Causes of Death in Acromegaly
Heart failure is the most common cause of death in patients with acromegaly. 1
Cardiovascular Complications in Acromegaly
Acromegaly, characterized by excessive growth hormone (GH) and insulin-like growth factor 1 (IGF-1) secretion, typically from a pituitary adenoma, leads to significant cardiovascular complications that contribute to increased mortality:
- Cardiac arrhythmias and sudden cardiac death are the leading causes of cardiovascular mortality in acromegaly 1
- Acromegalic cardiomyopathy is defined as concentric biventricular hypertrophy and diastolic dysfunction, which contributes significantly to morbidity and mortality 1
- Up to 50% of acromegalic patients have complex ventricular arrhythmias on 24-hour Holter monitoring, with approximately two-thirds being repetitive 2
- Strong correlation exists between ventricular arrhythmias and left ventricular mass and disease duration 2
Risk Factors for Cardiovascular Complications
Several factors increase the risk of developing cardiovascular complications in acromegaly:
- Disease duration is more strongly associated with biventricular enlargement, diastolic dysfunction, heart failure, and valvular disease than the degree of hormone elevation 1
- Advanced age and increased body mass index are additional risk factors for cardiomyopathy 1
- Uncontrolled GH/IGF-1 excess contributes to cardiovascular complications 3
- Coexistence of other cardiovascular risk factors such as hypertension and diabetes further increases risk 3
Spectrum of Cardiovascular Manifestations
Acromegaly patients commonly develop:
- Hypertension (present in the case patient with BP 165/96 mmHg)
- Cardiomyopathy with left ventricular hypertrophy
- Heart valve disease
- Arrhythmias (tachycardia noted in the case patient with HR 101 bpm)
- Atherosclerosis
- Coronary artery disease
- Congestive heart failure 3
Mortality in Acromegaly
Historically, cardiovascular complications have been the primary cause of death in acromegaly:
- The 1-year and 5-year mortality rates for acromegalic patients with chronic symptomatic congestive heart failure were 25% and 37.5%, respectively 4
- With modern treatment approaches, mortality rates have improved, but cardiac complications remain a significant concern 5
- Recent advances in treatment have shifted the leading cause of death in well-controlled patients toward neoplastic causes 1
Clinical Implications
For the 44-year-old woman in the case presentation:
- Her symptoms (headache, visual disturbance) suggest pituitary tumor effects
- Physical findings (enlarged hands/feet, coarse facial features, frontal bossing, enlarged jaw) are classic for acromegaly
- Vital signs (hypertension, tachycardia) and excessive sweating indicate cardiovascular and autonomic involvement
- Early diagnosis and treatment are essential to prevent progression to heart failure
Treatment Considerations
Appropriate surgical management of the pituitary tumor is paramount for improved long-term outcomes, as cardiac changes are potentially reversible, especially in younger patients 2. Medical therapy options include:
- Somatostatin receptor ligands (SRLs) like octreotide and lanreotide, which can reduce left ventricular hypertrophy and improve ventricular arrhythmia profiles 2
- GH receptor antagonists like pegvisomant for patients with inadequate response to surgery/radiation 6
- Combination therapy for partial or non-responders 6
Regular cardiovascular assessment with echocardiography is essential for monitoring these patients 6.