Heart failure as a manifestation of acromegaly

Czech version

Authors: Ivana Ságová ¹; Milan Dragula ²; Daniela Kantárová ²; Anton Vaňuga ^1,3; Peter Vaňuga ¹
Authors‘ workplace: Endokrinologické oddelenie, Národný endokrinologický a diabetologický ústav Ľubochňa, Slovenská republika ¹; II. interná klinika JLF UK a UN Martin, Slovenská republika ²; Alphamedical, s. r. o., Slovenská republika ³
Published in: Vnitř Lék 2020; 66(4): 82-86
Category: Case Report

Overview

Acromegaly is a rare disease with incidence of 3–4 patients per 1 000000 per year, which is mainly caused by benign tumour of the pituitary gland. Long-term presence of elevated growth hormone (GH) and insulin like growth factor 1 (IGF-1) levels accompanying this disease is associated with rheumatologic, cardiovascular, pulmonary and metabolic complications. Cardiovascular complications of acromegaly include a cardiomyopathy, arterial hypertension, arrhytmias, valvulopathy as well as endothelial dysfunction. Cardiovascular diseases are the leading cause of mortality in patients with acromegaly. An early diagnosis of acromegaly significantly influences both morbidity and mortality of patients suffering from this disease. We describe a 39-year-old patient with undiagnosed acromegaly presented with acute heart failure caused by acromegalic cardiomyopathy.

Keywords:

cardiomyopathy – acromegaly – v growth hormone – heart failure

Sources

1. Capatina C, Wass JH 60 Years Of Neuroendocrinology: Acromegaly. J Endocrinol 2015; 226: 141–160.

2. Sharma MD, Nguyen AV, Brown S et al. Cardiovascular disease in acromegaly. Huostonmethodist.org/debakey -journal 2007; 2: 64–67.

3. Matta MP, Caron P Acromegalic cardiomyopathy: a review of the literature. Pituitary 2003; 6: 203–207.

4. Kršek M Endokrinni choroby a jejich vliv na KV system. Medical Tribune 2015; XXX: 17.

5. Mosca S, Paolillo S, Colao A et al. Cardiovascular involvement inpatients affected by acromegaly: an appraisal. Int J Cardiol 2013; 167: 1712–1718.

6. Kahaly G, Olshausen KV, Mohr -Kahaly S et al. Arrhythmia profile in acromegaly. Eur Heart J 1992; 13: 51–56.

7. Vitale G, Pivonello R, Lombardi G et al. Cardiacabnormalities in acromegaly. Pathophysiology and implicationsfor management. Treat Endocrinol 2004; 3: 309–318

8. Warszawski L, Kasuki L, Sá R et al. Low frequencyof cardiac arrhythmias and lack of structural heart disease inmedically -naďve acromegaly patients: a prospective study atbaseline and after 1 year of somatostatin analogs treatment. Pituitary 2016; 19: 582–589.

9. Roca E, Mattogno PP, Porcelli Tet al. Plurihormonal ACTH -GH Pituitary Adenoma: Case Report and Systematic Literature Review. World neurosurgery 2018; 114: 158–164.

10. Colao A, Pivonello R, Grasso LF et al. Determinants of cardiac disease in newly diagnosed patients with acromegaly: results of a 10 year survey study. Eur J Endocrinol 2011; 165: 713–721.

11. Jayasena C, Comninos A, Clarke H et al. The effects of long term GH and IGF -I exposure on the development of cardiovascular, cerebrovascular and metabolic co -morbidities in treated patients with acromegaly. Clin Endocrinol 2011; 75: 220–225.

12. Colao A, Spinelli L, Marzullo P et al. Highprevalence of cardiac valve disease in acromegaly: an observational, analytical, case -control study. J Clin Endocrinol Metab 2003; 88: 3196–3201.

13. Pereira AM, van Thiel SW, Lindner JR et al. Increased prevalence of regurgitant valvular heart disease in acromegaly. J Clin Endocrinol Metab 2004; 89: 71–75.

14. van der Klaauw AA, Bax JJ, Roelfsema F et al. Uncontrolled acromegaly is associated with progressive mitral valvular regurgitation. Growth Horm IGF Res 2006; 16: 101–107.

15. Colao A, Marzullo P, Di Somma C et al. Growth hormone and the heart. Clin Endocrinol 2001; 54: 137–154.

16. Isgaard J, Tivesten A, Friberg P et al. The role of the GH/IGF -I axis forthe cardiac function and structure. Horm Metab Res 1999; 31: 50–54.

17. Castellano G, Affuso F, Conza P Di et al. The GH/IGF-1 Axis and Heart Failure. Curr Cardiol Rev 2009; 5: 203–215.

18. Mendoza E, Malong CL, Tanchee -Ngo MJ et al. Acromegaly With Cardiomyopathy, Cardiac Thrombus and Hemorrhagic Cerebral Infarct: A Case Report of Therapeutic Dilemma With Review of Literature. Int J Endocrinol Metab 2015; 13: 1–4.

19. John jr. AJ, Laws ER Surgical Treatment of Pituitary Adenomas. Dostupné z https:// www.ncbi.nlm.nih.gov/books/NBK278983/.

20. Hána V, Švancara J, Bandúrová L et al. Registry of sellar tumors - RESET: Diagnostic and therapy of acromegaly in Czech and Slovak republics in the 21st century. Diabetes, metabolizmus, endokrinologie a výživa 2013; 16: 219–224.

21. Colao A, Pivonello R, Galderisi M et al. Impact of treating acromegaly first with surgery or somatostatin analogs on cardiomyopathy. J Clin Endocrinol Metab 2008; 93: 2639–2646.

22. Sakai H, Tsuchiya K, Nakayama C et al. Improvement of endothelial dysfunction in acromegaly after transsphenoidal surgery. Endocr J 2008; 55: 853–859.

23. Melmed S New therapeutic agents for acromegaly. Nat Rev Endocrinol 2016; 12: 90–98.

24. Katznelson L, Laws EL, Melmed S et al. Acromegaly: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2014; 99: 3933–3951.

25. Zahr R, Fleseriu M Updates in Diagnosis and Treatment of Acromegaly. European Endocrinology 2018; 10: 57–61.

26. Carmichael JD et al. Acromegaly clinical trial methodology impact on reported biochemical efficacy rates of somatostatin receptor ligand treatments: a meta -analysis. J Clin Endocrinol Metab 2014; 99: 1825–1833.

27. Colao A, Marzullo P, Cuocolo A et al. Reversal ofacromegalic cardiomyopathy in young but not in middle -agedpatients after 12 months of treatment with the depot long acting somatostatin analogue octreotide. Clin Endocrinol 2003; 58: 169–176.

28. Annamalai AK, Webb A, Kandasamy N et al. A comprehensive study of clinical, biochemical, radiological, vascular, cardiac, and sleep parameters in an unselected cohort of patients with acromegaly undergoing presurgical somatostatin receptor ligand therapy. J Clin Endocrinol Metab 2013; 98: 1040–1050.

29. Colao A, Marzullo P, Ferone D et al. Cardiovascular effects of depot long -acting somatostatin analog Sandostatin LAR in acromegaly. J Clin Endocrinol Metab 2000; 86: 3132–3140.

30. Colao A, Cuocolo A, Marzullo P et al. Effects of one -year treatment with octreotide on cardiac performance in patients with acromegaly. J Clin Endocrinol Metab 1999; 84: 17–23.

31. Akutsu H, Kreutzer J, Wasmeier G et al. Acromegaly per se does not increase the risk for coronary artery disease. Eur J Endocrinol 2010; 162: 879–886.

32. Colao A, Auriemma RS, Galdiero M et al. Effects of initial therapy for five years with somatostatin analogs for acromegaly on growth hormone and insulin -like growth factorI levels, tumor shrinkage, and cardiovascular disease: a prospective study. J Clin Endocrinol Metab 2009; 94: 3746–3756.

33. Trainer PJ, Drake WM, Katznelson L et al. Treatment of acromegaly with the growth hormone -receptor antagonist pegvisomant. N Engl J Med 2000; 342: 1171–1177.

34. van der Lely AJ, Hutson RK, Trainer PJ et al. Long -term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 2001; 358: 1754–1759.

35. van der Lely AJ, Biller BM, Brue T et al. Long -term safety of pegvisomant in patients with acromegaly: comprehensive review of 1288 subjects in ACROSTUDY. J Clin Endocrinol Metab 2012; 97: 1589–1597.

36. Colao A, Pivonello R, Auriemma RS et al. Efficacy of 12-monthtreatment with the GH receptor antagonist pegvisomant inpatients with acromegaly resistant to long -term, high-dosesomatostatin analog treatment: effect on IGF -I levels, tumor mass, hypertension and glucose tolerance. Eur J Endocrinol 2006; 154: 467–477.

37. Auriemma RS, Pivonello R, De Martino MC et al. Treatment with GH receptor antagonist in acromegaly: effect on cardiac arrhythmias. Eur J Endocrinol 2012; 168: 15–22.

38. De Martino MC, Auriemma RS, Brevetti G et al. The treatment with growth hormone receptor antagonistin acromegaly: effect on vascular structure and function in patients resistant to somatostatin analogues. J Endocrinol Invest 2010; 33: 663–670.

39. Pivonello R, Galderisi M, Auriemma RS et al. Treatment with growth hormone receptor antagonist in acromegaly: effect on cardiac structure and performance. J Clin Encocrinol Metab 2007; 92: 476–482.

40. Kuhn E, Maione L, Bouchachi A et al. Long -term effects of pegvisomant on comorbidities in patients with acromegaly: a retrospective single -center study. Eur J Endocrinol 2015; 173: 693–702.

41. Auriemma RS, Grasso LF, Galdiero M et al. Effects of long -term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly. Endocrine 2016; 55: 872–884.

42. Baldwin A, Cundy T, Butler J et al. Progression of cardiovascular disease in acromegalic patients treated by external pituitary irradiation. Acta Endocrinol 1985; 1: 581–587.

43. Sninčák M Srdcové zlyhávanie v roku 2016 - novinky v odporúčaniach, súčasný stav, trendy. Via practica 2016; 13: 163–167.

44. Thomas J, Dattani A, Zemrak F et al. Renin -Angiotensin System. Blockade Improves Cardiac Indices in Acromegaly Patients. Exp Clin Endocrinol Diabetes 2017; 125: 365–367.

45. Bihan H, Espinosa C, Valdes -Socin H et al. Long -term outcome of patients with acromegaly and congestive heart failure. J Clin Endocrinol Metab 2004; 89: 5308–5313.

46. Silvermann CB, Baran A Dilated and Restrictive Cardiomyopathies. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/dilated -restrictive -cardiomyopathy/