PubMed · 5203047
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A M Granovskaia-Tsvetkova. 1970. [Acromegaly].. https://pubmed.ncbi.nlm.nih.gov/5203047/
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An echocardiographic follow-up of 25 patients (pts) was performed, after the first examinations in 1978-1979. 15 pts have died in the last 15 years (Group 1), while 10 still living (Group 2). In Group 1 either the impaired global left ventricular at the time of the first echocardiography predicted a high mortality i.e. there were only two pts with normal echocardiographic findings. The other 6 acromegalic pts with a "normal heart" have survived. The left ventricular hypertrophy of pts in Group 2 was observed to increase during the 15-year follow-up, because of the development of systemic hypertension. In conclusion, the echocardiographic findings are of a good predictive value in estimations of the survival rate in acromegalic pts.
Local expansion of pituitary tumors causes nonspecific symptoms, including hormone insufficiency, that may exist for years before diagnosis. Although they are more specific, symptoms of pituitary hormone oversecretion may also remain unrecognized and give rise to difficult diagnostic problems. Gonadotropic tumors do not elicit specific endocrine symptoms, whether they secrete complete gonadotropins or their biologically inactive free subunits. Hyperprolactinemia is not due to tumor secretion in the majority of cases, including some with a tumor in the pituitary (compressive hyperprolactinemia). When acromegaly is suspected, the unequivocal proof of excess growth hormone secretion is not easy to obtain, due to intermittent growth hormone secretion, both in normals and in acromegalics. The large variety of tests available for the etiological diagnosis of hypercorticism indicates the diagnostic difficulties that can be encountered. Corticotrope pituitary adenomas may be minute, and ectopic corticotropin secretion may remain occult. But on the other hand, the quality of the diagnostic tools available improves constantly. This includes new hormone measurements, such as insulin-like growth factor 1 and its binding proteins, dynamic tests, selective pituitary blood drawing by inferior petrosal sinus catheterism, pituitary nuclear magnetic resonance imaging and somatostatin-analogue scintiscan. In addition to the improving techniques of transphenoidal neurosurgery and pituitary radiotherapy, medical management of pituitary tumors remains a distinct possibility. Tumor hormone secretion can be controlled in some cases by drugs such as dopaminergic agents, somatostatin analogues and gonadoliberin analogues, which may also exert an antitumoral mass effect. Within the next few years we will be confronted with an increasing number of incidentally discovered pituitary tumors, due to the frequent use of high-resolution intracranial imaging.
We studied 10 adult patients with active acromegaly (4 men and 6 women, mean age 55 +/- 5 years and mean body mass index 27.9 +/- 1.1 kg/m2). Control values for the echocardiographic and exercise studies were obtained from 10 normal subjects matched for sex and age (5 men and 5 women, age 51.1 +/- 3.7 years and body mass index 25.3 +/- 1 kg/m2). Each patient underwent: (1) blood sampling for growth hormone (GH) assay every 3 hours; (2) a 2-dimensional, guided M-mode echocardiographic study; and (3) a cycloergometric exercise test at baseline and after treatment with a portable pump infusing octreotide, 500 micrograms/24 hours subcutaneously. All patients had left ventricular hypertrophy. Systolic function indexes did not significantly differ among normal subjects, whereas baseline Doppler studies showed abnormalities in left ventricular diastolic filling in acromegalic patients. At anaerobic threshold and at maximal exercise, acromegalic subjects sustained a significantly (p < 0.05) decreased workload (54 +/- 23 vs 94 +/- 11 and 87 +/- 37 vs 152 +/- 15 W) compared with control subjects. After octreotide, baseline heart rate (79 +/- 7 vs 87 +/- 8 beats/min, p < 0.05) and serum GH levels significantly decreased compared with levels before administration of octreotide. Systolic and diastolic functional indexes at rest significantly improved after octrotide in acromegalic patients. Both at anaerobic threshold and at maximal exercise, workload and oxygen consumption were significantly increased after octretide administration. Exercise capacity at anaerobic threshold was not significantly different in acromegalic subjects after octreotide when compared with normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)