Malign and benign tumor frequency in patients with acromegaly

Yıl 2020, Cilt: 13 Sayı: 2, 415 - 423, 14.05.2020

Nusret Yılmaz Gökhan Tazegül Ramazan Sarı Hasan Altunbaş Mustafa Balcı

https://doi.org/10.31362/patd.656681

Öz

Purpose: The aim of this study was to determine the prevalence of benign and malignant tumors in acromegaly patients in a single center.
Materials and Methods: Records of 92 patients with acromegaly were retrospectively reviewed. Main clinical characteristics of the patients and characteristics and frequency of benign and malignant tumors were evaluated.
Results: Median age of patients was 51 (26-83) years, 52 (56.5%) were female and 40 (43.5%) were male. 4.3% (n=4) of the patients had a malignancy. All malignancies were thyroid papillary carcinoma. 76.1% of the patients had at least one benign tumor. Of patients underwent specific imaging modalities, thyroid nodules was present in 76% (n=57) of patients who underwent thyroid ultrasography (n=74), colon polyps was present in 21.4% (n=15) of patients who underwent colonoscopy (n=70), gallbladder polyps were present in 5.5% (n = 4) of patients who underwent abdominal ultrasonography (n=72) and benign breast lesions were found in 11.5% (n=6) of women who underwent breast imaging (n=52).
Conclusion: There is an increased risk of thyroid nodules and thyroid cancer in patients with acromegaly. Therefore, acromegaly patients should be actively monitored for thyroid nodules, and if suspicious findings are detected on ultrasonography, they should be evaluated further.

Anahtar Kelimeler

Acromegaly, Tumor, Thyroid cancer

Akromegali hastalarında benign ve malign tümör sıklığı

Öz

Amaç: Bu çalışmada tek bir merkezde izlenen akromegali hastalarındaki benign ve malign tümör sıklığının belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Toplam 92 akromegali hastasının kayıtları retrospektif olarak incelendi. Hastaların temel klinik karakteristikleri ile hastalarda mevcut olan benign ve malign tümörlerin özellikleri ve sıklıkları değerlendirildi.
Bulgular: Hastaların medyan yaşları 51 (26-83) yıl , 52’si (%56,5) kadın ve 40’ı (%43,5) erkek idi. Hastaların %4,3’ünde (n=4) malignite mevcuttu. Saptanan malignitelerin tümü tiroid papiller karsinomu idi. Hastaların %76,1’inde en az bir benign tümör vardı. Tiroid ultrasonografisi (USG) yapılan hastaların (n=74) %76’sında (n=57) tiroid nodülü, kolonoskopi yapılan hastaların (n=70) %21,4’ünde (n=15) kolon polipi, abdominal USG yapılan hastaların (n=72) %5,5’inde (n=4) safra kesesi polipi, meme görüntülemesi yapılan kadınların (n=52) %11,5’inde (n=6) benign meme lezyonu mevcuttu.
Sonuç: Sonuç olarak akromegali hastalarında artmış tiroid nodülü ve tiroid kanseri riski mevcuttur. Bu nedenle akromegali hastaları tiroid nodülü yönünden aktif olarak izlenmeli, USG’de şüpheli bulgular saptanması durumunda ince iğne aspirasyon biyopsisi ile değerlendirilmelidir.

Anahtar Kelimeler

Akromegali, Tümör, Tiroid kanseri

Kaynakça

• Referans1. Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab 1998;83:2730-2734. DOI: 10.1210/jcem.83.8.5007
• Referans2. 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;55:67-71. DOI: 10.1507/endocrj.k07e-010
• Referans3. Terzolo M, Reimondo G, Berchialla P, Ferrante E, Malchiodi E, De Marinis L, et al. Acromegaly is associated with increased cancer risk: a survey in Italy. Endocr Relat Cancer 2017;24:495-504. DOI: 10.1530/ERC-16-0553
• Referans4. Wolinski K, Stangierski A, Dyrda K, et al. Risk of malignant neoplasms in acromegaly: a case-control study. J Endocrinol Invest 2017;40:319-322. DOI: 10.1007/s40618-016-0565-y
• Referans5. 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:e88787. DOI: 10.1371/journal.pone.0088787
• Referans6. 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;14:3484-3489. DOI: 10.3748/wjg.14.3484
• Referans7. Petrossians P, Daly AF, Natchev E, et al. Acromegaly at diagnosis in 3173 patients from the Liege Acromegaly Survey (LAS) Database. Endocr Relat Cancer 2017;24:505-518. DOI: 10.1530/ERC-17-0253
• Referans8. Chopin LK, Veveris-Lowe TL, Philipps AF, Herington AC. Co-expression of GH and GHR isoforms in prostate cancer cell lines. Growth Horm IGF Res. 2002;12:126-136. DOI: 10.1054/ghir.2002.0271
• Referans9. Slater M, Cooper M, Murphy CR. Human growth hormone and interleukin-6 are upregulated in endometriosis and endometrioid adenocarcinoma. Acta Histochem 2006;108:13-18. DOI: 10.1016/j.acthis.2006.01.004
• Referans10. Giovannucci E, Pollak MN, Platz EA, et al. A prospective study of plasma insulin-like growth factor-1 and binding protein-3 and risk of colorectal neoplasia in women. Cancer Epidemiol Biomarkers Prev 2000;9:345-349.
• Referans11. Katznelson L, Laws ER, Jr., Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014;99:3933-3951. DOI: 10.1210/jc.2014-2700
• Referans12. Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. American association of clinical endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocr Pract. 2011;17 Suppl 4:1-44. DOI: 10.4158/ep.17.s4.1
• Referans13. Giustina A, Chanson P, Bronstein MD, et al. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 2010;95:3141-3148. DOI: 10.1210/jc.2009-2670
• Referans14. Baris D, Gridley G, Ron E, et al. Acromegaly and cancer risk: a cohort study in Sweden and Denmark. Cancer Causes Control 2002;13:395-400. DOI: 10.1023/a:1015713732717
• Referans15. Higuchi Y, Saeki N, Iuchi T, et al. Incidence of malignant tumors in patients with acromegaly. Endoc J 2000;47: Suppl:S57-60.DOI:10.1507/endocrj.47.supplmarch _s57
• Referans16. Popovic V, Damjanovic S, Micic D, et al. Increased incidence of neoplasia in patients with pituitary adenomas. The Pituitary Study Group. Clin Endocrinol (Oxf) 1998;49:441-445. DOI: 10.1046/j.1365-2265.1998.00536.x
• Referans17. Dal J, Leisner MZ, Hermansen K, et al. Cancer Incidence in Patients With Acromegaly: A Cohort Study and Meta-Analysis of the Literature. J Clin Endocrinol Metab 2018;103:2182-2188. DOI: 10.1210/jc.2017-02457
• Referans18. Gullu BE, Celik O, Gazioglu N, Kadioglu P. Thyroid cancer is the most common cancer associated with acromegaly. Pituitary 2010;13:242-248. DOI: 10.1007/s11102-010-0224-9
• Referans19. Dagdelen S, Cinar N, Erbas T. Increased thyroid cancer risk in acromegaly. Pituitary 2014;17:299-306. DOI: 10.1007/s11102-013-0501-5
• Referans20. Boguszewski CL, Ayuk J. Management of endocrine disease: acromegaly and cancer: an old debate revisited. Eur J Endocrinol 2016;175:R147-156. DOI: 10.1530/EJE-16-0178
• Referans21. Gasperi M, Martino E, Manetti L, et al. Prevalence of thyroid diseases in patients with acromegaly: results of an Italian multi-center study. J Endocrinol Invest 2002;25:240-245. DOI: 10.1007/BF03343997
• Referans22. Ron E, Gridley G, Hrubec Z, Page W, Arora S, Fraumeni JF, Jr. Acromegaly and gastrointestinal cancer. Cancer 1991;68:1673-1677. DOI: 10.1002/1097-0142(19911015)68:8<1673::aid-cncr2820680802>3.0.co;2-0
• Referans23. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004;25:102-152. DOI: 10.1210/er.2002-0022
• Referans24. Kauppinen-Makelin R, Sane T, Valimaki MJ, et al. Increased cancer incidence in acromegaly--a nationwide survey. Clin Endocrinol (Oxf) 2010;72:278-279. DOI: 10.1111/j.1365-2265.2009.03619.x
• Referans25. Petroff D, Tonjes A, Grussendorf M, et al. The Incidence of Cancer Among Acromegaly Patients: Results From the German Acromegaly Registry. J Clin Endocrinol Metab 2015;100:3894-3902. DOI: 10.1210/jc.2015-2372
• Referans26. Tita P, Ambrosio MR, Scollo C, et al. High prevalence of differentiated thyroid carcinoma in acromegaly. Clin Endocrinol (Oxf) 2005;63:161-167. DOI: 10.1111/j.1365-2265.2005.02316.x
• Referans27. dos Santos MC, Nascimento GC, Nascimento AG, et al. Thyroid cancer in patients with acromegaly: a case-control study. Pituitary 2013;16:109-114. DOI: 10.1007/s11102-012-0383-y
• Referans28. Dogansen SC, Salmaslioglu A, Yalin GY, Tanrikulu S, Yarman S. Evaluation of the natural course of thyroid nodules in patients with acromegaly. Pituitary 2019;22:29-36. DOI: 10.1007/s11102-018-0923-1
• Referans29. Kim SY, Han KH, Moon HJ, Kwak JY, Chung WY, Kim EK. Thyroid nodules with benign findings at cytologic examination: results of long-term follow-up with US. Radiology 2014;271:272-281. DOI: 10.1148/radiol.13131334
• Referans30. Durante C, Costante G, Lucisano G, et al. The natural history of benign thyroid nodules. JAMA 2015;313:926-935. DOI: 10.1001/jama.2015.0956
• Referans31. Rosario PW, Calsolari MR. What Is the Best Criterion for Repetition of Fine-Needle Aspiration in Thyroid Nodules with Initially Benign Cytology? Thyroid 2015;25:1115-1120. DOI: 10.1089/thy.2015.0253
• Referans32. Nabarro JD. Acromegaly. Clin Endocrinol (Oxf) 1987;26:481-512. DOI: 10.1111/j.1365-2265.1987.tb00805.x
• Referans33. Dal J, Feldt-Rasmussen U, Andersen M, et al. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. Eur J Endocrinol 2016;175:181-190. DOI: 10.1530/EJE-16-0117
• Referans34. Mestron A, Webb SM, Astorga R, 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. DOI: 10.1530/eje.0.1510439
• Referans35. Wassenaar MJ, Cazemier M, Biermasz NR, et al. Acromegaly is associated with an increased prevalence of colonic diverticula: a case-control study. J Clin Endocrinol Metab 2010;95:2073-2079. DOI: 10.1210/jc.2009-1714
• Referans36. Jenkins PJ, Besser M. Clinical perspective: acromegaly and cancer: a problem. J Clin Endocrinol Metab 2001;86:2935-2941. DOI: 10.1210/jcem.86.7.7634
• Referans37. Iliaz R, Dogansen SC, Tanrikulu S, et al. Predictors of colonic pathologies in active acromegaly: single tertiary center experience. Wien Klin Wochenschr 2018;130:511-516. DOI: 10.1007/s00508-018-1367-3
• Referans38. Matyjaszek-Matuszek B, Obel E, Lewicki M, Kowalczyk-Boltuc J, Smolen A. Prevalence of neoplasms in patients with acromegaly - the need for a national registry. Ann Agric Environ Med 2018;25:559-61. DOI: 10.26444/aaem/85652
• Referans39. Manavela M, Vigovich C, Danilowicz K, et al. Thyroid autoimmune disorders in patients with acromegaly. Pituitary 2015;18:912-5. DOI: 10.1007/s11102-015-0670-5
• Referans40. Baldys-Waligorska A, Krzentowska A, Golkowski F, Sokolowski G, Hubalewska-Dydejczyk A. The prevalence of benign and malignant neoplasms in acromegalic patients. Endokrynol Pol 2010;61:29-34.
• Referans41. Delhougne B, Deneux C, Abs R, et al. The prevalence of colonic polyps in acromegaly: a colonoscopic and pathological study in 103 patients. J Clin Endocrinol Metab 1995;80:3223-6. DOI: 10.1210/jcem.80.11.7593429
• Referans42. 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. DOI: 10.1155/2014/152049
• Referans43. Gonzalez B, Vargas G, Mendoza V, Nava M, Rojas M, Mercado M. The Prevalence of Colonic Polyps in Patients with Acromegaly: A Case-Control, Nested in a Cohort Colonoscopic Study. Endocr Pract 2017;23:594-549. DOI: 10.4158/EP161724.OR
• Referans44. Bogazzi F, Cosci C, Sardella C, et al. Identification of acromegalic patients at risk of developing colonic adenomas. J Clin Endocrinol Metab 2006;91:1351-1356. DOI: 10.1210/jc.2005-2500
• Referans45. Berker D, Ates Tutuncu, Y, Isik, S, et al. Prevalence and recurrence rate of colonic lesions in acromegalic patients. Cent Eur J Med 2010;5:704-711.
• Referans46. Kurtulmus N, Yarman, S., Demir, K. Association between skin tags and colonic polyps in patients with acromegaly. Turkish Journal of Endocrinology and Metabolism 2005;9:45-47.
• Referans47. Annamalai AK, Gayton EL, Webb A, et al. Increased prevalence of gallbladder polyps in acromegaly. J Clin Endocrinol Metab 2011;96:E1120-1125.DOI: 10.1210/jc.2010-2669