Endocrine Abstracts

Is screening for colonic cancer in acromegaly fruitful?

C Wujanto, CNL Jayasena, A Banerjee, K Meeran & JF Todd

Imperial College, London, United Kingdom.

Background: Controversy exists over the prevalence of colonic neoplasia in individuals with acromegaly. Some previous studies have demonstrated an increased prevalence of colorectal neoplasia compared to controls, however others have shown no such association. Furthermore, colonoscopy in acromegalic individuals has an increased rate of complications and even death.

Aim: To determine the prevalence of colorectal neoplasia in patients with acromegaly, assess the benefits of subsequent colonoscopic examinations and establish potential risk factors associated with occurrences of neoplastic lesions.

Methods: A retrospective study of 85 acromegalic patients was performed. Of these, 70 had colonoscopy (male, 39; female, 31) previously. The mean age at first colonoscopy was 52.9 years and 7 (10%) patients have a positive family history of colorectal lesions.

Results: At first colonoscopy, polyps were found in 19 (27.1%) patients. There was no evidence of colonic malignancy. The most advanced lesion was hyperplastic polyp in 3 (4.3%) patients and tubulovillous adenoma in 7 (10.0%) patients. Compared to asymptomatic non-acromegalic subjects, prevalence of hyperplastic polyps, adenoma and carcinoma were not significantly increased in patients with acromegaly overall. However, an increased prevalence of colorectal neoplasia was found to be associated with being male (38.5% in males vs. 12.9% in females, P< 0.001), age above 60 years (peak prevalence of polyps, 35.7%, and adenoma, 21.4%, at age 60–69 years), elevated total GH exposure (median 129.6 mU/L), past history of non-colonic neoplasm (50.0%), previous colonic polyps (47.1%) and family history of colorectal cancer (1.5-fold increase).

Conclusion: This study demonstrated no significant increase in the overall prevalence of colorectal neoplasia in patients with acromegaly compared to the general population. However, it did reveal various risk factors that may constitute the basis of more selective guidelines for screening colonoscopy in acromegalic individuals.

Endocrine Abstracts (2005) 10 P53