Endocrine Abstracts

Background and aim: Acromegaly is a rare condition caused by an excessive secretion of growth hormone (GH) and insulin-like growth factor1 (IGF-1), which are responsible for exaggerated somatic growth, cardiometabolic disturbances and an increased neoplastic risk. This study aims to assess the tumorigenic potential of GH excessive secretion.

Patients and Methods: We conducted a retrospective study (1997-2020) at the Endocrinology department of Hedi Chaker University Hospital, Sfax, Tunisia. We involved 30 patients diagnosed with acromegaly, whose clinical, biochemical, and imaging peculiarities were collected from medical charts. Our patients benefited from a targeted screening for the more frequent neoplasia.

Results: Patients had a mean age of 45.8±12.4 years with a male predominance (51.7%). Symptoms had been evolving for 5.1±5.4 years. Acromegaly was secondary to a somatotropic adenoma in 96.7% and to a Growth hormone–releasing hormone (GHRH)-secreting pancreatic tumor in 3.3%. Clinical screening for breast cancer (breast palpation) and prostate cancer (digital rectal examination) did not reveal any suspicious lesions. Abdominal ultrasound showed one or more organomegalia in 33.3%: splenomegaly (16.7%), hepatomegaly (16.7%) and nephromegaly (8.3%). Colonoscopy performed in 14 patients was normal in 8 cases and showed polyps in 6 cases. Biopsy of the polyps did not reveal any signs of malignancy. Cervical ultrasound revealed a multi-nodular goiter in 16.7% and thyroid nodules in 11.1% of cases. Cytological study of suspected nodules confirmed their benign character.

Discussion: Despite remarkable therapeutic advances, 15-24% of deaths in acromegaly are due to cancer. The most reported neoplasia are gastrointestinal, thyroid, lung, breast and prostate. It is suggested that uncontrolled hypersecretion of GH/IGF-1 may promote the growth of tumor lesions, the carcinogenesis of pre-neoplastic lesions or the recurrence of previously treated cancers. Some studies also implicate genetic and epigenetic proto-oncogenes specific to acromegaly.