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Complications of acromegaly: thyroid and colon

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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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References

  1. Cohen P, Clemmons DR, Rosenfeld RG et al (2000) Does the GH–IGF axis play a role in cancer pathogenesis? Growth Horm IGF Res 10:297–305. doi:10.1054/ghir.2000.0171

    Article  CAS  PubMed  Google Scholar 

  2. Boguszewski CL, Ayuk J (2016) Management of endocrine disease: acromegaly and cancer: an old debate revisited. Eur J Endocrinol. doi:10.1530/EJE-16-0178

    PubMed Central  Google Scholar 

  3. Renehan AG, Zwahlen M, Minder C et al (2004) Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet (London, England) 363:1346–1353. doi:10.1016/S0140-6736(04)16044-3

    Article  CAS  Google Scholar 

  4. Jenkins PJ, Besser M (2001) Clinical perspective: acromegaly and cancer: a problem. J Clin Endocrinol Metab 86:2935–2941. doi:10.1210/jcem.86.7.7634

    Article  CAS  PubMed  Google Scholar 

  5. Melmed S (2001) Acromegaly and cancer: Not a problem? J Clin Endocrinol Metab 86:2929–2934. doi:10.1210/jcem.86.7.7635

    Article  CAS  PubMed  Google Scholar 

  6. Roelfsema F, Biermasz NR, Frolich M et al (2009) Diminished and irregular thyrotropin secretion with preserved diurnal rhythm in patients with active acromegaly. J Clin Endocrinol Metab 94:1945–1950. doi:10.1210/jc.2009-0174

    Article  CAS  PubMed  Google Scholar 

  7. Miyakawa M, Saji M, Tsushima T et al (1988) Thyroid volume and serum thyroglobulin levels in patients with acromegaly: correlation with plasma insulin-like growth factor 1 levels. J Clin Endocrinol Metab 67:973–978

    Article  CAS  PubMed  Google Scholar 

  8. Lamberg BA, Pelkonen R, Aro A, Grahne B (1976) Thyroid function in acromegaly before and after transsphenoidal hypophysectomy followed by cryoapplication. Acta Endocrinol (Copenh) 82:254–266

    CAS  Google Scholar 

  9. Geelhoed-Duijvestijn PH, Roelfsema F, Schröder-van der Elst JP et al (1992) Effect of administration of growth hormone on plasma and intracellular levels of thyroxine and tri-iodothyronine in thyroidectomized thyroxine-treated rats. J Endocrinol 133:45–49

    Article  CAS  PubMed  Google Scholar 

  10. Damjanović SS, Petakov MS, Raicević S et al (2000) Serum leptin levels in patients with acromegaly before and after correction of hypersomatotropism by trans-sphenoidal surgery. J Clin Endocrinol Metab 85:147–154. doi:10.1210/jcem.85.1.6296

    Article  PubMed  Google Scholar 

  11. Gøtzsche LS, Flyvbjerg A, Marshall S et al (1991) The influence of growth hormone and thyroxine on iodothyronine deiodinase activity in the liver, kidney and brown adipose tissue in hypophysectomized rats. Acta Endocrinol (Copenh) 125:219–226

    Google Scholar 

  12. Roelfsema F, Frölich M (1991) Pulsatile thyrotropin release and thyroid function in acromegalics before and during subcutaneous octreotide infusion. J Clin Endocrinol Metab 72:77–82. doi:10.1210/jcem-72-1-77

    Article  CAS  PubMed  Google Scholar 

  13. Wuster C, Steger G, Schmelzle A et al (1991) Increased incidence of euthyroid and hyperthyroid goiters independently of thyrotropin in patients with acromegaly. Horm Metab Res 23:131–134. doi:10.1055/s-2007-1003632

    Article  CAS  PubMed  Google Scholar 

  14. Gasperi M, Martino E, Manetti L et al (2002) Prevalence of thyroid diseases in patients with acromegaly: results of an Italian multi-center study. J Endocrinol Invest 25:240–245. doi:10.1007/BF03343997

    Article  CAS  PubMed  Google Scholar 

  15. Marzullo P, Cuocolo A, Ferone D et al (2000) Cardiac effect of thyrotoxicosis in acromegaly. J Clin Endocrinol Metab 85:1426–1432. doi:10.1210/jc.85.4.1426

    CAS  PubMed  Google Scholar 

  16. Chanson P, Salenave S, Kamenicky P et al (2009) Acromegaly. Best Pract Res Clin Endocrinol Metab 23:555–574. doi:10.1016/j.beem.2009.05.010

    Article  CAS  PubMed  Google Scholar 

  17. Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25:102–152. doi:10.1210/er.2002-0022

    Article  CAS  PubMed  Google Scholar 

  18. Katznelson L, Laws ER, Melmed S et al (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933–3951. doi:10.1210/jc.2014-2700

    Article  CAS  PubMed  Google Scholar 

  19. Gatto F, Barbieri F, Castelletti L et al (2011) In vivo and in vitro response to octreotide LAR in a TSH-secreting adenoma: characterization of somatostatin receptor expression and role of subtype 5. Pituitary 14:141–147. doi:10.1007/s11102-010-0271-2

    Article  CAS  PubMed  Google Scholar 

  20. Lamberts SW, Zuyderwijk J, den Holder F et al (1989) Studies on the conditions determining the inhibitory effect of somatostatin on adrenocorticotropin, prolactin and thyrotropin release by cultured rat pituitary cells. Neuroendocrinology 50:44–50

    Article  CAS  PubMed  Google Scholar 

  21. Amlashi FG, Tritos NA (2016) Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management. Endocrine. doi:10.1007/s12020-016-0863-3

    PubMed  Google Scholar 

  22. Atkinson H, England JA, Rafferty A et al (2013) Somatostatin receptor expression in thyroid disease. Int J Exp Pathol 94:226–229. doi:10.1111/iep.12024

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Razzore P, Colao A, Baldelli R et al (1999) Comparison of six months therapy with octreotide versus lanreotide in acromegalic patients: a retrospective study. Clin Endocrinol (Oxf) 51:159–164. doi:10.1046/j.1365-2265.1999.00812.x

    Article  CAS  Google Scholar 

  24. Carvalho P, Lau E, Carvalho D (2015) Surgery induced hypopituitarism in acromegalic patients: a systematic review and meta-analysis of the results. Pituitary 18:844–860. doi:10.1007/s11102-015-0661-6

    Article  PubMed  Google Scholar 

  25. Sarkar S, Rajaratnam S, Chacko G, Chacko AG (2014) Endocrinological outcomes following endoscopic and microscopic transsphenoidal surgery in 113 patients with acromegaly. Clin Neurol Neurosurg 126:190–195. doi:10.1016/j.clineuro.2014.09.004

    Article  PubMed  Google Scholar 

  26. Berkmann S, Fandino J, Müller B et al (2012) Pituitary surgery: experience from a large network in Central Switzerland. Swiss Med Wkly 142:w13680. doi:10.4414/smw.2012.13680

    PubMed  Google Scholar 

  27. Haugen BR, Alexander EK, Bible KC et al (2015) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. doi:10.1089/thy.2015.0020

    Google Scholar 

  28. Tode B, Serio M, Rotella CM et al (1989) Insulin-like growth factor-I: autocrine secretion by human thyroid follicular cells in primary culture. J Clin Endocrinol Metab 69:639–647

    Article  CAS  PubMed  Google Scholar 

  29. Cheung NW, Boyages SC (1997) The thyroid gland in acromegaly: an ultrasonographic study. Clin Endocrinol (Oxf) 46:545–549. doi:10.1046/j.1365-2265.1997.1680985.x

    Article  CAS  Google Scholar 

  30. Yoshinari M, Tokuyama T, Kuroda T et al (1992) Preserved thyroidal secretion of thyroxine in acromegalic patients with suppressed hypophyseal secretion of thyrotrophin. Clin Endocrinol (Oxf) 36:355–360

    Article  CAS  Google Scholar 

  31. Wolinski K, Czarnywojtek A, Ruchala M (2014) Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly—meta-analysis and systematic review. PLoS ONE. doi:10.1371/journal.pone.0088787

    Google Scholar 

  32. Dagdelen S, Cinar N, Erbas T (2014) Increased thyroid cancer risk in acromegaly. Pituitary 17:299–306. doi:10.1007/s11102-013-0501-5

    Article  PubMed  Google Scholar 

  33. Balkany C, Cushing GW (1995) An association between acromegaly and thyroid carcinoma. Thyroid 5:47–50. doi:10.1089/thy.1995.5.47

    Article  CAS  PubMed  Google Scholar 

  34. Dos Santos MCC, Nascimento GC, Nascimento AGC et al (2013) Thyroid cancer in patients with acromegaly: a case-control study. Pituitary 16:109–114. doi:10.1007/s11102-012-0383-y

    Article  PubMed  Google Scholar 

  35. Herrmann BL, Baumann H, Janssen OE et al (2004) Impact of disease activity on thyroid diseases in patients with acromegaly: basal evaluation and follow-up. Exp Clin Endocrinol Diabetes 112:225–230. doi:10.1055/s-2004-817967

    Article  CAS  PubMed  Google Scholar 

  36. de Uchoa HBDMP, Lima GAB, Corrêa LL et al (2013) Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center. Arq Bras Endocrinol Metabol 57:685–690

    Article  PubMed  Google Scholar 

  37. Gullu BE, Celik O, Gazioglu N, Kadioglu P (2010) Thyroid cancer is the most common cancer associated with acromegaly. Pituitary 13:242–248. doi:10.1007/s11102-010-0224-9

    Article  PubMed  Google Scholar 

  38. Popovic V, Damjanovic S, Micic D et al (1998) Increased incidence of neoplasia in patients with pituitary adenomas. Clin Endocrinol (Oxf) 49:441–445. doi:10.1046/j.1365-2265.1998.00536.x

    Article  CAS  Google Scholar 

  39. Barzilay J, Heatley GJ, Cushing GW (1991) Benign and malignant tumors in patients with acromegaly. Arch Intern Med 151:1629–1632

    Article  CAS  PubMed  Google Scholar 

  40. Davies L, Welch HG (2014) Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 140:317–322. doi:10.1001/jamaoto.2014.1

    Article  PubMed  Google Scholar 

  41. Ito Y, Miyauchi A (2015) Nonoperative management of low-risk differentiated thyroid carcinoma. Curr Opin Oncol 27:15–20. doi:10.1097/CCO.0000000000000143

    Article  PubMed  Google Scholar 

  42. Renehan AG, Painter JE, Bell GD et al (2005) Determination of large bowel length and loop complexity in patients with acromegaly undergoing screening colonoscopy. Clin Endocrinol (Oxf) 62:323–330. doi:10.1111/j.1365-2265.2005.02217.x

    Article  Google Scholar 

  43. Wassenaar MJE, Cazemier M, Biermasz NR et al (2010) Acromegaly is associated with an increased prevalence of colonic diverticula: a case-control study. J Clin Endocrinol Metab 95:2073–2079. doi:10.1210/jc.2009-1714

    Article  CAS  PubMed  Google Scholar 

  44. Dutta P, Bhansali A, Vaiphei K et al (2012) Colonic neoplasia in acromegaly: Increased proliferation or deceased apoptosis? Pituitary 15:166–173. doi:10.1007/s11102-011-0300-9

    Article  CAS  PubMed  Google Scholar 

  45. Bogazzi F, Ultimieri F, Raggi F et al (2002) Peroxisome proliferator activated receptor gamma expression is reduced in the colonic mucosa of acromegalic patients. J Clin Endocrinol Metab 87:2403–2406. doi:10.1210/jcem.87.5.8625

    CAS  PubMed  Google Scholar 

  46. Krzentowska A, Gołkowski F, Bałdys-Waligórska A, Hubalewska-Dydejczyk A (2010) [Gastrointestinal tract polyps in acromegaly patients]. Przegla̧d Lek 67:1266–1269

  47. Rokkas T, Pistiolas D, Sechopoulos P et al (2008) Risk of colorectal neoplasm in patients with acromegaly: a meta-analysis. World J Gastroenterol 14:3484–3489

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lois K, Bukowczan J, Perros P et al (2015) The role of colonoscopic screening in acromegaly revisited: review of current literature and practice guidelines. Pituitary 18:568–574. doi:10.1007/s11102-014-0586-5

    Article  CAS  PubMed  Google Scholar 

  49. Dworakowska D, Gueorguiev M, Kelly P et al (2010) Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines. Eur J Endocrinol 163:21–28. doi:10.1530/EJE-09-1080

    Article  CAS  PubMed  Google Scholar 

  50. Ron E, Gridley G, Hrubec Z et al (1991) Acromegaly and gastrointestinal cancer. Cancer 68:1673–1677

    Article  CAS  PubMed  Google Scholar 

  51. Orme SM, McNally RJ, Cartwright RA, Belchetz PE (1998) Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab 83:2730–2734. doi:10.1210/jcem.83.8.5007

    CAS  PubMed  Google Scholar 

  52. Baris D, Gridley G, Ron E et al (2002) Acromegaly and cancer risk: a cohort study in Sweden and Denmark. Cancer Causes Control 13:395–400. doi:10.1023/A:1015713732717

    Article  CAS  PubMed  Google Scholar 

  53. Terzolo M, Reimondo G, Gasperi M et al (2005) Colonoscopic screening and follow-up in patients with acromegaly: a multicenter study in Italy. J Clin Endocrinol Metab 90:84–90. doi:10.1210/jc.2004-0240

    Article  CAS  PubMed  Google Scholar 

  54. Kauppinen-Mäkelin R, Sane T, Välimäki MJ et al (2010) Increased cancer incidence in acromegaly—a nationwide survey. Clin Endocrinol (Oxf) 72:278–279. doi:10.1111/j.1365-2265.2009.03619.x

    Article  Google Scholar 

  55. Petroff D, Tönjes A, Grussendorf M et al (2015) the incidence of cancer among acromegaly patients: results from the German acromegaly registry. J Clin Endocrinol Metab 100:3894–3902. doi:10.1210/jc.2015-2372

    Article  CAS  PubMed  Google Scholar 

  56. Renehan AG, Odwyer ST, Shalet SM (2001) Screening colonoscopy for acromegaly in perspective. Clin Endocrinol (Oxf) 55:731–733

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, 49100, Israel

    Amit Tirosh & Ilan Shimon

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Amit Tirosh & Ilan Shimon

Authors
  1. Amit Tirosh
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  2. Ilan Shimon
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Correspondence to Ilan Shimon.

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Amit Tirosh has no conflicts of interest to declare. Ilan Shimon has received research grants, consulting and lectureship fees from Novartis and Pfizer.

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Tirosh, A., Shimon, I. Complications of acromegaly: thyroid and colon. Pituitary 20, 70–75 (2017). https://doi.org/10.1007/s11102-016-0744-z

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