Endocrine Abstracts

Purpose: Acromegalic patients carry a high burden of cardiovascular, metabolic, and neoplastic diseases, but there are limited studies focusing on morphological and functional changes in the kidneys.

Methods: The data of acromegalic patients followed over a 43-year period at our center were examined for the development of chronic kidney disease (CKD), renal cysts, and urological cancers.

Results: A total of 394 patients (202M/192F, mean age at diagnosis: 41.1±12.3 years, median duration of disease: 17-years) were included in the study. The median GH and IGF-1 levels at diagnosis were 12.1 ng/mL and 891.6 ng/mL, respectively. The majority (77.1%) of the patients had a pituitary macroadenoma, with a median diameter of 15 mm (range: 2-51 mm). At least one renal cyst was observed in 41% of the patients (size: 2-90 mm), with 47.4% located bilaterally. In the multiple regression model (MRM) analyzing the development of renal cysts, advanced age (OR:1.04, P<0.001), nephrolithiasis (OR:2.45, P=0.018), liver cyst (OR: 2.65, P=0.008), and multiple neoplasia (OR:1.91, P=0.045) were defined as independent risk factors. A 1 mEq/l increase in serum potassium level at diagnosis correlated with a 57.1% lower risk of renal cyst development (OR:0.429, P=0.028). CKD and nephrolithiasis were detected in 16.1% and 15.1% of the patients, respectively. Advanced age (OR:1.052, P=0.005), male gender (OR:3.575, P<0.001), and hypertension (OR:2.786, P=0.007) were determined as independent risk factors for CKD. In patients with and without CKD or renal cysts, levels of GH and IGF-1 at baseline, during follow-up, and at the last visit were comparable. Among the 65 (16.5%) acromegalic patients followed with a cancer diagnosis, urological cancers were detected in 8 cases (7M/1F). Following thyroid cancer urological cancers were the second most common in our series, including 3 renal cell carcinomas (RCC), 2 ureteral cancers, 2 bladder cancers, and 1 renal PEComa. The median age of patients with urological cancers was 68 (42-77) years, and the duration of acromegaly was 22.5 (10-37) years. In all three cases with RCC, there were also second primaries including papillary thyroid cancer, pancreatic cancer, and rectal cancer.

Conclusion: Our findings suggest that renal cysts are more prevalent in acromegalic patients compared to the general population, possibly indicating tubular dysfunction and morphological changes in the kidneys associated with chronic exposure to high levels of GH and IGF-1. The occurrence of urological cancers as the second most frequent type of cancer highlights the need for surveillance of acromegalic patients in this regard.