Incidence of hypogonadism and evaluation of its impact on cardiovascular risk factors and quality of life in acromegalic patients
A Rebora, E. Nazzari, D Malpassi, S Moretti, U Goglia, M Boschetti, F Minuto & D Ferone
Acromegaly and hypogonadism represent independent cardiovascular risk factors, worsening either different metabolic parameters or quality of life (QoL).
In our cohort of 41 acromegalic males (2082 years), 35 resulted affected by hypogonadotropic hypogonadism, while only six were eugonadal. Twenty-nine out 35 had low testosterone levels at diagnosis and six developed a post-surgical hypogonadism (testosterone cut-off: 350 ng/dl). Among hypogonadal subjects, only ten initiated hormone replacement therapy (HRT) while 25 do not. At diagnosis and at the last follow-up, we evaluated in the entire cohort: i) QoL by the AcroQoL questionnaire; ii) hormonal (GH, IGF1, prolactin, total testosterone) and iii) clinical and metabolic parameters (BMI, blood pressure, total cholesterol, HDL, LDL, triglycerides, fasting glucose, HbA1, uric acid). These parameters were correlated with disease control and testosterone levels at diagnosis and at the last follow-up.
Based on the latest criteria for disease control, at the last visit 28 patients were controlled, 4 uncontrolled and 9 partially controlled. As expected, IGF1 levels at the last visit were significantly lower than at diagnosis ((IGF1 SDS group 1:1.8±1.1, group 2 IGF1 SDS: −0.9±1.3 (P<0.01)), whereas testosterone levels were significantly increased, compared to the levels at the diagnosis, even in patients who did not underwent to HRT (P<0.05). AcroQol showed a corresponding scores improvement, while clinical and metabolic parameters were similar in both groups.
In conclusion, the incidence of hypogonadism in acromegalic subjects is very high at diagnosis, however, it improves significantly with disease control, independently from the therapeutic strategies. Hypogonadism may be partially related to the presence of the adenoma and improves with the treatment of the disease (improvement of testosterone levels also in subjects without HRT). Finally, the main factor that can reduce cardiovascular risk seems to be the achievement of disease control.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.