Akromegalik hastaların kolonoskopik değerlendirmesi: tek merkez deneyimi

Year 2023, Volume: 4 Issue: 5, 395 - 399, 27.10.2023

Yasemin Emür Günay , Serdar Durak , Arif Mansur Coşar , Murat Erkut , Sami Fidan

https://doi.org/10.47582/jompac.1345430

Abstract

Amaç: Akromegalili hastalarda kolonoskopik taramanın önemini ve gerekliliğini araştırmak.
Yöntemler: Bu çalışmaya Ocak 2008-Ocak 2021 tarihleri arasında Karadeniz Teknik Üniversitesi Gastroenteroloji Anabilim Dalı'nda tarama kolonoskopisi yapılan 82 akromegali hastası ve kontrol grubu olarak da 82 sağlıklı birey dahil edildi.
Bulgular: Hastaların akromegali tanısı anında ortalama yaşı 45.71 ± 12.61 idi. Hastaların %51,2'si (n=42) kadındı. Akromegali grubunda polip varlığı ve yetersiz barsak hazırlığı gibi anormal bulgular kontrol grubuna göre anlamlı olarak daha sıktı (p<0,05). Yetersiz barsak hazırlığı saptanan akromegali hastalarında tanı anında ölçülen GH düzeyi anlamlı olarak yüksekti (p<0,05). Polip dışı kolonoskopi bulguları, polip lokalizasyonu, histolojik tipler ve kolorektal kanser açısından iki grup arasında anlamlı fark yoktu.
Sonuç: Akromegalili hastalarda (özellikle tanı anında büyüme hormonı yüksek olanlarda) yetersiz barsak hazırlığı oranı daha yüksek olduğundan, barsak hazırlığının standart barsak hazırlığından farklı bir yaklaşımla yapılması bu hasta grubunda daha uygun olacaktır.

Keywords

Akromegali, Kolonoskopi, Büyüme hormonu, Kolon polipleri

Colonoscopic evaluation of acromegalic patients: a single center experience

Abstract

Aim: To investigate the importance and necessity of colonoscopic screening in patients with acromegaly.
Methods: This study included 82 patients with acromegaly and, 82 healthy individuals as the control group who underwent screening colonoscopy in the Gastroenterology Department of Karadeniz Technical University, between January 2008-January 2021.
Results:The mean age of the patients was 45.71 ± 12.61 years at the time of acromegaly diagnosis. 51.2% (n=42) of patients were female. Abnormal findings including evidence of polyps, and inadequate bowel preparation were significantly more common in the acromegaly group than the control(p<0,05). The GH level measured at the time of diagnosis was significantly higher in patients with acromegaly diagnosed with inadequate bowel preparation (p<0,05). There was no significant difference between the two groups in non-polyp colonoscopy findings, polyp localization, histologic types and colorectal cancer.
Conclusion: It would be reasonable to perform bowel preparation in patients with acromegaly (especially those with high GH at the time of diagnosis) using an approach different from standard bowel preparation, as the rate of inadequate bowel preparation is higher in this group of patients.

Keywords

Acromegaly, Colonoscopy, Growth hormone, Colon Polips

References

• Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006;91(12):4769-4775.
• Ochiai Y, Inoshita N, Iizuka T, et al. Clinicopathological features of colorectal polyps and risk of colorectal cancer in acromegaly. Eur J Endocrinol. 2020;182(3):313-318.
• Giustina A, Barkan A, Beckers A, et al. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. J Clin Endocrinol Metab. 2020;105(4):e937-946.
• Arlien-Søborg MC, Dal J, Madsen MA, et al. Reversible insulin resistance in muscle and fat unrelated to the metabolic syndrome in patients with acromegaly. EBioMedicine. 2022;75;103763.
• Ji X, Fu J, Li X, Yuan K, Sun X, Yao Q. Serum biomarkers of colonic polyps in patients with acromegaly: a meta-analysis and systematic review. Pituitary. 2023;26(1):1-8.
• Kasuki L, Maia B, Gadelha MR. Acromegaly and colorectal neoplasm: an update. review. Front Endocrinol. 2022;13:924952.
• Peng G, Li X, Zhou Y, et al. Clinical characteristics and associated factors of colonic polyps in acromegaly. Exp Clin Endocrinol Diabetes. 2022;130(11):714-722.
• Ortego J, Vega B, Sampedro J, Escalada J, Boixeda D, Varela C. Neoplastic colonic polyps in acromegaly. Horm Metab Res. 1994;26(12):609-610.
• Katznelson L, Laws Jr ER, Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-3951.
• Gordon MB, Nakhle S, Ludlam WH. Patients with acromegaly presenting with colon cancer: a case series. Case Rep Endocrinol. 2016;2016:5156295.
• Renehan A, O’Dwyer S, Shalet S. Guidelines for colonoscopic screening in acromegaly are inconsistent with those for other high risk groups. Gut. 2003;52(7):1071-1072.
• Kasuki L, Rocha P, Lamback E, Gadelha M. Determinants of morbidities and mortality in acromegaly. Arch Endocrinol Metab. 2019;63(6):630-637.
• Bolfi F, Neves AF, Boguszewski CL, Nunes-Nogueira VS. Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis. Eur J Endocrinol. 2019;181(5):L5-L6.
• Koksal AR, Ergun M, Boga S, et al. Increased prevalence of colorectal polyp in acromegaly patients: a case-control study. Diagn Ther Endosc. 2014;2014:152049.
• Yamamoto M, Fukuoka H, Iguchi G, et al. The prevalence and associated factors of colorectal neoplasms in acromegaly: a single center based study. Pituitary. 2015;18(3):343-351.
• Kurimoto M, Fukuda I, Hizuka N, Takano K. The prevalence of benign and malignant tumors in patients with acromegaly at a single institute. Endocr J. 2008;55(1):67-71.
• Lois K, Bukowczan J, Perros P, Jones S, Gunn M, James RA. The role of colonoscopic screening in acromegaly revisited: review of current literature and practice guidelines. Pituitary. 2015;18(4):568-574.
• Renehan AG, Bhaskar P, Painter JE, et al. The prevalence and characteristics of colorectal neoplasia in acromegaly. J Clin Endocrinol Metab. 2000;85(9):3417-3424.
• Ochiai Y, Inoshita N, Iizuka T, et al. Clinicopathological features of colorectal polyps and risk of colorectal cancer in acromegaly. Eur J Endocrinol. 2020;182(3):313-318.
• Wassenaar M, Cazemier M, Biermasz N, et al. Acromegaly is associated with an increased prevalence of colonic diverticula: a case-control study. J Clin Endocrinol Metab. 2010;95(5):2073-2079.
• Veysey M, Thomas L, Mallet A, et al. Prolonged large bowel transit increases serum deoxycholic acid: a risk factor for octreotide induced gallstones. Gut. 1999;44(5):675-681.
• Jensen EA, Young JA, Kuhn J, et al. Growth hormone alters gross anatomy and morphology of the small and large intestines in age-and sex-dependent manners. Pituitary. 2022;25(1):116-130.