Scientific letter
Prevalence of benign and malignant tumors in acromegalic patients
Prevalencia de tumores benignos y malignos en pacientes acromegálicos
Lorena Arnez, Belén Dalama, Betina Biagetti, Jordi Mesa
Corresponding author
Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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In this paper we analyse, in a group of acromegaly patients controlled in our hospital, the prevalence of benign and malignant neoplasms, as well as the relationship between <span class="elsevierStyleItalic">insulin-like growth factor-1</span> (IGF-1) levels and tumor disease. 61 patients (31 women [51%] and 30 males [49%]) were included retrospectively, from 50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 years of age at the time of diagnosis. The variables analysed were time of follow-up, IGF-1 at diagnosis and after treatment, the number of tumors per patient and whether benign or malignant. Of the 61 cases, 34 (55.7%) had no tumor, while the remaining 27 (44.3%) presented it, single or double. Thirty-one cases were female (51%), of which 17 developed tumors (63%), while males were 10 of the 30 cases (49%). Age at diagnosis of acromegaly was 50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 years of age, 48<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18 at the subgroup without tumor and 52<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16 years in the subgroup with tumor, no appreciable differences in age at diagnosis between the two. The time of progression from diagnosis of acromegaly until tumor development was 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16 years. The follow-up was 17<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 years (17<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 years in tumor free acromegalic patients and 16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 years in cases with tumor). 11 cases (18%) were diagnosed of malignant neoplasm, 6 of those in females (54.5%), 2 colon, one pancreatic, one breast ductal, one uterus and one gastric, and 5 in males (45.5%), 2 prostate, one renal, one lung and one bone. In 25 cases, the tumors were benign, 20 females (80%) (9 nodular goitres, 5 colonic polyps, 4 parathyroid adenomas, one breast adenoma and one schwannoma) and 5 (20.0%) in males (2 nodular goitres, a colonic polyp, one schwannoma and one pulmonary hamartoma). Of the 27 patients with acromegaly who developed tumors, in 18 cases it was a single one (9 benign and 9 malignant), and in 9 it was double (7 benign doubles and 2 both, benign and malignant). The double tumors were at the expense of nodular goitre, colonic polyp and parathyroid adenoma. IGF-1 at the time acromegaly was diagnosed in both groups of patients showed no significant difference between them. After treatment, IGF-1 decreased significantly in both, but again, with no differences between them.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the present study, the prevalence of malignancy is high, at 18%, even higher than the Spanish Acromegaly Registry (REA)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and the one reported by Colao et al. (10.9%),<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> influenced by the fact of being a retrospective study with a long follow-up period. The most common malignant tumors were colon and prostate adenocarcinoma (2 each), coinciding with those described in other series.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Herein, the prevalence of colon polyps and adenocarcinoma is high (9.8 and 3.3%, respectively), similar to those described in the REA (Spanish Acromegaly Registry) (9.5% and 1.2% respectively). We observed nodular goitre in 18% of cases, lower than expected, probably because only the surgically treated cases have been counted, with no cases of thyroid cancer among them. In recent years there has been increased debate over it after the publication of some studies that show an increase in its prevalence, such as Tita et al.,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> with 5.6%, and Gullu et al., with 4.7%.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Recently, in a prospective multicenter study using ultrasound as a screening method, Reverter et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> confirmed only two papillary carcinomas, accounting for 1.6% of the series and 3.3% of patients with nodules.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The increased risk of developing cancer in these patients has been associated with the growth hormone (GH) concentrations. The study by Orme et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> concluded that the GH after treatment is associated with increased mortality, both cardiovascular as well as tumor related, and normal GH levels equate the risk of cancer to that of the general population. Our study shows no difference between the degree of control obtained with the treatment and the appearance of tumors, perhaps explained by the small sample size, while considering the hypothesis that, due to genetic and epigenetic alterations, acromegaly patients are predisposed to develop cancer regardless of IGF-1.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> We confirm a high prevalence of tumors, highlighting nodular goitre, colon polyps, colon adenocarcinoma and prostate carcinoma. In conclusion, acromegaly should be considered as risk disease in connection with cancer development. We recommend to perform a colonoscopy to all of them, and subsequent tests depending on the outcome. Given the increased prevalence of prostate cancer, it is recommended that screening takes place at an earlier age than in the general population, and with respect to the high frequency of thyroid disease observed, the systematic use of ultrasound in these patients is justified.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arnez L, Dalama B, Biagetti B, Mesa J. Prevalencia de tumores benignos y malignos en pacientes acromegálicos. Endocrinol Nutr. 2015;145:368–369.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Mestron" 1 => "S.M. Webb" 2 => "R. Astorga" 3 => "P. Benito" 4 => "M. Catala" 5 => "S. 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