engleski

Left ventricular hypertrophy in acromegalic heart disease: is there an impact of pituitary adenoma size?

Heart involvement in acromegaly is mostly recognized by the presence of LV hypertrophy (LVH), often accompanied by diastolic dysfunction (DD). Although it is known that patients (pts) with active disease have more pronounced LVH than pts in remission, the impact of pituitary adenoma size might also be important. We sought to analyze the degree of LVH and DD in acromegaly with regard to adenoma size. The diagnosis of acromegaly was based on clinical characteristics, failure to suppress serum GH level below 1 &#181; g/L after a glucose tolerance test and a high serum IGF1 level. 32 pts with acromegaly (49&#177; 11 years) and normal systolic function were distributed in 2 groups by adenoma size (measured from MRI images of the hypothalamo-pituitary region). MACRO: 11 pts with macroadenoma (>10 mm in diameter) ; MICRO: 21 pts with microadenoma (<10 mm). All pts, and 26 healthy sex and age matched normals, underwent an echocardiographic exam extended with a myocardial velocity study. LV mass was calculated and indexed by body surface area to obtain the LV mass index (LVMI). The results are presented in table 1. There was a significantly higher LVMI in MICRO. DD was significantly worse in MICRO. There was no correlation between the LVMI and systolic blood pressure (SBP), disease duration nor age. Conclusion: A higher degree of LVH was found in MICRO compared to MACRO, which was accompanied by a higher grade of DD. There was no relation between LVMI and other parameters that might induce LVH. Furthermore, the activity of the disease was similarly distributed over both groups (MICRO: 66% ; MACRO: 50%). Thus, it seems that adenoma size might have a significant impact on LVH induction with pts with microadenoma developing more LVH, possibly due to higher or longer lasting peak hormone levels.

Left ventricular hypertrophy; Doppler echocardiography; acromegaly

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