Aortic intima media thickness increases and is independently related to insulin-like growth factor-1 level in patients with acromegaly

Year 2019, Volume: 44 Issue: Supplement 1, 100 - 107, 29.12.2019

Hilmi Erdem Sümbül , Derya Demirtaş

https://doi.org/10.17826/cumj.553729

Cited By: 1

Abstract

Purpose: In our article, we aimed to identify whether there is an increase in intima-media thickness (IMT) measured from the abdominal aorta in patients with acromegaly and to identify the parameters closely related to the aortic IMT (AIMT).

Materials and Methods: 52 patients with acromegaly and 46 healthy controls were included. For all participants, all the necessary laboratory tests were done for acromegaly. On vascular ultrasound examination, the internal carotid IMT, common-carotid IMT, and aortic IMT (AIMT) were measured. The study population was divided into 3 different groups; control group (Group I), acromegaly patients in remission (Group II) and acromegaly patients with active disease (group-III). 

Results: The incidence of hypertension, diabetes, and smoking was higher in Group-II-III than Group I. Insulin-like growth factor-1 (IGF-1) levels were increased from Group I to III and there was a significant difference between all groups. Common-carotid IMT and internal carotid IMT values were not significantly different between the groups. The AIMT value in Group III patients was statistically higher than the other two groups. The AIMT was similar between Groups I to II. Only the IGF-1 level was found to be independently associated with AIMT. 

Conclusion: In patients with active acromegaly disease, AIMT is significantly elevated without elevation of carotid IMT, and AIMT is independently associated with serum IGF-1 levels. AIMT could be a useful study to show the presence of early subclinical atherosclerosis in acromegaly patients.

Keywords

Acromegaly, ultrasonography, aortic intima-media thickness

Akromegali hastalarında aort intima media kalınlığı artmıştır ve insülin benzeri büyüme faktörü-1 düzeyi ile bağımsız olarak ilişkilidir

Abstract

Amaç: Çalışmamızda akromegali hastalarında abdominal aorttan ölçülen intima-media kalınlığında (IMK) bir artış olup olmadığını ve aort IMK(AIMK) ile yakından ilişkili parametreleri tanımlamayı amaçladık.

Gereç ve Yöntem: Çalışmaya 52 akromegali hastası ve 46 sağlıklı kontrol dahil edildi. Tüm katılımcılara akromegali için gerekli tüm laboratuvar testleri yapıldı. Vasküler ultrason incelemesinde internal karotid IMK, kommon karotid IMK ve AIMK ölçüldü. Çalışmaya dahil edilenler 3 gruba ayrıldı; kontrol grubu (Grup I), remisyondaki akromegali hastaları (Grup II) ve aktif hastalığı olan akromegali hastaları(Grup-III). 

Bulgular: Grup II-III’te hipertansiyon, diyabet ve sigara içme sıklığı Grup I’den daha yüksek saptandı. İnsülin benzeri büyüme faktörü-1 (IBBF-1) düzeyleri Grup I'den III'e doğru yükseliyordu ve tüm gruplar arasında anlamlı fark vardı. Gruplar arasında kommon-karotid IMK ve internal karotid IMK değerleri arasında anlamlı bir farklılık saptanmadı. Grup III hastalarında AIMK değerleri diğer gruplara göre istatistiksel olarak daha yüksek saptandı. AIMK grup I ve grup II hastalarında benzerdi. IBBF-1 düzeyi sadece AIMK ile bağımsız olarak ilişkili saptandı. 

Sonuç: Aktif akromegali hastalığı olanlarda karotid IMK artışı olmadan aortik IMK’da belirgin bir artış olmaktadır ve bu artış serum IBBF-1 düzeyleri ile bağımsız olarak ilişkilidir. AIMK, akromegali hastalarında erken subklinik ateroskleroz varlığını göstermek için yararlı bir çalışma olabilir.

Keywords

Akromegali, ultrasonografi, aort intima media kalınlığı, karotis intima media kalınlığı

References

• 1. Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, et al. Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99:3933-3951.
• 2. Koc AS, Gorgulu FF, Donmez Y, Icen YK. There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima-media thickness in hypertensive patients. J Med Ultrason (2001). 2018.
• 3. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. The Cardiovascular Health Study Collaborative Research Group. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340:14–22.
• 4. Avagnina P, Martini M, Terzolo M, Sansoé G, Peretti P, Tinivella M, et al. Assessment of functional liver mass and plasma flow in acromegaly before and after long-term treatment with octreotide. Metabolism. 1996; 45:109-113.
• 5. ArosioM, Reimondo G, Malchiodi E, Berchialla P, Borraccino A, De Marinis L, et al. Predictors of morbidity and mortality in acromegaly: an Italian survey. Eur J Endocrinol. 2012; 167:189–198.
• 6. Fieffe S, Morange I, Petrossians P, Chanson P, Rohmer V, Cortet C, et al. Diabetes in acromegaly, prevalence, risk factors, and evolution: data from the French Acromegaly Registry. Eur J Endocrinol. 2011; 164:877–884.
• 7. Vitale G, Pivonello R, Auriemma RS, Guerra E, Milone F, Savastano S, et al. Hypertension in acromegaly and in the normal population: prevalence and determinants. Clin Endocrinol (Oxf). 2005; 63:470–476.
• 8. Tan KC, Shiu SW, Janus ED, Lam KS. LDL subfractions in acromegaly: relation to growth hormone and insulin-like growth factor-I. Atherosclerosis. 1997; 129:59–65.
• 9. Demirpence M, Guler A, Yilmaz H, Sayin A, Pekcevik Y, Turkon H, et al. Is elevated urotensin II level a predictor for increased cardiovascular risk in subjects with acromegaly? J Endocrinol Invest. 2018.
• 10. Ozkan C, Altinova AE, Cerit ET, Yayla C, Sahinarslan A, Sahin D, et al. Markers of early atherosclerosis, oxidative stress and inflammation in patients with acromegaly. Pituitary. 2015; 18:621-629.
• 11. De Martino MC, Auriemma RS, Brevetti G, Vitale G, Schiano V, Galdiero M, et al. The treatment with growth hormone receptor antagonist in acromegaly: effect on vascular structure and function in patients resistant to somatostatin analogues. J Endocrinol Invest. 2010; 33:663-670.
• 12. Kartal I, Oflaz H, Pamukçu B, Meriç M, Aral F, Ozbey N, et al. Investigation of early atherosclerotic changes in acromegalic patients. Int J Clin Pract. 2010; 64:39-44.
• 13. Colao A, Marzullo P, Lombardi G. Effect of a six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. Eur J Endocrinol. 2002; 146:303-309.
• 14. Yaron M, Izkhakov E, Sack J, Azzam I, Osher E, Tordjman K, et al. Arterial properties in acromegaly: relation to disease activity and associated cardiovascular risk factors. Pituitary. 2016; 19:322-331.
• 15. Ozkan H, Celik O, Hatipoglu E, Kantarci F, Kadioglu P. Procalcitonin can be used as a marker of premature atherosclerosis in acromegaly. Pituitary. 2012; 15:358-64.
• 16. Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Rönnemaa T, Hartiala JJ, et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation. 2001; 104:2943–2947.
• 17. Mestron A, Webb SM, Astorga R, Benito P, Catala M, Gaztambide S, et al. Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). Eur J Endocrinol. 2004; 151:439–446.
• 18. Mosca S, Paolillo S, Colao A, Bossone E, Cittadini A, Iudice FL, et al. Cardiovascular involvement in patients affected by acromegaly: an appraisal. Int J Cardiol. 2013; 167:1712–1718.
• 19. Kamenicky P, Mazziotti G, Lombes M, Giustina A, Chanson P. Growth hormone, insulin-like growth factor-1, and the kidney: pathophysiological and clinical implications. Endocr Rev 2014;35: 234- 81.
• 20. Antoniazzi F, Monti E, Venturi G, Franceschi R, Doro F, Gatti D, et al. GH in combination with bisphosphonate treatment in osteogenesis imperfecta. Eur J Endocrinol. 2010; 163:479-487.
• 21. Gasser TC, Ogden RW, Holzapfel GA. Hyperelastic modelling of arterial layers with distributed collagen fibre orientations. J R Soc Interface. 2006; 3:15-35.
• 22. Labropoulos N, Zarge J, Mansour MA, Kang SS, Baker WH. Compensatory arterial enlargement is a common pathobiologic response in early atherosclerosis. Am J Surg. 1998; 176:140-143.
• 23. Astrand H, Rydén-Ahlgren A, Sundkvist G, Sandgren T, Länne T. Reduced aortic wall stress in diabetes mellitus. Eur J Vasc Endovasc Surg. 2007; 33:592-598. 24. McGill HC Jr, McMahan CA, Herderick EE, Tracy RE, Malcom GT, Zieske AW, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000; 20:836-845.
• 24. McGill HC Jr, McMahan CA, Herderick EE, Tracy RE, Malcom GT, Zieske AW, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000; 20:836-845.