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Pattern of adrenal morphology and function in patients with acromegaly
Author(s) -
Pappa Theodora,
Papanastasiou Labrini,
Koutmos Spiros,
Tsiavos Vaios,
Roussaki Peggy,
Zilos Athanasios,
Ragkou Despina,
Kaltsas Gregory,
Piaditis George
Publication year - 2012
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02580.x
Subject(s) - acromegaly , medicine , endocrinology , basal (medicine) , hormone , dexamethasone suppression test , aldosterone , saline , dexamethasone , growth hormone , diabetes mellitus
Eur J Clin Invest 2012; 42 (3): 275–281 Abstract Background Acromegaly is well known to induce hypertrophic and hyperplastic changes in various organs and is commonly accompanied by arterial hypertension. In our study, we assess the adrenal morphology and function in a series of patients with acromegaly and possible associations with the activity of the disease and arterial hypertension. Materials and methods Sixty patients with acromegaly, admitted to two endocrinology departments in the time period 2005–2010, were studied prospectively. Basal IGF‐1 and growth hormone levels after oral glucose tolerance test were used to assess the disease activity. All subjects underwent adrenal CT scan, basal adrenal hormonal investigation and evaluation with 24‐h urinary free cortisol and cortisol levels following low‐dose dexamethasone suppression test. In 33 acromegalics, the ‘modified’ saline infusion test (MSI), i.e. saline infusion after dexamethasone administration, was performed to identify autonomous aldosterone (ALD) secretion. Results Abnormal adrenal morphology was present in 48% of our patients, and a significant association was found between the presence of arterial hypertension and adrenal morphology. Among patients with adrenal morphological changes, 55% exhibited no adrenal secretory hyperactivity, 34% autonomous cortisol, 7% ALD and 4% combined autonomous cortisol and ALD secretion, when applying recently proposed modified cut‐off levels compared to widely used criteria. An increased prevalence of autonomous ALD secretion was shown among the subgroup of patients with acromegaly tested with MSI. Conclusions This study provides evidence of an increased prevalence of anatomic and functional adrenal alterations in patients with acromegaly; further studies will clarify the importance of evaluating these subjects with baseline hormonal investigation along with dynamic testing and modified cut‐offs.