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Horm Metab Res 2003; 35(11/12): 712-725
DOI: 10.1055/s-2004-814150
Review
© Georg Thieme Verlag Stuttgart · New York

Acromegaly and Colorectal Cancer: A Comprehensive Review of Epidemiology, Biological Mechanisms, and Clinical Implications

A.  G.  Renehan1 , J.  O’Connell2 , D.  O’Halloran2 , F.  Shanahan2 , C.  S.  Potten3 , S.  T.  O’Dwyer1 , S.  M.  Shalet4
  • 1Department of Surgery, Christie Hospital NHS Trust, Manchester, UK
  • 2Department of Medicine, University of Cork, Cork, Ireland
  • 3Department of Biological Sciences, University of Manchester, UK
  • 4Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK
Further Information

Publication History

Received 2 September 2003

Accepted after Revision 1 October 2003

Publication Date:
07 January 2004 (online)

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Acromegaly and Colorectal Cancer: A Comprehensive Review of Epidemiology, Biological Mechanisms, and Clinical ImplicationsHorm Metab Res 2004; 36(01): 70-71
DOI: 10.1055/s-2004-814358

Abstract

Acromegaly is an endocrine disorder characterised by sustained hypersecretion of growth hormone (GH) with concomitant elevation of insulin-like growth factor (IGF)-I, and is associated with malignancy and premature mortality from cardiovascular and respiratory diseases. In particular, there may be an increased risk of colorectal neoplasia, but the exact extent of this is contentious. Colonoscopy-based studies of adenoma prevalence rates in acromegalic patients are misleading, but population-based studies on colorectal cancer risk are more consistent - a meta-analysis estimated a pooled risk ratio of 2.04 (95 % CI: 1.32, 3.14). Possible mechanisms underlying this increased risk include direct actions as a consequence of elevated levels of circulating GH and IGF-I and/or other perturbations within the IGF system. Other possible mechanisms include altered bile acid secretion, altered cellular immunity, hyperinsulinaemia, shared genetic susceptibility and increased bowel length. However, most explanations only offer indirect evidence, and the expectation of acromegaly as a natural model of colorectal carcinogenesis has not materialised. From a clinical perspective, it seems reasonable to consider a once-only colonoscopic screening at approximately age 55 years, but potential risks and benefits should be balanced.

Key words

Acromegaly - Colorectal cancer - Growth hormone - Insulin-like growth factors - Screening

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Dr. A. Renehan

Department of Surgery · Christie Hospital NHS Trust

Wilmslow Road · Manchester · M20 4BX · UK

Phone: +44(161)4463363

Fax: +44(161)4463772

Email: arenehan@picr.man.ac.uk

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