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Alnaaim SA, Al-Kuraishy HM, Zailaie MM, Alexiou A, Papadakis M, Saad HM, Batiha GES. The potential link between acromegaly and risk of acute ischemic stroke in patients with pituitary adenoma: a new perspective. Acta Neurol Belg 2024; 124:755-766. [PMID: 37584889 DOI: 10.1007/s13760-023-02354-3] [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: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
Acromegaly is an endocrine disorder due to the excess production of growth hormone (GH) from the anterior pituitary gland after closed epiphyseal growth plates. Acromegaly is mainly caused by benign GH-secreting pituitary adenoma. Acute ischemic stroke (AIS) is one of the most common cardiovascular complications. It ranks second after ischemic heart disease (IHD) as a cause of disability and death in high-income countries globally. Thus, this review aimed to elucidate the possible link between acromegaly and the development of AIS. The local effects of acromegaly in the development of AIS are related to the development of pituitary adenoma and associated surgical and radiotherapies. Pituitary adenoma triggers the development of AIS through different mechanisms, particularly aneurysmal formation, associated thrombosis, and alteration of cerebral microcirculation. Cardiovascular complications and mortality were higher in patients with pituitary adenoma. The systemic effect of acromegaly-induced cardio-metabolic disorders may increase the risk for the development of AIS. Additionally, acromegaly contributes to the development of endothelial dysfunction (ED), inflammatory and oxidative stress, and induction of thrombosis that increases the risk for the development of AIS. Moreover, activated signaling pathways, including activator of transcription 3 (STAT3), nuclear factor kappa B (NF-κB), nod-like receptor pyrin 3 (NLRP3) inflammasome, and mitogen-activated protein kinase (MAPK) in acromegaly may induce systemic inflammation with the development of cardiovascular complications mainly AIS. Taken together, acromegaly triggers the development of AIS through local and systemic effects by inducing the formation of a cerebral vessel aneurysm, the release of pro-inflammatory cytokines, the development of oxidative stress, ED, and thrombosis correspondingly.
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Affiliation(s)
- Saud A Alnaaim
- Clinical Neurosciences Department, College of Medicine, King Faisal University, Hofuf, Saudi Arabia
| | - Hayder M Al-Kuraishy
- Department of Pharmacology, Toxicology and Medicine, Medical Faculty, College of Medicine, Al-Mustansiriyah University, PO Box 14132, Baghdad, Iraq
| | | | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, NSW, 2770, Australia
- AFNP Med, 1030, Vienna, Austria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany.
| | - Hebatallah M Saad
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh, 51744, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, Egypt
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Li S, Liu YJ. Application of quantitative orbital analysis to assess the activity of Graves' ophthalmopathy. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2023; 13:259-268. [PMID: 38204608 PMCID: PMC10774606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 01/12/2024]
Abstract
This study aimed to evaluate the diagnostic value of uptake ratios in the extraocular muscles (EOMs), lacrimal glands, and optic nerves to detect the inflammation activity of Graves' ophthalmopathy (GO) using quantitative analysis of 99m technetium (99mTc)-labeled diethylene triamine pentaacetic acid (DTPA) orbital single-photon emission computed tomography/computed tomography (SPECT/CT) images. The patients were categorized into an active stage (clinical activity score ≥ 3/7, n=23) or an inactive stage (clinical activity score < 3/7, n=38), based on their clinical activity score. The uptake ratio was manually determined by placing a region of interest within the area of highest uptake, as agreed upon by consensus, in the EOMs, lacrimal gland, and optic nerve on SPECT images corrected for CT attenuation. Patients with active GO exhibited significantly higher uptake ratios in the EOMs, lacrimal glands, and optic nerves compared to patients with inactive GO (all P < 0.01). These parameters have been proven effective in differentiating between active and inactive disease.
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Affiliation(s)
- Shuang Li
- Department of Nuclear Medicine, Xiangyang No. 1 People’s Hospital, Hubei University of MedicineXiangyang 441000, Hubei, China
| | - Yue-Jun Liu
- Department of Ophthalmology, Xiangyang No. 1 People’s Hospital, Hubei University of MedicineXiangyang 441000, Hubei, China
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