTS The incidence was 2.78 per million-person-years, with little gender predominance (female vs. male, 49.5 vs. 50.5%, respectively). There was female predominance only among 50 and 60 year-olds (incidence rate ratio: 1.37 and 1.43, p < 0.001 and p = 0.002). Among them, 673 (56.3%) had hypophysectomy surgery, and the young-onset (<40 years) patients had more re-operations (15.5%, p = 0.01). The overall mortality rate was 22.3 per 1,000 person-years, with a median survival of 4.67 years (with no gender differences, p = 0.38). The overall SMR of acromegaly patients was 1.41, and the onset-age-specific SMRs of the early- and middle-onset patients were higher than for those with late-onset. There were 87 newly diagnosed cancers in the cohort, with an incidence rate of 10.6 per 1,000 person-years (median 5.4 years). The overall SIR of cancers was 1.91, and there were no differences among gender, onset-age, and disease duration (all SIR >1, approximately 2). CONCLUSION Acromegaly is associated with an excessive risk of mortality and two-fold higher risk of cancers. Patients with acromegaly should be managed appropriately after the diagnosis.
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Affiliation(s)
- Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Jhong Jheng Spine and Orthopedic Hospital, Kaohsiung, Taiwan
| | - Jiing-Feng Lirng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan,
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan,
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan,
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Boguszewski CL, Boguszewski MCDS. Growth Hormone's Links to Cancer. Endocr Rev 2019; 40:558-574. [PMID: 30500870 DOI: 10.1210/er.2018-00166] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Several components of the GH axis are involved in tumor progression, and GH-induced intracellular signaling has been strongly associated with breast cancer susceptibility in genome-wide association studies. In the general population, high IGF-I levels and low IGF-binding protein-3 levels within the normal range are associated with the development of common malignancies, and components of the GH-IGF signaling system exhibit correlations with clinical, histopathological, and therapeutic parameters in cancer patients. Despite promising findings in preclinical studies, anticancer therapies targeting the GH-IGF signaling system have led to disappointing results in clinical trials. There is substantial evidence for some degree of protection against tumor development in several animal models and in patients with genetic defects associated with GH deficiency or resistance. In contrast, the link between GH excess and cancer risk in acromegaly patients is much less clear, and cancer screening in acromegaly has been a highly controversial issue. Recent studies have shown that increased life expectancy in acromegaly patients who attain normal GH and IGF-I levels is associated with more deaths due to age-related cancers. Replacement GH therapy in GH deficiency hypopituitary adults and short children has been shown to be safe when no other risk factors for malignancy are present. Nevertheless, the use of GH in cancer survivors and in short children with RASopathies, chromosomal breakage syndromes, or DNA-repair disorders should be carefully evaluated owing to an increased risk of recurrence, primary cancer, or second neoplasia in these individuals.
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Affiliation(s)
- Cesar Luiz Boguszewski
- Department of Internal Medicine, Endocrine Division (SEMPR), University Hospital, Federal University of Parana, Curitiba, Brazil
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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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20
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Ruchala M, Wolinski K. Health-Related Complications of Acromegaly-Risk of Malignant Neoplasms. Front Endocrinol (Lausanne) 2019; 10:268. [PMID: 31114546 PMCID: PMC6502963 DOI: 10.3389/fendo.2019.00268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/11/2019] [Indexed: 01/03/2023] Open
Abstract
The issue of increased risk of benign and malignant neoplasms in patients with acromegaly remains the topic of debate from many years and was addressed by numerous studies. Many of them have shown increase in the cancer incidence. Among particular types of malignancies, thyroid, colorectal, and breast cancer are most commonly indicated as associated with acromegaly. Single reports denoted increase in prevalence of neoplasms of other organs such as kidney, bone or central nervous system. Cardiovascular and respiratory tract disorders were traditionally consider as main causes of mortality in acromegalic patients, accounting for about 60 and 25% of deaths, respectively. However, according to a number of studies published over the current decade cancer became the most important cause of deaths. Aim of the current article was to review the literature concerning the risk of malignant neoplasms in acromegaly and its clinical implications.
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21
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Hao M, Luque-Fernandez MA, Lopez D, Cote K, Newfield J, Connors M, Vaidya A. Benign Adrenocortical Tumors and the Detection of Nonadrenal Neoplasia. Int J Endocrinol 2019; 2019:9035407. [PMID: 31781211 PMCID: PMC6875325 DOI: 10.1155/2019/9035407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/04/2019] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Patients with adrenocortical tumors have been frequently observed to have nonadrenal neoplasia. OBJECTIVE To investigate whether patients with benign adrenocortical tumors have a higher likelihood of having nonadrenal neoplasia detected. DESIGN AND PARTICIPANTS Case-control study of patients with benign adrenocortical tumors (cases; n = 400) and normal adrenal glands (controls; n = 400), who underwent repeated abdominal cross-sectional imaging. MAIN OUTCOMES Primary analyses: association between case-control status and benign abdominal neoplasia detected via cross-sectional imaging. Secondary analyses: association between case-control status and tumors detected via other imaging modalities. RESULTS The mean interval of abdominal imaging was 4.7 (SD = 3.8) years for cases and 5.9 (4.8) years for controls. Cases were more likely to have detected intraductal papillary mucinous neoplasms (IPMNs) of the pancreas (8.5% vs. 4.5%, adjusted OR = 2.22, 95% CI (1.11, 4.63)) compared with controls. In secondary analyses, cases were more likely to have detected thyroid nodules (25.5% vs. 17.0%, adjusted OR = 1.77, 95% CI (1.15, 2.74)), hyperparathyroidism or parathyroid adenomas (3.5% vs. 1.3%, adjusted OR = 3.00, 95% CI (1.00, 11.64)), benign breast masses (6.0% vs. 3.3%, adjusted OR = 3.25, 95% CI (1.28, 8.78)), and benign prostatic hyperplasia (20.5% vs. 5.3%, adjusted OR = 3.20, 95% CI (1.14, 10.60)). Using a composite outcome, cases had higher odds of detection of the composite of IPMN, thyroid nodules, parathyroid tumors, benign breast masses, and prostate hyperplasia (adjusted OR = 2.36, 95% CI: 1.60, 3.50) when compared with controls. CONCLUSIONS Patients with benign adrenocortical tumors had higher odds of detected pancreatic IPMN, as well as thyroid nodules, parathyroid tumors, benign breast masses, and prostate hyperplasia compared with patients with normal adrenal glands. These associations may have important implications for patient care and healthcare economics, regardless of whether they reflect incidental discoveries due to imaging detection or frequency bias, or a common risk for developing multiple neoplasia.
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Affiliation(s)
- Meng Hao
- Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
- Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Miguel Angel Luque-Fernandez
- Harvard School of Public Health, Boston, Massachusetts 02115, USA
- London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research Institute of Granada, Non-communicable Disease and Cancer Epidemiology Group, Andalusian School of Public Health, University of Granada, Granada, Spain
| | - Diana Lopez
- Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
- Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Kathryn Cote
- Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Jessica Newfield
- Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Molly Connors
- Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Anand Vaidya
- Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
- Harvard Medical School, Boston, Massachusetts 02115, USA
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22
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Dal J, Leisner MZ, Hermansen K, Farkas DK, Bengtsen M, Kistorp C, Nielsen EH, Andersen M, Feldt-Rasmussen U, Dekkers OM, Sørensen HT, Jørgensen JOL. Cancer Incidence in Patients With Acromegaly: A Cohort Study and Meta-Analysis of the Literature. J Clin Endocrinol Metab 2018; 103:2182-2188. [PMID: 29590449 DOI: 10.1210/jc.2017-02457] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
Abstract
CONTEXT Acromegaly has been associated with increased risk of cancer morbidity and mortality, but research findings remain conflicting and population-based data are scarce. We therefore examined whether patients with acromegaly are at higher risk of cancer. DESIGN A nationwide cohort study (1978 to 2010) including 529 acromegaly cases was performed. Incident cancer diagnoses and mortality were compared with national rates estimating standardized incidence ratios (SIRs). A meta-analysis of cancer SIRs from 23 studies (including the present one) was performed. RESULTS The cohort study identified 81 cases of cancer after exclusion of cases diagnosed within the first year [SIR 1.1; 95% confidence interval (CI), 0.9 to 1.4]. SIRs were 1.4 (95% CI, 0.7 to 2.6) for colorectal cancer, 1.1 (95% CI, 0.5 to 2.1) for breast cancer, and 1.4 (95% CI, 0.6 to 2.6) for prostate cancer. Whereas overall mortality was elevated in acromegaly (SIR 1.3; 95% CI, 1.1 to 1.6), cancer-specific mortality was not. The meta-analysis yielded an SIR of overall cancer of 1.5 (95% CI, 1.2 to 1.8). SIRs were elevated for colorectal cancer, 2.6 (95% CI, 1.7 to 4.0); thyroid cancer, 9.2 (95% CI, 4.2 to 19.9); breast cancer, 1.6 (1.1 to 2.3); gastric cancer, 2.0 (95% CI, 1.4 to 2.9); and urinary tract cancer, 1.5 (95% CI, 1.0 to 2.3). In general, cancer SIR was higher in single-center studies and in studies with <10 cancer cases. CONCLUSIONS Cancer incidence rates were slightly elevated in patients with acromegaly in our study, and this finding was supported by the meta-analysis of 23 studies, although it also suggested the presence of selection bias in some earlier studies.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michelle Z Leisner
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mads Bengtsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Caroline Kistorp
- Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiolgy and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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23
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Terzolo M, Reimondo G, Berchialla P, Ferrante E, Malchiodi E, De Marinis L, Pivonello R, Grottoli S, Losa M, Cannavo S, Ferone D, Montini M, Bondanelli M, De Menis E, Martini C, Puxeddu E, Velardo A, Peri A, Faustini-Fustini M, Tita P, Pigliaru F, Peraga G, Borretta G, Scaroni C, Bazzoni N, Bianchi A, Berton A, Serban AL, Baldelli R, Fatti LM, Colao A, Arosio M. Acromegaly is associated with increased cancer risk: a survey in Italy. Endocr Relat Cancer 2017; 24:495-504. [PMID: 28710115 DOI: 10.1530/erc-16-0553] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/13/2017] [Indexed: 12/15/2022]
Abstract
It is debated if acromegalic patients have an increased risk to develop malignancies. The aim of the present study was to assess the standardized incidence ratios (SIRs) of different types of cancer in acromegaly on a large series of acromegalic patients managed in the somatostatin analogs era. It was evaluated the incidence of cancer in an Italian nationwide multicenter cohort study of 1512 acromegalic patients, 624 men and 888 women, mean age at diagnosis 45 ± 13 years, followed up for a mean of 10 years (12573 person-years) in respect to the general Italian population. Cancer was diagnosed in 124 patients, 72 women and 52 men. The SIRs for all cancers was significantly increased compared to the general Italian population (expected: 88, SIR 1.41; 95% CI, 1.18-1.68, P < 0.001). In the whole series, we found a significantly increased incidence of colorectal cancer (SIR 1.67; 95% CI, 1.07-2.58, P = 0.022), kidney cancer (SIR 2.87; 95% CI, 1.55-5.34, P < 0.001) and thyroid cancer (SIR 3.99; 95% CI, 2.32-6.87, P < 0.001). The exclusion of 11 cancers occurring before diagnosis of acromegaly (all in women) did not change remarkably the study outcome. In multivariate analysis, the factors significantly associated with an increased risk of malignancy were age and family history of cancer, with a non-significant trend for the estimated duration of acromegaly before diagnosis. In conclusion, we found evidence that acromegaly in Italy is associated with a moderate increase in cancer risk.
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Affiliation(s)
- Massimo Terzolo
- Internal Medicine 1Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giuseppe Reimondo
- Internal Medicine 1Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paola Berchialla
- Statistical UnitDepartment of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Emanuele Ferrante
- Endocrinology and Diabetology UnitFondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Malchiodi
- Endocrinology and Diabetology UnitFondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura De Marinis
- Pituitary UnitDepartment of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | - Rosario Pivonello
- Division of EndocrinologyDepartment of Clinical Medicine and Surgery, University Federico II di Napoli, Naples, Italy
| | - Silvia Grottoli
- Division of EndocrinologyDiabetes and Metabolism, Department of Medical Science, University of Turin, ASOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Losa
- Pituitary UnitDepartment of Neurosurgery, San Raffaele Scientific Institute, University 'Vita- Salute', Milan, Italy
| | - Salvatore Cannavo
- Department of Clinical and Experimental Medicine-Endocrinology UnitUniversity of Messina, Messina, Italy
| | - Diego Ferone
- Endocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research (CEBR) IRCCS, AOU San Martino-IST, San Martino Hospital, University of Genova, Genova, Italy
| | | | - Marta Bondanelli
- Section of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ernesto De Menis
- Internal MedicineSan Valentino Hospital, Montebelluna, Treviso, Italy
| | - Chiara Martini
- Internal MedicineDepartment of Medicine, DIMED, University of Padova, Padova, Italy
| | - Efisio Puxeddu
- Department of MedicineSection of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy
| | - Antonino Velardo
- Department of Internal MedicineSection of Endocrinology and Metabolism, University of Modena, Modena, Italy
| | - Alessandro Peri
- Endocrine UnitDepartment of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | | | | | - Francesca Pigliaru
- Endocrinology and DiabetesDepartment of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Giulia Peraga
- Internal Medicine 1Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giorgio Borretta
- Division of Endocrinology and MetabolismSanta Croce and Carle Hospital, Cuneo, Italy
| | - Carla Scaroni
- Endocrinology UnitDepartment of Medicine, DIMED University of Padua, Padua, Italy
| | | | - Antonio Bianchi
- Pituitary UnitDepartment of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Berton
- Division of EndocrinologyDiabetes and Metabolism, Department of Medical Science, University of Turin, ASOU Città della Salute e della Scienza, Turin, Italy
| | - Andreea Liliana Serban
- Endocrinology and Diabetology UnitFondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Letizia Maria Fatti
- Division of Endocrine and Metabolic DiseasesSan Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Annamaria Colao
- Division of EndocrinologyDepartment of Clinical Medicine and Surgery, University Federico II di Napoli, Naples, Italy
| | - Maura Arosio
- Endocrinology and Diabetology UnitFondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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24
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Olsson DS, Hammarstrand C, Bryngelsson IL, Nilsson AG, Andersson E, Johannsson G, Ragnarsson O. Incidence of malignant tumours in patients with a non-functioning pituitary adenoma. Endocr Relat Cancer 2017; 24:227-235. [PMID: 28274953 DOI: 10.1530/erc-16-0518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/08/2017] [Indexed: 11/08/2022]
Abstract
Whether patients with non-functioning pituitary adenoma (NFPA) are at increased risk of developing malignant tumours has been sparsely studied and is a matter of debate. In this study, we have investigated the incidence of malignant tumours in a large and unselected group of patients with NFPA. The study was nationwide and included all patients diagnosed with NFPA between 1987 and 2011 (n = 2795) in Sweden, identified in the National Patient Register. Malignant tumours, occurring after the NFPA diagnosis, were identified in the Swedish Cancer Register between 1987 and 2014. Standardised incidence ratios (SIRs) for malignant tumours with 95% confidence intervals (CI) were calculated using the Swedish population as reference. In total, 448 malignant tumours were detected in 386 patients with NFPA, as compared to 368 expected malignancies in the general population (SIR 1.22 (95% CI 1.11-1.33)). The incidence of neoplasms of the brain was increased (SIR 5.83 (95% CI 4.03-8.14)). When analysing the total incidence of malignancies excluding neoplasms of the brain, the overall SIR was still increased (SIR 1.14 (95% CI 1.03-1.26)). The incidence of malignant neoplasm of skin other than malignant melanoma (SIR 1.99 (95% CI 1.55-2.52)) and malignant melanoma (SIR 1.62 (95% CI 1.04-2.38)) were increased, whereas the incidence of breast cancer (SIR 0.65 (95% CI 0.42-0.97)) was decreased. The incidence of other types of malignancies did not differ significantly from the expected incidence in the general population. In conclusion, patients with NFPA have an increased overall risk of developing malignancies. To what extent these findings are due to more frequent medical surveillance, genetic predisposition or endocrine changes, remains unknown.
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Affiliation(s)
- Daniel S Olsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Casper Hammarstrand
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental MedicineÖrebro University Hospital, Örebro, Sweden
| | - Anna G Nilsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Andersson
- Department of Occupational and Environmental MedicineInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of EndocrinologyInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Burman P, van Beek AP, Biller BMK, Camacho-Hübner C, Mattsson AF. Radiotherapy, Especially at Young Age, Increases the Risk for De Novo Brain Tumors in Patients Treated for Pituitary/Sellar Lesions. J Clin Endocrinol Metab 2017; 102:1051-1058. [PMID: 28359095 DOI: 10.1210/jc.2016-3402] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/09/2017] [Indexed: 12/31/2022]
Abstract
CONTEXT De novo brain tumors developing after treatment of pituitary/sellar lesions have been reported, but it is unknown whether this is linked to any of the treatment modalities. OBJECTIVE To study the occurrence of malignant brain tumors and meningiomas in a large cohort of patients treated for pituitary/sellar lesions, with special emphasis on the role of radiotherapy (RT). PATIENTS AND METHODS Patients (n = 8917) who were hypopituitary due to pituitary adenomas, craniopharyngiomas, and other sellar tumors followed in KIMS (Pfizer International Metabolic Database) from 1994 to 2012 were included. Treatment consisted of surgery and/or medical therapy in 4927 patients, RT alone, or with surgery in 3236 patients; data were missing in 754. Incidence rate ratios (RRs) were analyzed through Poisson regression methods with internal comparisons. RESULTS During 53,786 patient-years, 17 cases of malignant brain tumors (13 exposed to RT) and 27 meningiomas (22 exposed to RT) were reported. RR for RT vs no RT was 3.34 [95% confidence interval (CI), 1.06 to 10.6] for malignant brain tumors, and 4.06 (95% CI, 1.51 to 10.9) for meningiomas. The risk of developing a malignant brain tumor increased by 2.4-fold (P = 0.005) and meningioma by 1.6-fold with every 10 years of younger age at RT (P = 0.05). Incidence rates were similar in patients treated with conventional RT compared with stereotactic RT. CONCLUSION RT of pituitary tumors is associated with increased risk of developing malignant brain tumors and meningiomas, especially when given at younger ages. In balancing risks and benefits of RT, our findings emphasize that special consideration should be given to the age of the patient.
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Affiliation(s)
- Pia Burman
- Department of Endocrinology, Skånes University Hospital, University of Lund, 20502 Malmö, Sweden
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Beverly M K Biller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
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26
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Wolinski K, Stangierski A, Dyrda K, Nowicka K, Pelka M, Iqbal A, Car A, Lazizi M, Bednarek N, Czarnywojtek A, Gurgul E, Ruchala M. Risk of malignant neoplasms in acromegaly: a case-control study. J Endocrinol Invest 2017; 40:319-322. [PMID: 27770388 PMCID: PMC5331105 DOI: 10.1007/s40618-016-0565-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Acromegaly is a chronic disease resulting from pathological oversecretion of growth hormone and subsequently insulin growth factor-1. Several complications of the disease have been reported, including cardiovascular diseases, respiratory disorders but also increased risk of benign and malignant neoplasms. The aim of the study was to evaluate the risk of malignant neoplasms in the patients with acromegaly in comparison with the control group. PATIENTS AND METHODS Medical documentation of acromegalic patients treated in one medical center between 2005 and 2016 has been analyzed. Results were compared with sex- and age-matched group of subjects with prolactinomas and hormonally inactive pituitary lesions hospitalized in the same department. RESULTS Two hundred patients with acromegaly were included. Control group was composed of 145 patients. Any malignant neoplasm in anamnesis was present in 27 (13.5 %) patients with acromegaly and six (4.1 %) subjects from control group (p = 0.003). Thyroid cancer was present in 14 (7.0 %) patients with acromegaly and two (1.4 %) in control group (p = 0.02). Breast cancer was present in seven women (5.4 % of women) in acromegaly group but none of subjects in control group (p = 0.02). Colon cancer-4 (2.0 %) patients in acromegaly group and 0 in control group (p = 0.14). CONCLUSIONS Malignant neoplasms are significantly more common in patients with acromegaly. Particularly, risk of thyroid cancer was increased over fivefold. Systematic screening for neoplastic diseases should be important part of follow-up in these patients. Further case-control studies are strongly indicated to evaluate which neoplasms are more common in acromegalic patients and what is the exact risk of malignancy.
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Affiliation(s)
- K Wolinski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland.
| | - A Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - K Dyrda
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - K Nowicka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Pelka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - A Iqbal
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - A Car
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Lazizi
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - N Bednarek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - A Czarnywojtek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
- Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
| | - E Gurgul
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
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27
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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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Abstract
Growth hormone (GH) replacement in GH deficient (GHD) children secures normal linear growth, while in GHD adults it improves metabolic status, body composition and quality of life. Safety of GH treatment is an important issue in particular concerning the controversy of potential cancer risk. Unlike in congenital IGF-1 deficiency, there is no complete protection against cancer in GHD patients. Important modifiable risk factors in GHD patients are obesity, insulin resistance, sedentary behavior, circadian rhythm disruption, chronic low grade inflammation and concomitant sex hormone replacement. Age, family history, hereditary cancer predisposition syndromes or cranial irradiation may present non-modifiable risk factors. Quantifying the risk of cancer in relation to GH therapy in adult GHD patients is complex. There is evidence that links GH to cancer occurrence or promotion, but the evidence is progressively weaker when moving from in vitro studies to in vivo animal studies to epidemiological studies and finally to studies on GH treated patients. GH-IGF inhibition in experimental animals leads to decreased cancer incidence and progression. Epidemiological studies suggest an association of high normal circulating IGF-1 or GH to cancer incidence in general population. Data regarding cancer incidence in acromegaly are inconsistent but thyroid and colorectal neoplasias are the main source of concern. Replacement therapy with rhGH for GHD is generally safe. Overall the rate of de novo cancers was not increased in studies of GH-treated GHD patients. Additional caution is mandated in patients with history of cancer, strong family history of cancer and with advancing age. Childhood cancer survivors may be at increased risk for secondary neoplasms compared with general population. In this subgroup GH therapy should be used cautiously and with respect to other risk factors (cranial irradiation etc). We believe that the benefits of GH therapy against the morbidity of untreated GH deficiency outweigh the theoretical cancer risk. Proper monitoring of GH treatment with diligent cancer surveillance remains essential.
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Affiliation(s)
- Sandra Pekic
- University of Belgrade, School of Medicine, Dr Subotica 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Marko Stojanovic
- University of Belgrade, School of Medicine, Dr Subotica 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Vera Popovic
- University of Belgrade, School of Medicine, Dr Subotica 8, 11000 Belgrade, Serbia.
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Boguszewski CL, Ayuk J. MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and cancer: an old debate revisited. Eur J Endocrinol 2016; 175:R147-56. [PMID: 27089890 DOI: 10.1530/eje-16-0178] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/11/2016] [Indexed: 12/18/2022]
Abstract
Based on experimental and animal models, epidemiological data from non-acromegaly populations, and longitudinal and cross-sectional cohorts of patients with acromegaly, a potential association between acromegaly and cancer has long been hypothesized, in particular colorectal cancer, and, to a lesser extent, breast, thyroid and prostate cancers. The exact mechanisms underlying this potential association have not been fully elucidated. Results from studies examining cancer incidence and mortality in acromegaly have been inconsistent, with some demonstrating increased risk, whereas others show no increase. This article reviews the existing data relating to cancer risk and mortality in acromegaly, exploring the limitations of study designs and the impact of changes in disease control and patient outcomes over time.
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Affiliation(s)
- Cesar Luiz Boguszewski
- Department of Internal MedicineEndocrine Division (SEMPR), Federal University of Paraná, Curitiba, Brazil
| | - John Ayuk
- Consultant Endocrinologist/Honorary Senior LecturerDepartment of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Tarabay A, Cossu G, Berhouma M, Levivier M, Daniel RT, Messerer M. Primary pituitary lymphoma: an update of the literature. J Neurooncol 2016; 130:383-395. [PMID: 27581598 DOI: 10.1007/s11060-016-2249-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/20/2016] [Indexed: 11/27/2022]
Abstract
Primary intracranial lymphomas (Weller et al. in Neuro Oncol 14(12):1481-1484, 2012) are an emerging disease and an isolated localization in the pituitary gland i.e. primary pituitary lymphoma (PPL) represents a rare condition. We present an update of the most recent evidence for PPL through a systematic review of the literature. A systematic literature review was conducted using PubMed database up to October 2015. The population was defined as immunocompetent patients with a pathologically confirmed diagnosis of PPL. Patients' characteristics, clinical presentation, radiological features, pathology reports, adjuvant treatment and follow-up data were analyzed. We reported one case of PPL and included our data in this analysis. A total of 33 cases of PPL were identified, including ours. A slight not significant female prevalence was evident, with a mean age of 59 years at diagnosis. Visual troubles and headaches were the most common presenting symptoms. About 80 % of patients presented a cranial nerve (CN) deficit. The most frequently involved were the II and III CN. Anterior hypopituitarism was present in 70 % of cases and a diabetes insipidus in 36 % of cases. PPL was rarely limited to the sella and most often extended to the suprasellar and parasellar space. 70 % of cases underwent resection, 21 % a biopsy. A B-cell lymphoma was isolated in 82 % of cases, a T-cell lymphoma in 15 % and a NK/T cell lymphoma in one case. Overall mean survival rate was 14.4 months (95 % confidence interval 9.0-19.8 months) and there was no difference in terms of survival rates when patients were stratified according to the treatment they received. PPL is an emerging clinical entity. Literature data are too scarce to allow the definition of specific protocols of treatment and the management is based on the guidelines present for PCNSL. The role of surgery aiming at a complete resection of PPL should be reevaluated in wider studies including only this category of patients, to establish the real role of each therapeutic strategy.
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Affiliation(s)
- A Tarabay
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - G Cossu
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - M Berhouma
- Skull Base Surgery Unit, Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Levivier
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland
| | - M Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland.
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Ritvonen E, Löyttyniemi E, Jaatinen P, Ebeling T, Moilanen L, Nuutila P, Kauppinen-Mäkelin R, Schalin-Jäntti C. Mortality in acromegaly: a 20-year follow-up study. Endocr Relat Cancer 2016; 23:469-80. [PMID: 27185871 DOI: 10.1530/erc-16-0106] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort. PATIENTS AND METHODS We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly (n=333) compared with age- and gender-matched controls (n=4995). RESULTS During 20 (0-33) years follow-up, 113 (34%) patients (n=333, 52% women) and 1334 (27%) controls (n=4995) died (P=0.004). SMR (1.9, 95% CI: 1.53-2.34, P<0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2-2.2, P<0.001) were increased in acromegaly. Overall distribution of causes of death (P<0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma (n=5), breast (n=4), lung (n=3) and colon (n=3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P<0.001) and death (67 vs 76 years, P=0.0015). Compared with controls, women (36% vs 25%, P<0.01), but not men (31% vs 28%, P=0.44), had increased mortality. CONCLUSIONS In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.
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Affiliation(s)
- Elina Ritvonen
- Division of EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Pia Jaatinen
- School of MedicineUniversity of Tampere, Tampere, Finland Department of Internal MedicineTampere University Hospital, Tampere, Finland Department of Internal MedicineSeinäjoki Central Hospital, Seinäjoki, Finland
| | - Tapani Ebeling
- University of OuluOulu, Finland Oulu University HospitalOulu, Finland
| | - Leena Moilanen
- University of Eastern FinlandKuopio, Finland Kuopio University HospitalKuopio, Finland
| | - Pirjo Nuutila
- Turku PET centreUniversity of Turku, Turku, Finland Department of EndocrinologyTurku University Hospital, Turku, Finland
| | - Ritva Kauppinen-Mäkelin
- Center of Internal Medicine and RehabilitationJorvi Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Division of EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Lois K, Bukowczan J, Perros P, Jones S, Gunn M, James RA. The role of colonoscopic screening in acromegaly revisited: review of current literature and practice guidelines. Pituitary 2015; 18:568-74. [PMID: 25052731 DOI: 10.1007/s11102-014-0586-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Acromegaly is a chronic, debilitating and disfiguring condition with a significantly increased morbidity and mortality due to cardiovascular, as well as respiratory complications. Patients with acromegaly are usually diagnosed at the age of 40, however, the duration of symptoms can vary from 5 to 10 years before the formal diagnosis is confirmed. Recent advances in the field of acromegaly have improved survival significantly. A strong association between acromegaly and premalignant colonic lesions and colon cancer has been highlighted. Furthermore, patients with acromegaly have a greater lifetime risk of malignant transformation and a far worse overall prognosis from colorectal cancer, which is now considered a major disease related complication. MATERIALS AND METHODS A comprehensive search strategy was applied for the Medline/PubMed electronic database from its inception until April 2014. We considered all human research articles published in English, not classified as case report, editorial, comment, letter, or news. CONCLUSION Specific recommendations for large bowel endoscopic screening in patients with acromegaly have been proposed. In this comprehensive review we discuss the current state of knowledge and evidence on colonoscopic screening in patients with acromegaly illustrated by a case of aggressive colorectal cancer presenting late in a young woman with difficult to control acromegaly.
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Affiliation(s)
- K Lois
- Regional Pituitary Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
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Child CJ, Conroy D, Zimmermann AG, Woodmansee WW, Erfurth EM, Robison LL. Incidence of primary cancers and intracranial tumour recurrences in GH-treated and untreated adult hypopituitary patients: analyses from the Hypopituitary Control and Complications Study. Eur J Endocrinol 2015; 172:779-90. [PMID: 25810462 DOI: 10.1530/eje-14-1123] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/25/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Speculation remains that GH treatment is associated with increased neoplasia risk. Studies in GH-treated childhood cancer survivors suggested higher rates of second neoplasms, while cancer risk data for GH-treated and untreated hypopituitary adults have been variable. We present primary cancer risk data from the Hypopituitary Control and Complications Study (HypoCCS) with a focus on specific cancers, and assessment of recurrence rates for pituitary adenomas (PA) and craniopharyngiomas (CP). DESIGN Incident neoplasms during HypoCCS were evaluated in 8418 GH-treated vs 1268 untreated patients for primary malignancies, 3668 GH-treated vs 720 untreated patients with PA history, and 956 GH-treated vs 102 untreated patients with CP history. METHODS Using population cancer rates, standardised incidence ratios (SIRs) were calculated for all primary cancers, breast, prostate, and colorectal cancers. Neoplasm rates in GH-treated vs untreated patients were analysed after propensity score adjustment of baseline treatment group imbalances. RESULTS During mean follow-up of 4.8 years, 225 primary cancers were identified in GH-treated patients, with SIR of 0.82 (95% CI 0.71-0.93). SIRs (95% CI) for GH-treated patients were 0.59 (0.36-0.90) for breast, 0.80 (0.57-1.10) for prostate, and 0.62 (0.38-0.96) for colorectal cancers. Cancer risk was not statistically different between GH-treated and untreated patients (relative risk (RR)=1.00 (95% CI 0.70-1.41), P=0.98). Adjusted RR for recurrence was 0.91 (0.68-1.22), P=0.53 for PA and 1.32 (0.53-3.31), P=0.55 for CP. CONCLUSIONS There was no increased risk for all-site cancers: breast, prostate or colorectal primary cancers in GH-treated patients during HypoCCS. GH treatment did not increase the risk of PA and CP recurrences.
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Affiliation(s)
- Christopher J Child
- Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey GU20 6PH, UKinVentiv Health ClinicalBurlington, Massachusetts 01803 USALilly Research LaboratoriesIndianapolis, Indiana 46285, USADivision of EndocrinologyDiabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USADepartment of EndocrinologySkånes University Hospital, Lund 221 85, SwedenDepartment of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
| | - Daniel Conroy
- Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey GU20 6PH, UKinVentiv Health ClinicalBurlington, Massachusetts 01803 USALilly Research LaboratoriesIndianapolis, Indiana 46285, USADivision of EndocrinologyDiabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USADepartment of EndocrinologySkånes University Hospital, Lund 221 85, SwedenDepartment of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
| | - Alan G Zimmermann
- Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey GU20 6PH, UKinVentiv Health ClinicalBurlington, Massachusetts 01803 USALilly Research LaboratoriesIndianapolis, Indiana 46285, USADivision of EndocrinologyDiabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USADepartment of EndocrinologySkånes University Hospital, Lund 221 85, SwedenDepartment of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
| | - Whitney W Woodmansee
- Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey GU20 6PH, UKinVentiv Health ClinicalBurlington, Massachusetts 01803 USALilly Research LaboratoriesIndianapolis, Indiana 46285, USADivision of EndocrinologyDiabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USADepartment of EndocrinologySkånes University Hospital, Lund 221 85, SwedenDepartment of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
| | - Eva Marie Erfurth
- Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey GU20 6PH, UKinVentiv Health ClinicalBurlington, Massachusetts 01803 USALilly Research LaboratoriesIndianapolis, Indiana 46285, USADivision of EndocrinologyDiabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USADepartment of EndocrinologySkånes University Hospital, Lund 221 85, SwedenDepartment of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
| | - Leslie L Robison
- Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey GU20 6PH, UKinVentiv Health ClinicalBurlington, Massachusetts 01803 USALilly Research LaboratoriesIndianapolis, Indiana 46285, USADivision of EndocrinologyDiabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USADepartment of EndocrinologySkånes University Hospital, Lund 221 85, SwedenDepartment of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
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Unal OK, Cinkilic N, Gul OO, Cander S, Vatan O, Ersoy C, Yilmaz D, Tuncel E. Investigation of genotoxicity in acromegaly from peripheral blood lymphocyte cultures using a micronucleus assay. J Clin Endocrinol Metab 2014; 99:E2060-6. [PMID: 24963647 DOI: 10.1210/jc.2014-1641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although patients with acromegaly may have an increased risk of developing several types of cancers, the degree of risk for malignancy in these patients is unresolved. OBJECTIVE The present study aimed to investigate the potential genotoxic effects of acromegaly on the cell cycle in peripheral blood lymphocyte cultures. DESIGN This was a single center, crossover, case-control study conducted on the acromegalic patients in Turkey. SETTING The study was conducted in the outpatient clinic of a university hospital. PATIENTS Seventy-one consecutively screened acromegalic patients and 56 controls participated in the study. INTERVENTION Patients were included, regardless of the disease activity status and their treatment duration before the study. MAIN OUTCOME MEASURES The primary end point was the frequency of micronucleus (MN) in the peripheral blood lymphocyte cultures, and the secondary end point was its clinical correlations. RESULTS The MN level was 3.82 ± 1.49 in the control group and 18.00 ± 6.13 in the acromegalic group (P < .01), whereas the nuclear division index (NDI) was 1.79 ± 0.12 in the control group and 1.68 ± 0.07 in the acromegalic group (P < .01). Neither MN nor NDI was correlated with age, GH, IGF-I, initial GH, initial IGF-I, duration of the remission period, and initial tumor size. Only the MN level was positively correlated with the duration of disease (r = 0.323, P = .014). CONCLUSION Our results indicated that acromegalic patients had genotoxic damage at a substantial level, and there was a positive correlation between the duration of disease and genotoxicity level.
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Affiliation(s)
- Oguz Kaan Unal
- Department of Endocrinology and Metabolism (O.K.U., O.O.G., S.C., C.E., E.T.), Uludag University Medical School, and Department of Biology (N.C., O.V., D.Y.), Uludag University Science and Arts Faculty, 16059 Bursa, Turkey; Department of Endocrinology and Metabolism (O.K.U.), Acibadem University Medical School, 16110 Bursa, Turkey; State Hospital (O.O.G.), 16090 Bursa, Turkey; and Sevket Yilmaz Research Hospital (S.C.), 16310 Bursa, Turkey
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Reverter JL, Fajardo C, Resmini E, Salinas I, Mora M, Llatjós M, Sesmilo G, Rius F, Halperin I, Webb SM, Ricart V, Riesgo P, Mauricio D, Puig-Domingo M. Benign and malignant nodular thyroid disease in acromegaly. Is a routine thyroid ultrasound evaluation advisable? PLoS One 2014; 9:e104174. [PMID: 25127456 PMCID: PMC4134205 DOI: 10.1371/journal.pone.0104174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/08/2014] [Indexed: 11/18/2022] Open
Abstract
Data on the prevalence of benign and malignant nodular thyroid disease in patients with acromegaly is a matter of debate. In the last decade an increasing incidence of thyroid cancer has been reported. The aim of this study was to evaluate the prevalence of goiter, thyroid nodules and thyroid cancer in a large series of patients with acromegaly with a cross-sectional study with a control group. Six Spanish university hospitals participated. One hundred and twenty three patients (50% men; mean age 59±13 years; disease duration 6.7±7.2 years) and 50 controls (51% males, mean age 58±15 years) were studied. All participants underwent thyroid ultrasound and fine needle aspiration. Cytological analysis was performed in suspicious nodules between 0.5 and 1.0 cm and in all nodules greater than 1.0 cm. Goiter was more frequently found in patients than in controls (24.9 vs. 8.3%, respectively; p<0.001). Nodular thyroid disease as well as nodules greater than 1 cm were also more prevalent in acromegalic patients (64.6%, vs. 28.6%, p<0.05 and 53.3 vs. 28.6%, respectively; p<0.05), and all underwent fine needle aspiration. Suspicious cytology was detected in 4 patients and in none of the controls. After thyroidectomy, papillary thyroid carcinoma was confirmed in two cases (3.3% of patients with thyroid nodules), representing 1.6% of the entire group of patients with acromegaly (2.4% including a case with previously diagnosed papillary thyroid carcinoma). These data indicated that thyroid nodular disease and cancer are increased in acromegaly, thus justifying its routine ultrasound screening.
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Affiliation(s)
- Jordi L. Reverter
- Service of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carmen Fajardo
- Service of Endocrinology, Hospital Universitario de la Ribera, Alzira, Spain
| | - Eugenia Resmini
- IIB- Sant Pau and Service of Endocrinology, Department of Medicine, Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Salinas
- Service of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Mireia Mora
- Service of Endocrinology, Hospital Clínic, Barcelona, Spain
| | - Mariona Llatjós
- Service of Pathology, Department of Medicine, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Gemma Sesmilo
- Service of Endocrinology, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - Ferran Rius
- Service of Endocrinology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Irene Halperin
- Service of Endocrinology, Hospital Clínic, Barcelona, Spain
| | - Susan M. Webb
- IIB- Sant Pau and Service of Endocrinology, Department of Medicine, Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Veronica Ricart
- Service of Radiology, Hospital Universitario de la Ribera, Alzira, Spain
| | - Pedro Riesgo
- Service of Neurosurgery, Hospital Universitario de la Ribera, Alzira, Spain
| | - Dídac Mauricio
- Service of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Manel Puig-Domingo
- Service of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
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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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Mian C, Ceccato F, Barollo S, Watutantrige-Fernando S, Albiger N, Regazzo D, de Lazzari P, Pennelli G, Rotondi S, Nacamulli D, Pelizzo MR, Jaffrain-Rea ML, Grimaldi F, Occhi G, Scaroni C. AHR over-expression in papillary thyroid carcinoma: clinical and molecular assessments in a series of Italian acromegalic patients with a long-term follow-up. PLoS One 2014; 9:e101560. [PMID: 25019383 PMCID: PMC4096503 DOI: 10.1371/journal.pone.0101560] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/07/2014] [Indexed: 02/03/2023] Open
Abstract
AIM Acromegaly reportedly carries an increased risk of malignant and benign thyroid tumors, with a prevalence of thyroid cancer of around 3-7%. Germline mutations in the aryl-hydrocarbon receptor (AHR) interacting protein (AIP) have been identified in familial forms of acromegaly. The molecular and endocrine relationships between follicular thyroid growth and GH-secreting pituitary adenoma have yet to be fully established. Our aim was to study the prevalence of differentiated thyroid cancer (DTC) in acromegaly, focusing on the role of genetic events responsible for the onset of thyroid cancer. METHODS Germline mutations in the AIP gene were assessed in all patients; BRAF and H-N-K RAS status was analyzed by direct sequencing in thyroid specimens, while immunohistochemistry was used to analyze the protein expression of AIP and AHR. A set of PTCs unrelated to acromegaly was also studied. RESULTS 12 DTCs (10 papillary and 2 follicular carcinomas) were identified in a cohort of 113 acromegalic patients. No differences in GH/IGF-1 levels or disease activity emerged between patients with and without DTC, but the former were older and more often female. BRAF V600E was found in 70% of the papillary thyroid cancers; there were no RAS mutations. AIP protein expression was similar in neoplastic and normal cells, while AHR protein was expressed more in PTCs carrying BRAF mutations than in normal tissue, irrespective of acromegaly status. CONCLUSIONS The prevalence of DTC in acromegaly is around 11% and endocrinologists should bear this in mind, especially when examining elderly female patients with uninodular goiter. The DTC risk does not seem to correlate with GH/IGF-1 levels, while it may be associated with BRAF mutations and AHR over-expression. Genetic or epigenetic events probably play a part in promoting thyroid carcinoma.
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Affiliation(s)
- Caterina Mian
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | | | - Nora Albiger
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Daniela Regazzo
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Paola de Lazzari
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Gianmaria Pennelli
- II Pathology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Sandra Rotondi
- Department of Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Davide Nacamulli
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Maria Rosa Pelizzo
- Surgical Pathology Unit, Department of Surgery, University-Hospital of Padua, Padua, Italy
| | - Marie-Lise Jaffrain-Rea
- Department of Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
- Neuromed Institute, Department of Neurological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University-Hospital “Santa Maria della Misericordia,” Udine, Italy
| | - Gianluca Occhi
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine, University-Hospital of Padua, Padua, Italy
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van Bunderen CC, van Varsseveld NC, Erfurth EM, Ket JCF, Drent ML. Efficacy and safety of growth hormone treatment in adults with growth hormone deficiency: a systematic review of studies on morbidity. Clin Endocrinol (Oxf) 2014; 81:1-14. [PMID: 24750271 DOI: 10.1111/cen.12477] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/19/2014] [Accepted: 04/15/2014] [Indexed: 11/27/2022]
Abstract
Due to the positive effects demonstrated in randomized clinical trials on cardiovascular surrogate markers and bone metabolism, a positive effect of growth hormone (GH) treatment on clinically relevant end-points seems feasible. In this review, we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency (GHD) with emphasis on morbidity: fatal and nonfatal cardiovascular disease (CVD) and stroke, fractures, fatal and nonfatal malignancies and recurrences, and diabetes mellitus. A positive effect of GH treatment on CVD and fracture risk could be concluded, but study design limitations have to be considered. Stroke and secondary brain tumours remained more prevalent. However, other contributing factors have to be taken into account. Regrowth and recurrences of (peri)pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment. All fatal and nonfatal malignancies were not more prevalent in GH-treated adults compared to the general population. However, follow-up time is still relatively short. The studies on diabetes are difficult to interpret, and more evidence is awaited. In clinical practice, a more individualized assessment seems appropriate, taking into consideration the underlying diagnosis of GHD, other treatment regimens, metabolic profile and the additional beneficial effects of GH set against the possible risks. Large and thoroughly conducted observational studies are needed and seem the only feasible way to inform the ongoing debate on health care costs, drug safety and clinical outcomes.
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Affiliation(s)
- Christa C van Bunderen
- Section of Endocrinology, Department of Internal Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Gittleman H, Ostrom QT, Farah PD, Ondracek A, Chen Y, Wolinsky Y, Kruchko C, Singer J, Kshettry VR, Laws ER, Sloan AE, Selman WR, Barnholtz-Sloan JS. Descriptive epidemiology of pituitary tumors in the United States, 2004-2009. J Neurosurg 2014; 121:527-35. [PMID: 24926650 DOI: 10.3171/2014.5.jns131819] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECT Pituitary tumors are abnormal growths that develop in the pituitary gland. The Central Brain Tumor Registry of the United States (CBTRUS) contains the largest aggregation of population-based data on the incidence of primary CNS tumors in the US. These data were used to determine the incidence of tumors of the pituitary and associated trends between 2004 and 2009. METHODS Using incidence data from 49 population-based state cancer registries, 2004-2009, age-adjusted incidence rates per 100,000 population for pituitary tumors with ICD-O-3 (International Classification of Diseases for Oncology, Third Edition) histology codes 8040, 8140, 8146, 8246, 8260, 8270, 8271, 8272, 8280, 8281, 8290, 8300, 8310, 8323, 9492 (site C75.1 only), and 9582 were calculated overall and by patient sex, race, Hispanic ethnicity, and age at diagnosis. Corresponding annual percent change (APC) scores and 95% confidence intervals were also calculated using Joinpoint to characterize trends in incidence rates over time. Diagnostic confirmation by subregion of the US was also examined. The overall annual incidence rate increased from 2.52 (95% CI 2.46-2.58) in 2004 to 3.13 (95% CI 3.07-3.20) in 2009. Associated time trend yielded an APC of 4.25% (95% CI 2.91%-5.61%). When stratifying by patient sex, the annual incidence rate increased from 2.42 (95% CI 2.33-2.50) to 2.94 (95% CI 2.85-3.03) in men and 2.70 (95% CI 2.62-2.79) to 3.40 (95% CI 3.31-3.49) in women, with APCs of 4.35% (95% CI 3.21%-5.51%) and 4.34% (95% CI 2.23%-6.49%), respectively. When stratifying by race, the annual incidence rate increased from 2.31 (95% CI 2.25-2.37) to 2.81 (95% CI 2.74-2.88) in whites, 3.99 (95% CI 3.77-4.23) to 5.31 (95% CI 5.06-5.56) in blacks, 1.77 (95% CI 1.26-2.42) to 2.52 (95% CI 1.96-3.19) in American Indians or Alaska Natives, and 1.86 (95% CI 1.62-2.13) to 2.03 (95% CI 1.80-2.28) in Asians or Pacific Islanders, with APCs of 3.91% (95% CI 2.88%-4.95%), 5.25% (95% CI 3.19%-7.36%), 5.31% (95% CI -0.11% to 11.03%), and 2.40% (95% CI -3.20% to 8.31%), respectively. When stratifying by Hispanic ethnicity, the annual incidence rate increased from 2.46 (95% CI 2.40-2.52) to 3.03 (95% CI 2.97-3.10) in non-Hispanics and 3.12 (95% CI 2.91-3.34) to 4.01 (95% CI 3.80-4.24) in Hispanics, with APCs of 4.15% (95% CI 2.67%-5.65%) and 5.01% (95% CI 4.42%-5.60%), respectively. When stratifying by age at diagnosis, the incidence of pituitary tumor was highest for those 65-74 years old and lowest for those 15-24 years old, with corresponding overall age-adjusted incidence rates of 6.39 (95% CI 6.24-6.54) and 1.56 (95% CI 1.51-1.61), respectively. CONCLUSIONS In this large patient cohort, the incidence of pituitary tumors reported between 2004 and 2009 was found to increase. Possible explanations for this increase include changes in documentation, changes in the diagnosis and registration of these tumors, improved diagnostics, improved data collection, increased awareness of pituitary diseases among physicians and the public, longer life expectancies, and/or an actual increase in the incidence of these tumors in the US population.
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Affiliation(s)
- Haley Gittleman
- Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center
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Wolinski K, Czarnywojtek A, Ruchala M. Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly--meta-analysis and systematic review. PLoS One 2014; 9:e88787. [PMID: 24551163 PMCID: PMC3925168 DOI: 10.1371/journal.pone.0088787] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/11/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Acromegaly is a quite rare chronic disease caused by the increased secretion of growth hormone (GH) and subsequently insulin - like growth factor 1. Although cardiovascular diseases remains the most common cause of mortality among acromegalic patients, increased prevalence of malignant and benign neoplasms remains a matter of debate. The aim of this study is to evaluate the risk of thyroid nodular disease (TND) and thyroid cancer in patients with acromegaly. Materials and Methods PubMed, Cochrane Library, Scopus, Cinahl, Academic Search Complete, Web of Knowledge, PubMed Central, PubMed Central Canada and Clinical Key databases were searched to identify studies containing. Random–effects model was used to calculate pooled odds ratios and risk ratios of TND in acromegaly. Studies which not included control groups were systematically reviewed. Results TND was more frequent in acromegaly than in control groups (OR = 6.9, RR = 2.1). The pooled prevalence of TND was 59.2%. Also thyroid cancer (TC) proved to be more common in acromegalic patients (OR = 7.5, RR = 7.2), prevalence was 4.3%. The pooled rate of malignancy (calculated per patient) was equal to 8.7%. Conclusions This study confirms that both TND and TC occur significantly more often in acromegalic patients than in general population. These results indicate that periodic thyroid ultrasound examination and careful evaluation of eventual lesions should be an important part of follow-up of patients with acromegaly.
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Affiliation(s)
- Kosma Wolinski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Agata Czarnywojtek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
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Dogan S, Atmaca A, Dagdelen S, Erbas B, Erbas T. Evaluation of thyroid diseases and differentiated thyroid cancer in acromegalic patients. Endocrine 2014; 45:114-21. [PMID: 23670709 DOI: 10.1007/s12020-013-9981-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/06/2013] [Indexed: 12/30/2022]
Abstract
Thyroid diseases are frequently seen in patients with acromegaly. The aim of this study is to evaluate thyroid diseases and thyroid cancer in acromegalic patients followed in a single institution. The data of 92 acromegalic (43 male, 49 female) patients followed over 12 years were retrieved retrospectively from the hospital recordings. All available data for gender, age, body weight and height, duration of acromegaly, age at diagnosis of acromegaly, treatment methods for acromegaly and history of thyroid disease, serum GH, IGF-1, thyroid function tests, thyroid ultrasonography (US), thyroid scintigraphy and thyroid fine needle aspiration biopsy (FNAB) results were recorded for the patients. The mean age of the patients was 43.9 ± 10.8 years and the mean disease duration was 12 ± 6.9 years. Thyroid US was performed in 64 patients who had nodular or diffuse goiter on palpation during the post-treatment follow-up and nodules were found in 44 (47.8 %) patients. Final diagnosis in 64 patients with thyroid US results and thyroid function tests including 26 patients with FNAB were as follows: 31 (48.4 %) benign multinodular goiter (MNG), 6 (9.4 %) simple nodular goiter, 1 (1.6 %) toxic MNG, 1 (1.6 %) Hurthle cell adenoma, and 5 (7.8 %) differentiated thyroid cancer. In addition, 9 (14.1 %) patients had diffuse goiter. One of the patients with diffuse goiter had amiodarone induced thyrotoxicosis. Eleven (17.1 %) patients had normal thyroid US and no other thyroid disease. Patients with nodules had longer disease duration than patients without nodules (14.2 ± 6.6 vs. 9.4 ± 3.4 years, p = 0.043). Thyroid volume was positively correlated with post-treatment GH and post-treatment IGF-1 levels (r = 0.309, p = 0.041 and r = 0.423, p = 0.004), respectively. We found that 7.8 % of our acromegalic patients with thyroid US results were diagnosed with thyroid cancer. Therefore, acromegalic patients must be considered as a high risk group for the development of thyroid cancer and must be closely followed for thyroid nodules and tumors.
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Affiliation(s)
- Serkan Dogan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Bolfi F, Miot HA, Resende M, Mazeto GMSF, Romeiro FG, Yamashiro FDS, Nunes VDS. Frequency of various types of neoplasia in a group of acromegalic patients. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2013; 57:612-6. [PMID: 24343629 DOI: 10.1590/s0004-27302013000800005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 05/23/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the frequency of colon cancer, primary hyperparathyroidism, thyroid tumor, and skin cancer in all acromegalic patients in follow-up at the Clinics Hospital - Botucatu Medical School, from 2005 to 2011. SUBJECTS AND METHODS These patients were evaluated retrospectively for colon cancer, primary hyperparathyroidism, dermatological, and thyroid tumors. RESULTS Of 29 patients included at the beginning of the study, two were excluded. Among 19 patients submitted to colonoscopy, one presented colon adenocarcinoma (5%). Thyroid nodules were present in 63% of patients, and papilliferous carcinoma was confirmed in two patients (7,7%). Four patients were confirmed as having primary hyperparathyroidism (15%). The most common dermatologic lesions were thickened skin (100%), acrochordons (64%), epidermal cysts (50%), and pseudo-acanthosis nigricans (50%). Only one patient presented basal cell carcinoma. CONCLUSION Although a small number of acromegalic patients was studied, our findings confirm the high frequency of thyroid neoplasias and primary hyperparathyroidism in this group of patients.
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Uchoa HBDMP, Lima GAB, Corrêa LL, Vidal APS, Cavallieri SA, Vaisman M, Buescu A, Gadelha MR. Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center. ACTA ACUST UNITED AC 2013; 57:685-90. [DOI: 10.1590/s0004-27302013000900003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/29/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES: Acromegaly is frequently associated with thyroid diseases. In this study, we evaluated the frequency of thyroid disorders in a series of acromegalic patients. SUBJECTS AND METHODS: We evaluated 106 acromegalic patients using thyroid ultrasonography (US) and measurements of GH, IGF-I, free T4, TSH and anti-thyroperoxidase antibody levels. IGF-I was expressed in mass units and age-related standard deviation scores (SD-scores). Fine-needle aspiration biopsy (FNAB) was performed on thyroid nodules with a diameter greater than one centimeter or with suspicious characteristics. RESULTS: Thyroid disorders were found in 75 patients. Eleven patients had diffuse goiter, 42 patients had nodular goiter, and 22 patients had unspecific morphological abnormalities. Four patients (3.8%) had thyroid carcinoma. Considering the patients with diffuse or nodular goiter, thyroid volume was greater in patients with active acromegaly, and was positively correlated with GH, IGF-I, and IGF-I SD-score. CONCLUSIONS: Our study confirmed that benign thyroid diseases are frequent in acromegalic patients. The prevalence of thyroid cancer was higher than in the overall population. We suggest that thyroid US should be routinely performed in patients with acromegaly.
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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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45
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Acute myeloid leukemia and colon carcinoma during the course of acromegaly. Int J Hematol 2013; 98:620-4. [DOI: 10.1007/s12185-013-1431-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
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Burman P, Mattsson AF, Johannsson G, Höybye C, Holmer H, Dahlqvist P, Berinder K, Engström BE, Ekman B, Erfurth EM, Svensson J, Wahlberg J, Karlsson FA. Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality. J Clin Endocrinol Metab 2013; 98:1466-75. [PMID: 23457412 DOI: 10.1210/jc.2012-4059] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Patients with hypopituitarism have an increased standardized mortality rate. The basis for this has not been fully clarified. OBJECTIVE To investigate in detail the cause of death in a large cohort of patients with hypopituitarism subjected to long-term follow-up. DESIGN AND METHODS All-cause and cause-specific mortality in 1286 Swedish patients with hypopituitarism prospectively monitored in KIMS (Pfizer International Metabolic Database) 1995-2009 were compared to general population data in the Swedish National Cause of Death Registry. In addition, events reported in KIMS, medical records, and postmortem reports were reviewed. MAIN OUTCOME MEASURES Standardized mortality ratios (SMR) were calculated, with stratification for gender, attained age, and calendar year during follow-up. RESULTS An excess mortality was found, 120 deaths vs 84.3 expected, SMR 1.42 (95% confidence interval: 1.18-1.70). Infections, brain cancer, and sudden death were associated with significantly increased SMRs (6.32, 9.40, and 4.10, respectively). Fifteen patients, all ACTH-deficient, died from infections. Eight of these patients were considered to be in a state of adrenal crisis in connection with death (medical reports and post-mortem examinations). Another 8 patients died from de novo malignant brain tumors, 6 of which had had a benign pituitary lesion at baseline. Six of these 8 subjects had received prior radiation therapy. CONCLUSION Two important causes of excess mortality were identified: first, adrenal crisis in response to acute stress and intercurrent illness; second, increased risk of a late appearance of de novo malignant brain tumors in patients who previously received radiotherapy. Both of these causes may be in part preventable by changes in the management of pituitary disease.
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Affiliation(s)
- P Burman
- Department of Endocrinology, Skånes University Hospital Malmö, University of Lund, Malmö, Sweden.
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Svensson J, Carlzon D, Petzold M, Karlsson MK, Ljunggren Ö, Tivesten A, Mellström D, Ohlsson C. Both low and high serum IGF-I levels associate with cancer mortality in older men. J Clin Endocrinol Metab 2012; 97:4623-30. [PMID: 23015658 DOI: 10.1210/jc.2012-2329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although recent population-based studies suggest a U-shaped relationship between serum IGF-I concentration and all-cause mortality, the distribution of death causes underlying this association remains unclear. We hypothesized that high IGF-I levels associate with increased cancer mortality, whereas low IGF-I levels associate with increased cardiovascular disease (CVD) mortality. METHODS Serum IGF-I levels were measured in 2901 elderly men (mean age 75.4, range 69-81 yr) included in the prospective population-based Osteoporotic Fractures in Men Study (Sweden) study. Mortality data were obtained from central registers with no loss of follow-up. The statistical analyses included Cox proportional hazards regressions with or without a spline approach. RESULTS During the follow-up (mean 6.0 yr), 586 of the participants died (cancer deaths, n = 211; CVD deaths, n = 214). As expected, our data revealed a U-shaped association between serum IGF-I levels and all-cause mortality. Low as well as high serum IGF-I (quintile 1 or 5 vs. quintiles 2-4) associated with increased cancer mortality [hazard ratio (HR) = 1.86, 95% confidence interval (CI) = 1.34-2.58; and HR = 1.90, 95% CI = 1.37-2.65, respectively]. Only low serum IGF-I associated with increased CVD mortality (quintile 1 vs. quintiles 2-4, HR = 1.48, 95% CI = 1.08-2.04). These associations remained after adjustment for multiple covariates and exclusion of men who died during the first 2 yr of follow-up. CONCLUSIONS Our findings demonstrate that both low and high serum IGF-I levels are risk markers for increased cancer mortality in older men. Moreover, low IGF-I levels associate with increased CVD mortality.
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Affiliation(s)
- Johan Svensson
- Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden.
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Sattler MG, van Beek AP, Wolffenbuttel BH, van den Berg G, Sluiter WJ, Langendijk JA, van den Bergh AC. The incidence of second tumours and mortality in pituitary adenoma patients treated with postoperative radiotherapy versus surgery alone. Radiother Oncol 2012; 104:125-30. [DOI: 10.1016/j.radonc.2012.04.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 11/30/2022]
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Risk of neoplasms in acromegaly. Contemp Oncol (Pozn) 2012; 16:111-7. [PMID: 23788865 PMCID: PMC3687397 DOI: 10.5114/wo.2012.28790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/17/2012] [Accepted: 05/07/2012] [Indexed: 11/17/2022] Open
Abstract
Acromegaly is a chronic disease caused by the excessive secretion of growth hormone (GH), and as a result, of insulin-like growth factor-1 (IGF-1). Untreated, the condition reduces the patients' life expectancy and leads to a series of complications, among which an increased risk of carcinogenesis is considered most important. This paper is an analysis of the publications on the issue of the formation of neoplasms, both malignant and benign, in acromegalic patients. Although the influence of acromegaly on carcinogenesis remains controversial, a number of studies indicate that the frequency of developing tumors in this patient group is higher. Moreover, numerous publications particularly stress the increased risk of developing neoplasms in patients who had been untreated for a long period of time and show elevated levels of GH and IGF-1. Consequently, a quick diagnosis and the implementation of effective treatment play a key role in the management of this disease.
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Morita K, Nakamura F, Kamikubo Y, Mizuno N, Miyauchi M, Yamamoto G, Nannya Y, Ichikawa M, Kurokawa M. Pituitary lymphoma developing within pituitary adenoma. Int J Hematol 2012; 95:721-4. [DOI: 10.1007/s12185-012-1075-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 11/28/2022]
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