Evaluation of Hematological Indices in Acromegalic Patients

Year 2023, Volume: 18 Issue: 2, 87 - 92, 12.07.2023

Emek Topuz , Dilek Tüzün , Ümit Nur Özbay , Murat Şahin

https://doi.org/10.17517/ksutfd.1179747

Abstract

Objective: Acromegaly is a chronic systemic disease characterized by autonomous and excessive secretion of growth hormone (GH). Acromegaly is most
commonly caused by ais a somatotroph adenoma of the anterior pituitary. In acromegaly, mortality primarily results from are cerebrovascular, cardiovascular,
respiratory diseases and malignancies. Monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW),
platelet distribution width (PDW) and delta neutrophil index (DNI) are popular inflammatory markers. This study’s purpose was to assess pre/post-treatment
levels of NLR, GH, RDW, MLR, PDW and DNI in acromegalic patients and to investigate the impact of acromegaly treatment on these markers.
Materials and Methods: Twenty-six patients with acromegaly, treated and followed at our endocrinology outpatient clinic between April 2014 and February
2022 were included in the study. Age, sex, comorbidities, medications, complete blood count, kidney and liver function tests, pathology reports, tumor
size, pre/post-treatment levels of IGF-1, GH, DNI, NLR, MLR, RDW and PDW were retrieved from patients’ files and outcomes were evaluated.
Results: Among 26 patients included in the study, 12 (46%) were female and 14 (53%) were male. The average age of the patients was 53.73±16.21 years
(range, 25-79). There were 11 (42%) patients with type 2 diabetes mellitus and 9 (34%) patients with hypertension. A statistically significant reduction was
observed in post-operative GH, IGF-1, NLR, DNI, PDW and RDW values compared to preoperative values (during active disease phase) and at 6 months in
patients with postoperative cure, and compared to pretreatment values in patients without postoperative remission who received medical treatment. A reduction
was also observed in post-treatment MLR compared to pretreatment ratio but the difference was non-significant. There was no statistically significant
correlation between the IGF-1 levels at the time of diagnosis and NLR, RDW, PDW in patients with acromegaly.
Conclusion: Studies on the values of circulating inflammatory biomarkers in patients with acromegaly and their relationship to treatment remain unclear. In
our study, higher pre-treatment GH, IGF-1, NLR, DNI, PDW, RDW values were found compared to post- treatment. This suggests that having chronically
higher than normal values of IGF-1 may also lead to increased inflammatory markers such as NLR and increased atherosclerotic risk. Chronic subclinical
inflammation caused by uncontrolled disease might lead to an increase in mortality and morbidity in acromegalic patients. Therefore, early diagnosis and
treatment of acromegaly are crucial.

Keywords

Acromegaly, delta neutrophil index., monocyte/lymphocyte ratio, neutrophil/lymphocyte ratio

Project Number

Yok

Akromegali Hastalarında Hematolojik İndekslerin Değerlendirilmesi

Abstract

Amaç: Akromegali, genellikle hipofiz adenomu tarafından salgılanan otonom büyüme hormonu (BH) fazlalığı ile giden bir hastalıktır. Akromegalide mortalitenin
ana nedeni serebrovasküler, kardiyovasküler, solunum olayları ve malignitelerdir. Nötrofil/lenfosit oranı (NLR), monosit/lenfosit oranı (MLR), eritrosit
dağılım genişliği (RDW) ve trombosit dağılım genişliği (PDW), Delta nötrofil indeks (DNİ) popüler inflamasyon markerlarıdır. Bu çalışmada akromegali hastalarında
tedavi öncesi ve sonrasında IGF-1, BH, DNİ, NLR, MLR, RDW ve PDW parametrelerini inceleyerek değerlendirmeyi ve akromegali tedavisinin bu
parametreler üzerindeki etkisini araştırmayı amaçladık.
Gereç ve Yöntemler: Hastanemiz Endokrinoloji polikliniğinde Nisan 2014 -Şubat 2022 yıllarında takip ve tedavi edilen akromegali hastalarının dosyalarından
ve hastane kayıtlarından yaş, cinsiyet, ek hastalıkları, kullandığı ilaçlar, tam kan sayımı, böbrek fonksiyon testleri, karaciğer fonksiyon testleri, patoloji sonuçları,
tümör boyutları, ek komorbiditelerini kaydederek sonuçlarını değerlendirdik. Tedavi öncesi ve sonrasında rutin olarak elde edilmiş olan IGF-1, BH, DNİ, NLR,
MLR, RDW ve PDW düzeylerini inceleyerek karşılaştırdık.
Bulgular: Çalışmaya alınan toplam 26 hastanın, 12 si kadın (%46), 14 ü erkek (%53) idi. Hastaların yaşları 25 ile 79 (ortalama: 53.73±16.21 ) arasındaydı.
Hastaların 11 tanesinin (%42) tip 2 diyabetes mellitus, 9 tanesinin (%34) hipertansiyon tanısı mevcuttu. Hastaların cerrahi öncesi aktif hastalık döneminde ve
cerrahi sonrası kür olan hastaların 6. aydaki değerleri ile cerrahi sonrası remisyona girmeyen medikal tedavi alan hastaların, tedavi sonrası BH, IGF-1, NLR,
DNI, PDW, RDW değerlerinde tedavi öncesi değerlere göre istatistiksel olarak anlamlı düşüş izlendi. M/L oranında da tedavi sonrası değerler tedavi öncesi
değerlere göre düşmüştü fakat istatiksel olarak anlamlı değildi. Akromegali hastalarında tanı anındaki IGF-1 düzeyi ile NLR, RDW, PDW arasında istatiksel
olarak anlamlı bir ilişki saptanmadı.
Sonuç: Akromegalide kardiyovasküler hastalık sıklığı ve kardiyovasküler risk faktörleri artmıştır. Akromegali hastalarında dolaşımdaki inflamatuar belirteçlerin
düzeyleri ve bunların tedaviyle ilişkisi üzerine yapılan çalışmalar çelişkilidir. Bizim çalışmamızda GH, IGF-1, NLR, DNI, PDW, RDW değerlerinde tedavi
öncesinde tedavi sonrasına göre yüksek değer saptanmıştır. Yüksek seviyelerde IGF-1’e uzun süreli maruz kalmanın, NLR gibi inflamutuar belirteçlerde artış
ve aterosklerotik riskte artma ve buna bağlı olarak artmış kardiyovasküler riske de yol açabileceğini düşündürmektedir. Kontrolsüz hastalığa bağlı subklinik inflamasyondaki
artışlar, akromegali hastalarında artan morbidite ve mortaliteye katkıda bulunabilir. Bu nedenle akromegalide erken tanı ve tedavi çok önemlidir.

Keywords

Akromegali, ,delta nötrofil indeks, ,monosit/lenfosit oranı, nötrofil/lenfosit oranı

Supporting Institution

Yok

Project Number

Yok

References

• Hoskuldsdottir GT, Fjalldal SB, Sigurjonsdottir HA. The incidence and prevalence of acromegaly, a nationwide study from 1955 through 2013. Pituitary. 2015;18(6):803–807.
• Lavrentaki A, Paluzzi A, Wass JAH, Karavitaki N. Epidemiology of acromegaly: Review of population studies. Pituitary. 2017;20(1):4–9.
• Hipofiz çalışma grubu. Hipofiz Hastaliklari Tanı, Tedavi ve İzlem Kılavuzu. Ankara, 2020.
• Kim TY, Kim SJ, Kim YS, Lee JW, Park EJ, Lee SJ et al. Delta neutrophil index as an early predictive marker of severe acute pancreatitis in the emergency department. United Eur Gastroenterol J. 2019;7(4):488–495.
• Kim H, Kim Y, Lee HK, Kim KH, Yeo CD. Comparison of the delta neutrophil index with procalcitonin and C-reactive protein in sepsis. Clin Lab. 2014;60(12):2015–2021.
• Akbas EM, Demirtas L, Ozcicek A, Timuroglu A, Bakirci EM, Hamur H et al. Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med. 2014;7(7):1794–1801.
• Demirtas L, Degirmenci H, Akbas EM, Ozcicek A, Timuroglu A, Gurel A et al. Association of hematological indicies with diabetes, impaired glucose regulation and microvascular complications of diabetes. Int J Clin Exp Med. 2015;8(7):11420–11427.
• Akyel A, Yayla Ç, Erat M, Çimen T, Doğan M, Açıkel S et al. Neutrophil-to-lymphocyte ratio predicts hemodynamic significance of coronary artery stenosis. Anatol J Cardiol. 2015;15(12):1002–1007.
• Oylumlu M, Yıldız A, Oylumlu M, Yüksel M, Polat N, Bilik MZ et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol. 2015;15(4):277–283.
• Ural ÜM, Şehitoğlu İ, Tekin YB, Şahin FK. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in patients with endometrial hyperplasia and endometrial cancer. J Obstet Gynaecol Res. 2015;41(3):445–448.
• Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012;23(4):265–273.
• Wolters TLC, van der Heijden CDCC, van Leeuwen N, Hijmans-Kersten BTP, Netea MG, Smit JW, et al. Persistent inflammation and endothelial dysfunction in patients with treated acromegaly. Endocr Connect. 2019;8(12):1553–1567.
• Verhelst J, Velkeniers B, Maiter D, Haentjens P, T’Sjoen G, Rietzschel E et al. Active acromegaly is associated with decreased hs-CRP and NT-proBNP serum levels: insights from the Belgian registry of acromegaly. Eur J Endocrinol. 2013;168(2):177–184.
• Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638–1843.
• Liu J, Du J, Fan J, Liu K, Zhang B, Wang S et al. The Neutrophil-to-Lymphocyte Ratio Correlates with Age in Patients with Papillary Thyroid Carcinoma. ORL J Otorhinolaryngol Relat Spec. 2015;77(2):109–116.
• Yue S, Zhang J, Wu J, Teng W, Liu L, Chen L. Use of the Monocyte-to-Lymphocyte Ratio to Predict Diabetic Retinopathy. Int J Environ Res Public Health. 2015 Aug 21;12(8):10009–10019.
• Song CS, Park D Il, Yoon MY, Seok HS, Park JH, Kim HJ, et al. Association between red cell distribution width and disease activity in patients with inflammatory bowel disease. Dig Dis Sci. 2012;57(4):1033–1038.
• Bekler A, Ozkan MTA, Tenekecioglu E, Gazi E, Yener AU, Temiz A et al. Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome. Angiology. 2015;66(7):638–643.
• Lee SJ, Park EJ, Lee KJ, Cha YS. The delta neutrophil index is an early predictive marker of severe acute cholecystitis. Dig Liver Dis. 2019;51(11):1593–1598.
• Yune HY, Chung SP, Park YS, Chung HS, Lee HS, Lee JW et al. Delta neutrophil index as a promising prognostic marker in out of hospital cardiac arrest. PLoS One. 2015;10(3):e0120677.
• Kong T, Kim TH, Park YS, Chung SP, Lee HS, Hong JH et al. Usefulness of the delta neutrophil index to predict 30-day mortality in patients with ST segment elevation myocardial infarction. Sci Rep. 2017;7(1):15718.
• Boero L, Cuniberti L, Magnani N, Manavela M, Yapur V, Bustos M et al. Increased oxidized low density lipoprotein associated with high ceruloplasmin activity in patients with active acromegaly. Clin Endocrinol (Oxf). 2010;72(5):654–660.
• Arikan S, Bahceci M, Tuzcu A, Gokalp D. Serum tumour necrosis factor-alpha and interleukin-8 levels in acromegalic patients: acromegaly may be associated with moderate inflammation. Clin Endocrinol (Oxf). 2009;70(3):498–499.
• Unübol M, Güney E, Türe M, Eryılmaz U. Mean platelet volume and arterial stiffness in patients with acromegaly. Anadolu Kardiyol Derg. 2014;14(5):456–463.
• Üçler R, Aslan M, Atmaca M, Alay M, Ademoğlu EN, Gülşen I. Evaluation of blood neutrophil to lymphocyte and platelet to lymphocyte ratios according to plasma glucose status and serum insulin-like growth factor 1 levels in patients with acromegaly. Hum Exp Toxicol. 2016;35(6):608–612.
• Akyay ÖZ, Selek A, Batman A, Çetinarslan B, Cantürk Z, Tarkun İ. Hematological Indices and Their Relationship with Treatment in Acromegaly Patients. Kocaeli Med J. 2021;10(60):5–11.