What is the most common cause of death in patients with acromegaly?

Most Common Cause of Death in Acromegaly

Heart failure is the most common cause of death in patients with acromegaly. 1

Cardiovascular Complications in Acromegaly

Acromegaly is characterized by excessive levels of circulating growth hormone (GH) and its tissue mediator, insulin-like growth factor 1 (IGF-1). These patients face significant cardiovascular complications that contribute to increased mortality:

• Cardiovascular disease accounts for approximately 60% of deaths in acromegalic patients 2
• Specific cardiac complications include:
  • Biventricular hypertrophy (acromegalic cardiomyopathy) 3
  • Diastolic and systolic dysfunction 4
  • Arrhythmias and sudden cardiac death 3
  • Valvular heart disease 1
  • Hypertension 5
  • Atherosclerosis and coronary artery disease 5

Pathophysiology of Cardiac Complications

The development of cardiac complications in acromegaly follows a specific progression:

• Early stage: Hyperkinetic syndrome with increased heart rate and cardiac output 4
• Intermediate stage: Concentric biventricular hypertrophy and diastolic dysfunction 3
• Advanced stage: Systolic dysfunction and heart failure 4

Disease duration plays a more significant role than the degree of hormone elevation in the development of cardiac complications 3. Prolonged exposure to excess GH and IGF-1 leads to:

• Myocardial hypertrophy independent of hypertension 1
• Interstitial fibrosis 4
• Lymphomononuclear infiltration 4
• Myofibrillar derangement 4

Other Causes of Mortality in Acromegaly

While heart failure is the predominant cause of death, other significant causes include:

• Respiratory complications, particularly sleep apnea 4
• Cerebrovascular disease 1
• Malignancies, particularly colorectal cancer 1
  • Patients with acromegaly have an increased prevalence of colorectal adenomas and cancer 1
  • Regular colonoscopic screening is recommended starting at age 40 1

Impact of Treatment on Mortality

Effective treatment of acromegaly can improve cardiovascular outcomes:

• Normalization of GH and IGF-1 levels decreases mortality rates 1
• Surgical management of the pituitary tumor can lead to regression of cardiac changes, especially in younger patients 1
• Somatostatin analogs (octreotide, lanreotide) have been shown to reduce left ventricular hypertrophy and improve ventricular arrhythmia profiles 1

Clinical Implications

The patient described in the question presents with classic features of acromegaly (enlarged hands and feet, coarse facial features, frontal bossing, enlarged jaw) along with symptoms that suggest cardiovascular involvement (hypertension, tachycardia, headache). This presentation warrants:

• Prompt diagnosis and treatment of the underlying pituitary disorder 1
• Comprehensive cardiac evaluation including echocardiography 5
• Management of cardiovascular risk factors 1
• Regular screening for other complications, including colonoscopy 1

Early intervention is critical as cardiac changes may be reversible in early stages but can become irreversible if left untreated for several years 1, 4.