What are the common disorders associated with acromegaly?

Common Disorders in Patients with Acromegaly

Patients with acromegaly commonly develop cardiovascular, metabolic, respiratory, gastrointestinal, and musculoskeletal complications that significantly increase morbidity and mortality if left untreated. 1, 2

Cardiovascular Complications

• Cardiomyopathy: Acromegalic cardiomyopathy progresses through three stages:

  1. Early hyperkinetic stage with biventricular hypertrophy and increased contractility
  2. Intermediate stage with significant hypertrophy and diastolic dysfunction
  3. End stage with impaired systolic and diastolic function and overt heart failure 1

• Hypertension: Present in approximately 35% of patients 3

• Arrhythmias: Sinus bradycardia occurs in 5.5% of patients 4

• Valvular heart disease: Common complication requiring monitoring 5

• Atherosclerosis and coronary artery disease: Accelerated by GH/IGF-1 excess 5

Metabolic Complications

• Diabetes mellitus: Occurs in approximately 39% of patients due to GH-induced insulin resistance 6, 3
• Impaired glucose tolerance: Common precursor to diabetes 1
• Dyslipidemia: Contributes to cardiovascular risk 7

Respiratory Complications

• Obstructive sleep apnea: Common and improves with treatment of acromegaly 1
• Ventilatory dysfunction: Contributes to increased mortality 7

Gastrointestinal Complications

• Colorectal polyps and cancer: Increased prevalence requiring regular colonoscopic screening starting at age 40 1, 2
  • Patients with adenoma at first screening should be screened every 3 years
  • Patients with negative colonoscopy should be screened every 5 years 1
• Cholelithiasis: Common with somatostatin analog treatment 4
• Steatorrhea and malabsorption: Due to inhibition of pancreatic enzymes by treatment 4

Endocrine Complications

• Thyroid dysfunction: Slight decreases in thyroid function during treatment 4
• Hyperprolactinemia: Present in approximately 17% of patients 3
• Hypocortisolism: Occurs in about 38% of patients 3
• Hypogonadism: Affects approximately 34% of patients 3

Musculoskeletal Complications

• Arthropathy: Most important cause of morbidity and functional disability 7
  • Reversible at initial stages but not if left untreated for years
• Carpal tunnel syndrome: Common peripheral nerve entrapment 7
• Osteoarthritis: Progressive joint deterioration 3

Management Considerations

1. Multidisciplinary approach is essential, involving endocrinologists, cardiologists, and other specialists 2

2. Regular monitoring of:

   • GH and IGF-1 levels to assess disease control 1
   • Blood glucose and HbA1c levels 1
   • Cardiovascular function 1
   • Thyroid function 4

3. Treatment impact on comorbidities:

   • Pharmacological treatment improves left ventricular hypertrophy, hypertension, and sleep apnea 1
   • Treatment may not significantly improve established arthropathy 1
   • Somatostatin analogs may negatively affect glucose metabolism 1
   • Pegvisomant typically has beneficial effects on glucose metabolism 1

Clinical Pitfalls and Caveats

1. Late diagnosis: Acromegaly is often diagnosed years after symptom onset, allowing complications to develop and progress 2

2. Treatment-related complications:

   • Somatostatin analogs can cause gallstones, bradycardia, and glucose metabolism disturbances 4
   • Regular monitoring for these side effects is essential

3. Colonoscopy challenges: Total colonoscopy (not just sigmoidoscopy) is required but may be technically difficult in acromegalic patients 1

4. Cardiovascular risk assessment: May be underestimated due to the unique pathophysiology of acromegaly-related cardiac disease 5

5. Diabetes management: Requires special consideration as it occurs independently of obesity and has unique pathophysiology 6