title: Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities.
abstract: Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy. rosario.pivonello@unina.it.
authors.forename: Rosario
authors.identifier: http://orcid.org/0000-0002-9632-1348
authors.initials: R
authors.lastname: Pivonello
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Renata S
authors.initials: RS
authors.lastname: Auriemma
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Ludovica F S
authors.initials: LF
authors.lastname: Grasso
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pivonello
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Simeoli
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Patalano
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Galdiero
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
mesh_terms: D000172:Acromegaly / Q000150:complications* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D015897:Comorbidity; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D024821:Metabolic Syndrome / Q000209:etiology / Q000378:metabolism; D012891:Sleep Apnea Syndromes / Q000209:etiology / Q000378:metabolism
chemical_list: D019382:Human Growth Hormone
keywords: Acromegaly; Cardiomyopathy; Medical therapy; Metabolic syndrome; Pituitary surgery; Sleep apnea