Treatments in Endocrinology

, Volume 3, Issue 5, pp 309–318 | Cite as

Cardiac Abnormalities in Acromegaly

Pathophysiology and Implications for Management
  • Giovanni Vitale
  • Rosario Pivonello
  • Gaetano Lombardi
  • Annamaria Colao
Review Article

Abstract

Cardiovascular disease is claimed to be one of the most severe complications of acromegaly, contributing significantly to mortality in this disease. In fact, an excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-I) causes a specific derangement of cardiomyocytes, leading to abnormalities in cardiac muscle structure and function, inducing a specific cardiomyopathy.

In the early phase of acromegaly the excess of GH and IGF-I induces a hyperkinetic syndrome, characterized by increased heart rate and increased systolic output. Concentric hypertrophy is the most common feature of cardiac involvement in acromegaly, found in more than two thirds of patients at diagnosis. This abnormality is commonly associated with diastolic dysfunction and eventually with impaired systolic function ending in heart failure, if the GH/IGF-I excess is left untreated. In addition, abnormalities of cardiac rhythm and of heart valves have also been described in acromegaly. The coexistence of other complications, such as arterial hypertension and diabetes mellitus, aggravates acromegalic cardiomyopathy.

Successful control of acromegaly induces a decrease in left ventricular mass and an improvement in diastolic function, while the effects of GH/IGF-I suppression on systolic function are more variable. However, since cardiovascular alterations in young patients with short disease duration are milder than in those with longer disease duration, it is likely to be easier to reverse and/or arrest acromegalic cardiomyopathy in young patients with early-onset disease.

In conclusion, careful assessments of cardiac function, morphology, and activity are required in patients with acromegaly. An early diagnosis and prompt effective treatment are important in order to reverse acromegalic cardiomyopathy.

Keywords

Growth Hormone Acromegaly Left Ventricular Hypertrophy Left Ventricular Mass Growth Hormone Deficiency 

Notes

Acknowledgments

The authors have provided no information on sources of funding or on conflicts of interest that are directly relevant to the content of this review.

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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Giovanni Vitale
    • 1
  • Rosario Pivonello
    • 1
  • Gaetano Lombardi
    • 1
  • Annamaria Colao
    • 1
  1. 1.Department of Molecular and Clinical Endocrinology and Oncology, ‘Federico II’ School of MedicineUniversity of NaplesNaplesItaly

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