Challenges in the diagnosis and management of acromegaly: a focus on comorbidities.
BACKGROUND
Acromegaly is a rare, insidious disease resulting from the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), and is associated with a range of comorbidities. The extent of associated complications and mortality risk is related to length of exposure to the excess GH and IGF-1, thus early diagnosis and treatment is imperative. Unfortunately, acromegaly is often diagnosed late, when patients already have a wide range of comorbidities. The presence of comorbid conditions contributes significantly to patient morbidity/mortality and impaired quality of life.


METHODS
We conducted a retrospective literature review for information relating to the diagnosis of acromegaly, and its associated comorbidities using PubMed. The main aim of this review is to highlight the issues of comorbidities in acromegaly, and to reinforce the importance of early diagnosis and treatment.


CONCLUSIONS
Successful management of acromegaly goes beyond treating the disease itself, since many patients are diagnosed late in disease evolution, they present with a range of comorbid conditions, such as cardiovascular disease, diabetes, hypertension, and sleep apnea. It is important that patients are screened carefully at diagnosis (and thereafter), for common associated complications, and that biochemical control does not become the only treatment goal. Mortality and morbidities in acromegaly can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management.
Endocrinology Unit, Centro Médico Imbanaco Cali, Cali, Colombia.
Alin
A
Abreu
Internal Medicine Department, Hospital of Neiva, University Surcolombiana, Neiva, Colombia.
Alejandro Pinzón
AP
Tovar
Internal Medicine Department, University Industrial of Santander, Bucaramanga, Colombia.
Rafael
R
Castellanos
Department of Internal Medicine, Endocrinology Fundación Cardio-Infantil, Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia.
Alex
A
Valenzuela
Endocrinology Unit, Hospital Universitario San Ignacio, Bogotá, Colombia.
Claudia Milena Gómez
CM
Giraldo
Internal Medicine Department, Hospital San Jerónimo de Montería, Montería, Córdoba, Colombia.
Alejandro Castellanos
AC
Pinedo
Endocrinology Unit, Hospital Universitario Departamental de Nariño, CENTRO de Endocrinologia CENDOO, Universidad Nacional de Colombia, Pasto, Colombia.
Doly Pantoja
DP
Guerrero
Endocrinology Department, Hospital Universitario San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia.
Carlos Alfonso Builes
CA
Barrera
Endocrinology Faculty, Universidad Caldas, Manizales, Colombia.
Humberto Ignacio
HI
Franco
Federal University of Minas Gerais, Belo Horizonte, Brazil.
Antônio
A
Ribeiro-Oliveira
Endocrinology and Chair, Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University Medical School, Recife, Brazil.
Lucio
L
Vilar
Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho, 255, 7ºandar, sala 7037, São Carlos, SP, CEP 05403-000, Brazil.
Raquel S
RS
Jallad
Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho, 255, 7ºandar, sala 7037, São Carlos, SP, CEP 05403-000, Brazil.
Felipe Gaia
FG
Duarte
Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Mônica
M
Gadelha
Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Brazil.
Cesar Luiz
CL
Boguszewski
Neuroendocrine Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Julio
J
Abucham
Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasília, Brazil.
Luciana A
LA
Naves
Neuroendocrine Unit, Division of Neurosurgery, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP, Brazil.
Nina Rosa C
NR
Musolino
Department of Odontology, Central Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP, Brazil.
Maria Estela Justamante
ME
de Faria
Department of Odontology, Central Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP, Brazil.
Ciliana
C
Rossato
Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho, 255, 7ºandar, sala 7037, São Carlos, SP, CEP 05403-000, Brazil. mdbronstein@uol.com.br.
Marcello D
MD
Bronstein
D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002349:Carpal Tunnel Syndrome / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D019468:Disease Management; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006261:Headache / Q000209:etiology; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D008260:Macroglossia / Q000453:epidemiology; D010003:Osteoarthritis / Q000453:epidemiology; D011379:Prognosis; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D014786:Vision Disorders / Q000209:etiology
Acromegaly comorbidities; Acromegaly diagnosis; Latin America