Cardiometabolic comorbidities more likely for adults with acromegaly than without
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Key takeaways:
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Adults with acromegaly are more likely to have hypertension, diabetes and other comorbidities than healthy adults.
- Acral enlargement, headache and facial changes most often led to an acromegaly diagnosis.
Cardiometabolic comorbidities, such as hypertension, cardiac arrythmias and diabetes, are more common in adults with acromegaly than those without the condition, according to a systematic review and meta-analysis published in Pituitary.
“The aim of [the] current systematic review was to identify the most prevalent clinical signs, symptoms and comorbidities at time of diagnosis in acromegaly patients,” Tessa N.A. Slagboom, MD, a PhD candidate in the department of endocrinology and metabolism at Amsterdam UMC in the Netherlands, and colleagues wrote. “Since systematic overviews are currently lacking, we are the first to report these features in a clear and scientifically based way. With the identification of these features, we can present a combination of complaints and comorbidities that should raise suspicion of acromegaly in both patients and medical caregivers more promptly.”
Researchers reviewed the PubMed, Embase and Web of Science databases for studies that analyzed the prevalence of clinical signs, symptoms and comorbidities of acromegaly in adults. The databases were searched from inception until Nov. 18, 2021. Study characteristics and demographics were obtained. Researchers collected the prevalence of signs, symptoms and comorbidities of acromegaly at diagnosis and for controls if available. Symptoms leading to the diagnosis of acromegaly were also collected.
There were 124 studies conducted in 38 countries and published from 1973 to 2021 included in the review.
The most common symptoms of acromegaly were acral enlargement, reported in 90% of adults; facial features associated with acromegaly, present in 65% of participants; oral changes, reported in 62% of participants; headache, prevalent in 59% of adults; and fatigue or tiredness, reported in 53% of adults. The most frequently reported comorbidities were myocardial or left ventricle hypertrophy in 59% of participants, hypercalciuria in 55%, endometrial polyp or myoma uteri in 53%, fatty liver in 47% and diastolic dysfunction in 46%.
Compared with age- and sex-matched controls, adults with acromegaly were more likely to have hypertension, left ventricle hypertrophy, diastolic or systolic dysfunction, cardiac arrhythmias, prediabetes or diabetes, dyslipidemia, intestinal polyps and malignancy. Compared with the general population, those with acromegaly were more likely to report hyperhidrosis, macroglossia, left ventricle hypertrophy, diabetes and sleep apnea. Symptoms or conditions that were more frequently found among adults with acromegaly but were also common in the general population included fatigue, diastolic dysfunction, fatty liver disease, osteoporosis, depression and voice problems. The prevalence of carpal tunnel syndrome was twice as high among adults with acromegaly than the general population and papillary thyroid cancer and colorectal cancer was more than 10-fold higher in acromegaly than the general population. However, the incidences of all three conditions were rare overall.
Clinical signs, symptoms and comorbidities that most often led to an acromegaly diagnosis were acral enlargement, headache, facial changes, diabetes, prognathism, thyroid cancer, visual defect, menstrual disorder, osteoporosis and transient ischemic attack.
“It should be taken into consideration that the risk of bias for studies included in this systematic review was high,” the researchers wrote. “Selection bias was present in about half of the studies, mainly including healthy acromegaly patients and patients who were treated by surgical removal of the pituitary tumor. In approximately one out of three studies, the response rate was unclear. For most of the larger studies describing multiple symptoms and comorbidities, the method of measurement of these symptoms was unclear, just as it was unclear if they were measured in the same way for all patients.”
The researchers said future studies should examine whether it is possible to use clinical signs, symptoms and comorbidities to determine a person’s risk for acromegaly.
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