SFEEU2024 Society for Endocrinology Clinical Update 2024 Workshop B: Disorders of the hypothalamus and pituitary (II) (15 abstracts)
Endocrine metabolic disorders secondary to acromegaly, description of a clinical case in a south american patient
Anderson Felipe Arias Ariza , María Juliana Estévez Gómez , Diego Andrey Acevedo Peña , Silvia Fernanda Castillo Goyeneche , Luis Andres Dulcey , Jaime Gomez Ayala , Maria Camila Amaya , Emily Gutierrez , Maria Camila Gomez Contreras , Juan Alejandro Gomez Contreras , Juan Sebastian Theran Leon , Gabriela Sofia Ramos Caballero , Juan Sebastian Ramos Caballero , Laura Nathalia Gutierrez , Angie Lizcano , Maria Paula Ciliberti & Camilo Blanco
Autonomous University of Bucaramanga, Bucaramanga, Colombia
Introduction: Acromegaly is caused by excessive secretion of growth hormone (GH), usually by a pituitary adenoma, and a concomitant excess of insulin-like growth factor 1 (IGF-1). Excess GH and IGF-1 exert many actions on the cardiovascular (CV) system and especially on cardiovascular disease (CVD) risk factors which are common, especially in active acromegaly, but often persist after adequate treatment in patients with controlled disease.
Clinical case: This is a male patient in the fifth decade of life with a history of acromegaly under pharmacological management as well as heart failure with LVEF of 15%, type 2 diabetes requiring insulin, angioplasty of the anterior descending and circumflex artery at cardiac level and management with angioplasty of the two carotid arteries presented simultaneously at the age of 42 years. She is under management for comorbidities. Currently with a NYHA class III with contraindication for surgical management of pituitary adenoma due to high surgical risk. She is being managed with octreotide and cabergoline by Endocrinology. Continued management by Cardiology and Internal Medicine.
Discussion: In large population cohorts, normal or high IGF-1 levels are associated with lower prevalence of cardiovascular risk factors (CVD) and mortality. IGF-1 administration shows protective effects, but both low and supraphysiological levels are associated with risks. IGF-1 resistance in dysmetabolic states explains contradictory associations between IGF-1 and CVD. In higher risk populations, the relationship between IGF-1 and blood pressure is inverse, changing in cohorts with elevated IGF-1 levels, such as in patients with acromegaly. Although an independent effect of excess HC/IGF-1 on the vasculature has not been demonstrated, controlled and uncontrolled acromegaly is associated with microvascular damage, endothelial dysfunction, and proinflammatory changes. The underlying mechanisms involve metabolic alterations, oxidative stress and inflammation. This case report highlights the importance of analyzing the cardiovascular effects of acromegaly and the need for comprehensive risk factor management.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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