Endocrine Abstracts

Background

Acromegaly is a rare disease, caused by an autonomous excessive secretion of growth hormone (GH). Apart from skeletal alterations, the GH excess leads to metabolic and visceral disease. Thus, one of the most frequent associated complications is the cardio-vascular one represented by hypertension, cardiomyopathy and ischemic heart disease. The presence of multiple complications in patients with acromegaly leads not only to increased morbidity and mortality but also decreased quality of life.

Methods

The study gathers 42 patients with acromegaly (16/26 m/f) divided into two subgroups on the basis of treatment (SA – somatostatin analogue as monotherapy/in dual therapy with dopamine agonist; PEG- GH receptor blocker- Pegvisomant- in monotherapy or dual therapy with SA). Assessment of the hormonal and metabolic status was performed in all subjects. Regarding cardio-vascular function, we calculated the SCORE risk using the European High Risk Chart and the Framingham Risk score for coronary heart disease, while also measuring several important parameters through 2D echocardiography. Quality of life was assessed using ACRO-QoL, a disease-specific questionnaire and SF-36, a generic questionnaire.

Results

There were no significant differences between the PEG and SA groups regarding total ACRO-QoL scores (76.64 ± 15.38 vs. 78.82 ± 17.65) and SF-36 (85.78 ± 37.43 vs. 87.89 ± 31.77). Instead we have found a significant lower personal relations score in the PEG group compared to SA (26.85 ± 6.024 vs. 27.96 ± 5.84, p=0.026). Concerning the cardio-vascular function, there was a significantly lower SCORE risk (1.72 vs. 1.91, p=0, 034) and Framingham score (6.63 vs. 7.73, p=0, 013) in the PEG group compared to the SA group and the PEG group had also lower blood pressures at the moment of examination using less antihypertensive drugs (1.75 ± 0.88 vs. 3 ± 1.14, p=0.038). Also, there were no significant differences regarding 2D echocardiography parameters in the two groups.

Conclusion

The results confirm that GH receptor blocker (Pegvisomant) has a better cardio-vascular outcome for the patients despite having similar quality of life scores compared to the SA group, the only difference being lower personal relations score assessed through ACRO-QoL questionnaire.