Prevalence of neoplasms in acromegaly: a Turkish single-center retrospective study

Year 2025, Volume: 7 Issue: 1, 33 - 36, 10.01.2025

Gülsüm Yüzbaşıoğlu Mirza , Mümtaz Takır , Cündullah Torun , Özgür Bahadır

https://doi.org/10.38053/acmj.1571279

Abstract

Aims: This study aimed to investigate the prevalence of benign and malignant neoplasms and to assess associated clinical conditions in patients with acromegaly.
Methods: In this single center, retrospective and observational study, data from 71 patients with acromegaly followed at an endocrinology and metabolism diseases outpatient clinic between January 2010 and December 2023 were reviewed through the hospital's electronic database. Patients' medical histories, demographic data, blood examinations, medications, pituitary MRI scans, thyroid ultrasound, mammography, colonoscopy, endoscopy, and pathology reports were evaluated. Acromegaly diagnosis was based on elevated insulin-like growth factor-1 (IGF-1) levels and unsuppressed growth hormone (GH) levels after oral glucose tolerance testing. The chi-square test and Mann-Whitney U test were used to compare patients with malignancy to other patients in terms of demographic and clinical characteristics.
Results: The study included predominantly female patients (60.6%) with an average age of 55.6 years. The mean age at diagnosis was 44.3±11.3 years, and the mean disease duration was 11.3±8.4 years. Malignancies, including breast, thyroid, and colorectal cancers, were detected in 9.9% of patients. Additionally, thyroid nodules were present in 62% of patients, and colon polyps in 14.1%. No significant differences were observed in clinical features including age, gender, disease duration, GH levels, IGF-1 levels, adenoma size, or remission frequency between patients with and without malignancy (p>0.05 for all).
Conclusion: This study reveals an increased prevalence of breast, colon, and thyroid cancers in patients with acromegaly.
Performing cancer screenings in patients with acromegaly more comprehensively and at an earlier stage compared to the normal
population may be beneficial.

Keywords

Acromegaly, neoplasm, cancer screening

References

• Chanson P, Salenave S. Acromegaly. Orphanet J Rare Dis. 2008;25(3):1-17.
• Kasuki L, Rocha PDS, Lamback EB, Gadelha MR. Determinants of morbidities and mortality in acromegaly. Arch Endocrinol Metab. 2019; 63(6):630-637.
• Fleseriu M, Langlois F, Lim DST, Varlamov EV, Melmed S. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol. 2022;10(11):804-826.
• Mizera Ł, Elbaum M, Daroszewski J, Bolanowski M. Cardiovascular complications of acromegaly. Acta Endocrinol (Buchar). 2018;14(3):365-374.
• Giovanucci E. Insulin, insulin- like growth factors and colon cancer: a review of the evidence. J Nutr. 2001;131(11 Suppl):3109S-3120S.
• Ron E, Gridley G, Hrubec Z, Page W, Arora S, Fraumeni JF. Acromegaly and gastrointestinal cancer. Cancer. 1991;68(8):1673-1677.
• Baris D, Gridley G, Ron E, et al. Acromegaly and cancer risk: a cohort study in Sweden and Denmark. Cancer Causes Control. 2002;13(5):395-400.
• Wolinski K, Czarnywojtek A, Ruchala M. Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly--meta-analysis and systematic review. PLoS One. 2014;9(2):e88787.
• Rokkas T, Pistiolas D, Sechopoulos P, Margantinis G, Koukoulis G. Risk of colorectal neoplasm in patients with acromegaly: a meta-analysis. World J Gastroenterol. 2008;14(22):3484-3489.
• Ritvonen E, Löyttyniemi E, Jaatinen P, et al. Mortality in acromegaly: a 20-year follow-up study. Endocr Relat Cancer. 2016;23(6):469-480.
• Dekkers OM, Biermasz NR, Pereira AM, Romijn JA, Vandenbroucke JP. Mortality in acromegaly: a metaanalysis. J Clin Endocrinol Metab. 2008; 93(1):61-67.
• Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102-152.
• Baldys-Waligórska A, Krzentowska A, Gołkowski F, Sokołowski G, Hubalewska-Dydejczyk A. The prevalence of benign and malignant neoplasms in acromegalic patients. Endokrynol Pol. 2010;61(1):29-34.
• Gullu BE, Celik O, Gazioglu N, Kadioglu P. Thyroid cancer is the most common cancer associated with acromegaly. Pituitary. 2010;13(3):242-248.
• Woliński K, Stangierski A, Gurgul E, et al. Thyroid lesions in patients with acromegaly - case-control study and update to the meta-analysis. Endokrynol Pol. 2017;68(1):2-6.
• Ruchała M, Szczepanek-Parulska E, Fularz M, Woliński K. Risk of neoplasms in acromegaly. Contemp Oncol (Pozn). 2012;16(2):111-117.
• Pizzato M, Li M, Vignat J, et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol. 2022;10(4):264-272.
• Popovic V, Damjanovic S, Micic D, et al. Increased incidence of neoplasia in patients with pituitary adenomas. The pituitary study group. Clin Endocrinol. 1998;49(4):441-445.
• Terzolo M, Reimondo G, Berchialla P, et al. Acromegaly is associated with increased cancer risk: a survey in Italy. Endocr Relat Cancer. 2017; 24(9):495-504.
• Nabarro JD. Acromegaly. Clin Endocrinol. 1987;26(4):481-512.
• Jenkins PJ, Fairclough PD, Richards T, et al. Acromegaly, colonic polyps and carcinoma. Clin Endocrinol (Oxf). 1997;47(1):17-22.
• Can M, Kocabaş M, Karakose M, et al. Thyroid nodules in patients with acromegaly: frequency according to the ACR TI-RADS classification and its relationship with disease activity. Exp Clin Endocrinol Diabetes. 2021;129(12):931-936.
• Klein I, Parveen G, Gavaler JS, Vanthiel DH. Colonic polyps in patients with acromegaly. Ann Intern Med. 1982;97(1):27-30.
• Ramos O Jr, Boguszewski CL, Teixeira S, De Bem R, Parolim B, Prolla JC. Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study. Arq Gastroenterol. 2009;46(2):90-96.
• Renehan AG, Brennan BM. Acromegaly, growth hormone and cancer risk. Best Pract Res Clin Endicrinol Metab. 2008;22(4):639-657.
• Clayton PE, Banerjee I, Murray PG, Renehan AG. Growth hormone, the insulin-like growth factor axis, insulin and cancer risk. Nat Rev Endocrinol. 2011;7(1):11-24.
• Christopoulos PF, Msaouel P, Koutsilieris M. The role of the insulin-like growth factor-1 system in breast cancer. Mol Cancer. 2015;14(1):43.